As a former medical school dean and residency program director, I was in the fortunate position of frequently hearing the thoughts, opinions, and insights of the learners around me. Their observations were powerful—and often proved to be the observations that catalyzed change. As the only national foundation focused solely on improving health professions education, I believe it is crucial that the Macy Foundation continues to elevate the voices of learners across the health professions as we work toward effecting meaningful change. In fact, catalyzing change could be considered the theme of our work over this past year.
In multiple talks that I presented at institutions and organizations around the country over this last year, I shared the recommendations emanating from our 2021 conference on COVID-19 and the Impact on Medical and Nursing Education to ensure that we not lose the momentum from the pandemic to enhance and improve our learning environments to better prepare our learners to be the health professionals that their future patients need. It was during one of these talks, the Marvin R. Dunn Address at the 2022 ACGME Annual Education Conference, that I announced a new effort from the Josiah Macy Jr. Foundation—the Catalyst Awards for Transformation in Graduate Medical Education. The goal of this special RFA was to implement innovative projects that support civility, psychological safety, and thriving in the clinical learning environment for residents and fellows, with special consideration given for projects that were co-created with learners. We announced the inaugural recipients of the Catalyst Awards earlier this month and look forward to learning more from them as they work to improve the clinical learning environment for all learners.
As Dr. Robbie Henson so eloquently described in her contribution to a Macy Notes blog post earlier this year, “while the instructor may have content and skill expertise, the learner has lived expertise. The understanding of both is necessary to achieve the outcome we seek.” This lesson was foremost in our minds when we organized the invitations for the 2022 Macy Conference on Ensuring Fairness in Medical Education Assessment. As a result, the largest number of learners we have ever had attended the 2022 conference, contributing to a set of recommendations that will provide actionable steps in ameliorating a longstanding issue in medical education. In fact, one of the conference co-chairs was herself an MD-PhD student, and 11 of the 42 invited attendees were students or residents. Fairness in clinical assessment is an issue that has long troubled students who are concerned about bias and discrimination in assessment and the impact this has on their future professional opportunities. The topic is an extension of the work that began in 2019 with the launch of the Foundation’s strategic priorities and was a recommendation from the 2020 Macy Conference, which addressed bias and discrimination in health professions learning environments. The engagement of learners in the 2022 conference was crucial in evolving the recommendations, recognizing that learners’ experience of unfair assessments, particularly those who are historically underrepresented in medicine, should be central to any solutions proposed. Remedying this significant issue requires immediate attention to co-creating and continuously improving all the factors that go into systems of equitable assessment. We look forward to publishing the four papers and four case studies commissioned for the conference along with the final version of the recommendations in Academic Medicine this summer.
As another sign of how seriously we consider the issue of fairness in clinical evaluation, we awarded a Board Grant earlier this year to the Children’s Hospital of Philadelphia. The primary goal of their project is to demonstrate how to develop more equitable assessment systems in medical education through a process of co-creation with stakeholders. If successful, this project will not only implement equitable learner grading systems that are acceptable by all stakeholders and capable of generating high-quality assessments at five pediatric residency programs, but also create a template for other programs across the continuum of medical education to do the same.
As we look forward to the next year, we will also see an evolution in the Macy Faculty Scholars Program. Following an external review of the program, we are seeking to expand the range and the reach of this career development award by bringing in scholars from a broader array of institutions and by providing the opportunity to those who are earlier in their careers. In this second generation of the Macy Faculty Scholars Program, we will work to develop meaningful connections and engagement with a broader range of candidates and institutions to bring new voices into the work being done in health professional education and leadership.
Health professions education continues to face new challenges. Last June, the United States Supreme Court rolled back efforts to address the threats of climate change, eliminated barriers to obtaining guns, and eliminated the national right to abortion. It is likely that in 2023 the Court may also overturn more than 40 years of precedents that allowed educational institutions to consider race in their admissions decisions. The Macy Foundation is committed to using whatever levers exist, including grant making, conference convening, opinion pieces, and collaborations to advance initiatives in our strategic priority areas to promote and support diversity, equity, and belonging; collaborative, high-performing teams; and successful navigation of ethical dilemmas. Here are some recent examples of how we have used our tactics to accomplish this:
- On December 12, 2022, I joined multiple other organizations at the White House Summit on STEMM Equity and Excellence hosted by the White House Office of Science and Technology Policy in collaboration with the Doris Duke Charitable Foundation and the American Association for the Advancement of Science. The Macy Foundation joined other public and private partners and launched the STEMM Opportunity Alliance, a new initiative supported by more than 90 organizations and $1.2 billion in investment towards improving equity in STEMM.
- On November 23, I co-authored a piece appearing in STAT News urging medical schools to end their participation in US News and World Report (USNWR), understanding that the ranking system is in direct opposition to medical schools’ goal of education for a well-trained, diverse, and culturally competent medical workforce. As we wrote, “the USNWR rankings do little more than reaffirm prestige and the financial prosperity of schools, promoting a cycle by which the wealthiest schools seek those students with the most privilege and wealth and vice versa, exacerbating disparities and creating competition that does nothing to advance the health of the public or the education of future physicians.”
- One of the grants awarded in 2022 was to The Nocturnists, a well-regarded podcast among medical students, residents, and graduate students, who requested support to create a special series on the impact of the Supreme Court’s Dobbs decision on reproductive health care and education. The ethical dilemmas posed by the Dobbs decision represent one of the largest morality crises in the history of medicine in the United States. Educators are unable to teach what they know to be life-saving skills, learners are forced to sacrifice their own education, and clinicians at all levels will need to delay and deny care to avoid criminal prosecution. The impact on patients is devastating.
I am grateful to the many brave learners and leaders in health professions education who continue to “be the change” and who work so tirelessly and compassionately to support patients and colleagues in pursuit of a safer, fairer, and healthier future for our patients, communities, and ourselves.