Introduction/Background

The evidence is clear - achieving Justice, Equity, Diversity and Inclusion (JEDI) improves education and care for patients and the communities we serve. As Medical Education (MedEd) leaders spanning the continuum of students to CME, we are accountable for addressing structural “isms” in all forms (eg, race, gender-identity, religion) and preparing our faculty to learn in this area. Implicit bias training, upstander workshops, and journal/book clubs are a common starting point. Yet data on the competency level of our faculty specific to identified JEDI competency domains is not available. Data must be used to guide our continued faculty development efforts, faculty retreats, continuing medical education activities and to monitor progress over time.

Hypothesis/Aim Statement

Our purpose was to reframe a literature based structural fluency milestone (aka structural “isms” including race, gender identity, differently abled) as a needs assessment tool for faculty development and long-term tracking.

Methods

In summer 2021, our existing ACGME like milestone - developed by an interprofessional team (eg, MedEd, Ethics, DE&I) to be applicable across the continuum of medical education - was reframed as a needs assessment tool on SurveyMonkey. The self-assessment asked respondents to rate their competence in each structural fluency competency domain framed within ACGME domains (eg, MK, PC, SBP). For each domain, the annotated rating scale allowed participants to check where they perceived themselves in the progression from Level 1 to Level 5 (novice to proficient), consistent with the standard ACGME competency ratings model. Teaching faculty received an e-mail directly from SurveyMonkey to facilitate reminders to non-respondents.

Results

Survey was electronically distributed over a 3-week period to 155 teaching faculty with a 48% response rate (75/155) taking an average of 3 minutes to complete. The mean, standard deviation and percentage of respondents by domain are presented in table form with Level 4 = competent and Level 5 = proficient. On average are faculty are not yet competent – with between 21-47% below level 4 and SD range from 1.2-1.7.

Structural Fluency Competency Domain

Mean Competency Level

SD

% at Level < 4

Medical Knowledge

3.6

1.2

67%

Patient Care

3.8

1.3

53%

Interpersonal Communication

4.0

1.2

68%

Professionalism

3.6

1.1

67%

Practice Based Learning & Improvement

3.6

1.7

79%

Systems Based Care

3.6

1.2

67%

Conclusions

Utilizing a competency framework that parallels the ACGME milestone yields needs assessment data to focus faculty development and CME efforts. For example, we will use the levels of competence in the patient care domain, to target the gaps between Level 3 (Attributes patient’s condition in context of structural limiters -not non-compliance + Identifies and incorporates mitigation strategies to address structural risks in patient care) and Level 4 (Develops and collaborates with patient on plan of care cognizant of patient’s intersectionality and its influences on their health care values and decisions and structural limiters and identity (ies). Data will also allow us to track competence of faculty over time.