"How can we effectively teach about the difficult topics of race and racism?" asked Camara Jones, M.D., M.P.H., Ph.D., during her keynote address at the School of Medicine’s fifth Medical Education Day on May 18.
Racism is a system, not an individual flaw, explained Jones, and race is not coded in our genes. Rather it is way that a society assigns value and access to opportunity based on the way someone looks. Racism affects everyone and saps the strength of a whole society through the waste of human resources, she said. Stressing the urgency of teaching about race and racism, Jones used analogy and allegory as ways to communicate and foster discourse about these complex and troubling issues.
The School of Medicine’s Teaching and Learning Center (TLC)—which provides the school with expertise in educator development, assessment, learning technologies, and curriculum design—sponsored the event. Janet P. Hafler, Ed.D, professor of pediatrics and TLC’s director, said that Jones’ lecture dovetailed with recent medical school initiatives, including hiring its first chief diversity officer, to enhance inclusion and diversity among students, residents, and faculty.
Jones presented her “Cliff Analogy” as a way to “understand different levels of health intervention and to explain why those involved in the health enterprise should be thinking about racism.” The analogy began with a population teetering at the cliff edge of health or falling into illness. How did that population get there? Such social determinants of health as poverty result in health disparities early on. Jones then asked the audience to consider the influence of racism, sexism, and economic and power systems on how resources are distributed and who ends up at the edge of the cliff.
Her next allegory, “The Gardener’s Tale,” offered a framework for understanding racism on three levels: institutionalized, personally mediated, and internalized. Two flower boxes produce different colored blossoms from identical seeds; one box has rich potting soil and produces red blossoms, the other box has nutrient-deficient, rock-filled soil and produces pink blossoms. The separation of the seeds in different soils, the boxes that keep the seeds separate, and the failure of the gardener to nurture the poor soil represent institutionalized racism. When the gardener, who views the struggling pink blossoms as inferior, plucks them before they can go to seed, that is personally mediated racism. And when the pink blossoms reject pink pollen because they see red as intrinsically better, racism has become internalized.
In her final allegory “Japanese Lanterns: Colored Perceptions,” Jones described sitting in a garden decorated with colored lanterns and watching as moths sorted themselves by color around the lanterns, the yellow moths hovering around the yellow lantern and the purple moths around the purple one. The moths, she realized, were not purple or yellow, but shades of white or tan—the color was a reflection from the lantern. “This story,” said Jones, “shows that colors we think we see are due to the lights by which we look.”
Jones said her hope was to equip people to name racism, encourage them ask how is racism operating here, and inspire them to organize and strategize to act.
Following the keynote, participants attended small group workshops, including "A Pathway to Educational Scholarship: Documenting your Contributions," co-facilitated by Hafler, John Encandela, Ph.D., TLC's associate director for curriculum and educator assessment, and associate professor of psychiatry; and Susan Kashaf, M.D., M.P.H., assistant professor of medicine and a member of the dean's committee for review of clinician educator appointment and promotion requirements.
Participants discussed the four domains of educational scholarship—teaching, mentoring, curriculum development, and educational leadership—and how to evaluate and document their contributions in these areas. Clinician educators, said Kashaf, typically go beyond the traditional metric of papers and article authorship position with such activities as teaching by the bedside, developing instructional videos, writing curricula, speaking at conferences, and serving on editorial boards or committees. Participants discussed the challenges of evaluating these activities. "Even if you are not up for a professorship or a promotion, evaluate and document what you are doing," said Encandela. "Think about how to fill out these categories now for your portfolio or how you would write a letter for yourself."
In another workshop, participants watched a video of a physician interaction with a medical student, then used a scale with descriptors to rate the student’s performance. The workshop, “A Practical Approach to Teaching and Assessing Learners’ Clinical Reasoning Skills,” focused on a new assessment tool called the Entrustable Professional Activity (EPA). The School of Medicine is one of 10 medical schools collaborating in an Association of American Medical Colleges five-year pilot program to develop and test this assessment strategy.
“An EPA is a unit of professional practice that can be fully entrusted to a trainee as soon as he or she has demonstrated the necessary competence to execute this activity unsupervised,” said Michael Green, M.D., M.Sc., professor of medicine, associate director for student assessment at the TLC, and leader of the EPA pilot program at Yale. Green, along with Hafler; France Galerneau, M.D., associate professor of obstetrics, gynecology, and reproductive sciences; and Thilan Wijesekera, M.D., instructor in internal medicine, were co-facilitators of the workshop.
Because EPAs are independently executable, observable, and measureable, they indicate where a trainee’s behaviors and competencies lie on a spectrum ranging from pre-entrustable to entrustable. Faculty members can use EPAs to make competency-based decisions about clinical reasoning skills and determine the level of supervision needed by a trainee. Focusing on a trainee’s readiness for safely executing an activity without direct supervision, EPAs represent a paradigm shift in assessment.
At the poster session that concluded the day-long event, which included over 60 project presentations, the following awards were conferred:
Education Research, Winning Poster, Adeniyi Fisayo, M.D., Pharm.D., “Attitudes and Perceptions of Neurology Residents to Neuro-Ophthalmology”
Education Research, Winning Poster, Thilan Wijesekera, M.D., Bryan Brown, M.D., Natalie Lomayesva, YSM 2020, “The Right Reasons: A Faculty Development Workshop for Teaching Clinical Reasoning”
Education Research, Honorable Mention, Gabriella Grisotti, M.D., James M. Healy, Neeta Erinjeri, Danielle Heller, Kristin Oliveria, “Do Surgery Residents feel pain? A survey evaluating musculoskeletal pain in residents after operating”
Education Research, Honorable Mention, Wendy F. Li, YSM 2018, Nicholas Apostolopoulos, YSM 2018, Anand D. Gopal, YSM 2018, Christopher C. Teng, M.D., Kristen Nwanyanwu, M.D., MBA, Maria E. Parente, Ph.D., Claudia Merson, MEd, Susan H. Forster, M.D., “Near Peer Teaching in an Inner City High School Outreach Program”
Innovation in Education, Winning Poster, Aimee Alphonso, YSM 2018, Shefali Pathy, M.D., MPH, Christy Bruno, D.O., Beth Emerson, M.D., Crina Boeras, M.D., Janice Crabtree, Lindsay Johnson, M.D., M.Ed., Vrunda Desai, M.D., Marc Auerbach, M.D., M.Sc., “Shoulder Dystocia and Neonatal Resuscitation: An Integrated Obstetrics and Pediatrics Training Intervention for Medical Students”
Innovation in Education, Winning Poster, Sarita Soares, M.D., “Scanning the Future: Creating a Point-Of-Care Ultrasound Curriculum for Yale Internal Medicine Residents”
Innovation in Education, Honorable Mention, Elise Schlissel, M.D., Andrea Asnes, M.D., MSW, Ada Fenick, M.D., Marjorie S. Rosenthal, M.D., MPH, Yale Pediatrics “HealthyLives: A Resident-Centered Advocacy and Community Engagement Curriculum”
Innovation in Education, Honorable Mention, Kali D. Cyrus, M.D., MPH, Michael Solotke, YSM 2020, Nicole (Nix) Sitkin, YSM 2018, John Encandela, Ph.D., “Recognizing the Elephant in the Room: Physician-and Patient-Focused Sessions to Enhance Student Awareness of Bias”
Innovation in Education, Honorable Mention, Gowthaman Gunabushanam, M.D., Felix Nautsch, M.D., Rachel Liu, M.D., Frank Minja, M.D., Leslie Scoutt, M.D., “Personal Ultrasound Teaching Simulator”