News and Commentary Macy Catalyst Awards: Supporting Change Agents in the Clinical Learning Environment

A group photo of the Catalyst Awards recipients convening
Catalyst Awards for Transformation in Graduate Medical Education Convening

The Josiah Macy Jr. Foundation will begin accepting applications for a third cycle of Macy Catalyst Awards for Transformation in Graduate Medical Education on June 24, 2024. For this third round of awards, the project period has been extended to 18 months and the award amount increased to $100,000. Proposals, which may be submitted by any resident, fellow, and faculty member involved with graduate medical education, should describe, implement, and evaluate innovative strategies to equip learners with the tools, skills, and strategies to flourish in the clinical learning environment. 

In last month’s blog post, I decried the distress that both residents and faculty are experiencing in clinical learning environments, and I called on academic medicine to commit to a new social contract to help alleviate that distress. We need to commit to a shared mission that everyone who learns and works in clinical environments should experience safety, support, and opportunities to flourish. The benefits of doing so would extend to patients, families, and communities who receive care in those environments.

In keeping with this effort, earlier this month my Macy colleagues and I spent time with an inspiring group of medical educators and residents who are working as change agents within their institutions. With support from Macy—as their seven institutions are the inaugural recipients of our Catalyst Awards for Transformation in Graduate Medical Education—they are exploring and expanding strategies and interventions to promote safety, civility, and thriving in their clinical learning environments.

More specifically, this first group of Catalyst Awards recipients—funded for one year from 2023–2024—is testing different strategies and interventions that have similar goals: helping residents and fellows manage bias, discrimination, microaggressions, and other forms of mistreatment. To facilitate the building of a community of practice around their efforts, we convened the principal investigators (PIs) and some of their resident learners in person to share with each other and with us what they have discovered in their projects, as well as their plans for next steps.

Managing Microaggressions

According to everyone who presented their projects at the convening, microaggressions and other forms of mistreatment are common occurrences in clinical learning environments. This is well documented in the literature, but effective interventions to address these problems are not, which is why the Macy Foundation is publishing a special Academic Medicine supplement later this year on this topic. The supplement will feature case studies describing the seven inaugural Catalyst Awards projects as well as six commissioned background papers that provide broader context around the specific interventions detailed in the case studies. Each of the case studies will describe and/or analyze efforts to arm residents, fellows, and other health care professionals with the training and support needed to recognize, respond to, and follow up when they are on the receiving end of—or witness to—microaggressions in the clinical learning environment. They will also more broadly discuss how to imbue civility and psychological safety in the clinical learning environment.

Listening to the Catalyst Awards PIs and their colleagues talk about their projects, I was struck by themes and outcomes that were shared across the seven institutions. I anticipate that the following will be among those explored in the journal supplement.

  • Co-creation is key. Some of the projects began as ideas originally proposed by residents, and nearly all of them engaged residents in the design and/or implementation of the projects. The involvement of residents is a powerful key to the success of such projects because it is their voices that microaggressions are often intended to silence.
  • Learners find responding to faculty members’ microaggressions most difficult. Co-creation of projects like these also helps residents and faculty connect and build trusting relationships, which can be a challenge in today’s clinical learning environments. In follow-up surveys after participants went through training to learn how to respond to microaggressions, many said they felt more skilled and more confident in their abilities, but also that they might hesitate to respond when a faculty member was the source of the mistreatment.
  • Time is a major barrier to commitment and participation. Every presenter mentioned time as a primary hurdle to successful recruitment and engagement of project leaders and participants. The PIs discussed a variety of ideas for addressing this age-old challenge in graduate medical medication.
  • Sharing stories is valuable. The synergy in the room during the project presentations was palpable. While we at Macy were concerned that there may be overlap and redundancy in the presentations, the presenters were fascinated by what they could learn from the differences that result when similar efforts are implemented in institutions with different cultures and climates, systems and structures, policies and processes, resources and relationships, and more. Also, when success stories are shared and projects are replicated, their legitimacy—sometimes questioned within the context of diversity, equity, and inclusion—is increased.

During the convening, we also heard presentations from two of the commissioned authors who are producing papers for the Academic Medicine special supplement. Dr. Jennifer Best, associate dean for graduate medical education and associate professor of medicine at the University of Washington School of Medicine, delivered the keynote at the start of the convening, describing academic medicine as a house—one in which people learn, work, and receive care—that needs to be rebuilt. She described the original tools that were used to build, and now maintain, the house, including pain resulting from oppression, silence resulting from fear, and despair resulting from isolation and lack of hope for the future. “We are all inside the house, and it has been condemned,” she said. She explained that to rebuild and transform academic medicine’s house, we need to adopt a new “liberatory design” mindset—one that shifts the relationship between those in the house with and without power—and use new tools, including peace, hope, and love, so that everyone feels safe and like they belong in the house.

Dr. Patricia Poitevien, senior associate dean for DEI and associate professor of pediatrics at Brown University’s Warren Alpert Medical School, closed the convening by reminding us that “DEI work is not just DEI work—it’s the same work that is needed to create the optimal culture and learning environment within academic medicine.” We will not optimize our clinical learning environments without diversity, equity, and inclusion, and we will not achieve diversity, equity, and inclusion without optimizing our learning environments. Unfortunately, DEI is under attack across the country; opponents are perpetuating myths and spreading misinformation and have managed to appropriate and weaponize the term “DEI.” Dr. Poitevien also talked about the ways in which diversity, equity, and inclusion align with providing patient-centered care and learner-centered education, and explained how the backlash against DEI makes those quality goals impossible to achieve and sustain. 

Advancing Priorities

While we took the opportunity presented by the first set of Catalyst Awards applications received to support a group of similar efforts targeting microaggressions and other forms of mistreatment, the awards program was created with a broader goal in mind: to advance work in the Foundation’s three priority areas, which are 1) promoting diversity, equity, and belonging; 2) increasing collaboration among future health professionals; and 3) preparing health professionals to navigate ethical dilemmas. Currently, a second cohort of six 2024 Catalyst Awards recipients is implementing a wider variety of projects across the Foundation’s priority areas.

The 13 total projects that have so far received Macy Catalyst Awards nourish my optimism, as do the learners who will eventually lead the transformation of academic medicine. I wholeheartedly agree with one of the faculty members at the Catalyst Awards convening who said, “I am most impressed by the collective voice of new generations who have catalyzed these conversations [at our institutions]. It is not a coincidence that our projects emerged from our trainees.” My optimism leads me to believe that meaningful efforts to advance a culture of civility and safety in the clinical learning environment will prevail and we will co-create optimal experiences for future generations of physicians and other health care professionals. And, as a result, we will improve health and health care for everyone. 

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