Academic medicine : journal of the Association of American Medical Colleges
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Managing a Specialty Service During the COVID-19 Crisis: Lessons From a New York City Health System.
The COVID-19 pandemic has stretched health care resources to a point of crisis throughout the world. To answer the call for care, health care workers in a diverse range of specialties are being retasked to care for patients with COVID-19. Consequently, specialty services have had to adapt to decreased staff available for coverage coupled with a need to remain available for specialty-specific emergencies, which now require a dynamic definition. In this Invited Commentary, the authors describe their experiences and share lessons learned regarding triage of patients, staff safety, workforce management, and the psychological impact as they have adapted to a new reality in the Department of Neurosurgery at Montefiore Medical Center, a COVID-19 hot spot in New York City.
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Across academic medicine, and particularly among faculty and medical school leadership, the status quo is unacceptable when it comes to gender diversity, equity, and inclusion. The Association of American Medical Colleges has launched a bold gender equity initiative, endorsed by its Board of Directors, to implore academic medical institutions to take meaningful and effective actions. Defining what progress should look like to guide these actions is worth deeper exploration. ⋯ What is needed is a fundamental conversation about privilege, intersectionality across different backgrounds, and progress. Institutional leaders have a choice to make. Will we make gender equity a top priority system-wide because we recognize that doing so leads to organizational excellence? Do we understand that establishing a robust, comprehensive definition of gender equity and how it is practiced will result in better outcomes for all? And are we ready and able to prioritize and be accountable for efforts that are measurable, with clear definitions of progress; driven and reinforced by leadership directives; inclusive of all, including men as well as women of diverse backgrounds and orientations; and systemic rather than ad-hoc? Implementing such actions requires initiating difficult conversations, making conscious choices, and modeling best practices from leaders who have successfully made gender equity a priority.
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Entrustable professional activities (EPAs) can be used to operationalize competency-based medical education. Mobile apps can efficiently capture feedback based on direct observation. To leverage the benefits of both, the authors developed an assessment tool that combines EPAs with mobile technology. ⋯ The authors' EPA mobile app was efficient, generated high-quality feedback, and produced entrustment scores that improved as the residents gained experience. Challenges included uneven adoption. Looking forward, the authors plan to examine the enablers and barriers to adoption from an implementation science perspective.