Jessica Bunin

Student Promotions Committees (SPCs) are tasked with making life-altering decisions regarding student advancement, remediation, and dismissal. Most research focuses on the legal requirements of due process, yet the nuanced role of the student's case presentation has received minimal scholarly attention. This study investigates the criteria SPC committees utilize when evaluating student presentations and how these factors influence committee decisions. This qualitative study employed elements of constructivist grounded theory to frame data collection and analysis. We conducted 15 semi-structured interviews with current and former SPC members at a U.S. military medical school. Using constant comparative methods, 'insight' was identified as a salient in faculty decisions. To interpret these findings, we utilized a conceptual framework from rehabilitation science, which describes the mechanisms by which courts evaluate an individual's potential for reform. Insight emerged as a critical component of the SPC's deliberation process, serving as both an essential prerequisite for professional growth and a significant indicator of future risk when found lacking. Students demonstrated insight by assuming full ownership of their academic or professional issues, utilizing institutional resources, and actively collaborating with the committee. Conversely, a lack of insight was signaled by doing nothing, externalizing blame, or repeating problematic actions despite prior interventions. The prominence of insight suggests that medical education has unintentionally adopted a burden of proof like the legal system, requiring students to demonstrate rehabilitation to maintain their professional standing. By articulating these implicit expectations, this study provides transparency, potentially fostering a more equitable and effective remediation process.

Medical education's pursuit of excellence often inadvertently fosters a "hidden curriculum" of perfectionism and shame. This culture can transform adaptive striving into maladaptive perfectionism, where a fear of failure leads learners to view mistakes not as growth opportunities but as evidence of moral failings and personal inadequacy. When errors inevitably occur, the potential result is shame or an identity-focused belief that "I am bad." The resulting isolation and self-doubt potentially can lead to imposter syndrome, burnout, and depression. This paper explores the critical role of shame-informed mentorship, an approach that recognizes how shame influences learner behavior and development. By responding with intentional strategies that preserve dignity, mentors can mitigate shame's potential impact and transform it into a catalyst for professional growth. We argue that by helping learners distinguish between corrosive shame ("I am the problem") and productive guilt ("I did something wrong"), mentors can facilitate behavioral change without damaging the learner's core identity. The paper offers practical, evidence-based strategies organized into three themes: Recognition-identifying "shame primers" such as perfectionistic histories and "shame triggers" like public questioning; Navigation-using validation, self-compassion, and the practice of "failing forward" to process active shame events; Cultivation-building long-term resilience through intellectual humility and the normalization of shared narratives. Collectively, these strategies provide a framework for intentionally building psychological safety and normalizing mistakes. By equipping mentors with tools to recognize and respond to shame, and by creating a culture that prioritizes formative feedback and a growth mindset, mentors can help transform shame from a destructive force into a catalyst for professional identity development and sustainable practice.

Introduction: Much of the current literature on remediation centers on procedural steps, due process, and the implementation of model programs. However, these studies frequently omit the critical perspective of the learners undergoing the process, which can reveal hidden forces that shape medical students’ experiences.Methods: We conducted narrative interviews with 15 practicing physicians who remediated as medical students 5–15 years ago. Data were analyzed by examining plot, characters, and event sequences. Upon identifying a pattern of stages, we applied van Gennep’s three-phase framework of rites of passage: separation, liminality, and aggregation.Results: Remediation remained a vivid, salient experience for participants, characterized by disorientation. Separation was marked by strained community interactions and symbolic “parting.” The liminal phase involved isolation and ambiguity while awaiting institutional decisions. Notably, aggregation, reintegration into the medical community, was achieved by few; more than half of the participants still feel excluded or marginalized years later.Discussion: Remediation is a harrowing process with long-lasting professional consequences. While all participants experienced separation and liminality, the failure to achieve aggregation highlights the “long shadow” remediation casts over a remediated physicians’ career. We suggest that remediation committees consider providing a ritual specific to the reintegration phase to ensure learners feel successfully folded back into the professional community.

Phenomenon. The language of medicine (i.e., biomedical discourse) represents queerness as pathological, yet it is this same discourse medical education researchers use to resist that narrative. To be truly inclusive, we must examine and disrupt the biomedical discourse we use. The purpose of this study is to disrupt oppressive biomedical discourses by examining the language and structures medical educators use in their publications about queerness in relation to physicians and physician trainees. Approach. We searched PubMed, Web of Science, CINAHL, PsycINFO, and ERIC in October 2021 and again in June 2023 using a combination of controlled vocabulary (select terms designated by a database to enhance and reduce ambiguity in search) and keywords to identify articles related to sexuality, gender, identity, diversity and medical professionals. Searches were limited to articles published from 2013 to the present to align with the passage of The Respect for Marriage Act. Articles were included if they focused on the experiences and paths of physicians and physician trainees identifying with or embodying queerness, were authored by individuals based in the United States, and presented empirical studies. We excluded articles only discussing attitudes of cisgender heterosexual individuals about queerness. Two authors independently screened all articles for inclusion. We then used narrative techniques to "re-story" included articles into summaries, which we analyzed with four guiding questions, using queer theory as a sensitizing concept. Finally, we sought recurrent patterns in these summaries. Findings. We identified 2206 articles of which 23 were included. We found that biomedical discourse often: characterized individuals associated with queerness as a single homogenous group rather than as individuals with a breadth of identities and experiences; implied queer vulnerability without naming-and making responsible-the causes or agents of this vulnerability; and relied minimally on actual intervention, instead speculating on potential changes without attempting to enact them. Reflections. Authors each reflect on these findings from their positionalities, discussing: disrupting essentializing categories like "LGBT"; addressing harm through allyship around queerness; editorial responsibility to disrupt structures supporting oppressive biomedical discourse; the importance of program evaluation and interventions; and shifting the focus of medical education research toward queerness using QuantCrit theory.

Introduction: Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine. Materials and Methods: We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions. Results: The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = −2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($\chi _{\left( 1 \right)}^2$ = 12.92, P < .001, Cramer’s V = 0.254). Conclusions: While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine.

Health disparities in the Military Health System (MHS) have been consistently documented despite the system ensuring equal access to care for its beneficiaries. Research has shown that social, economic, and political factors (i.e., Social Determinants of Health) and health care-specific factors like provider bias and systemic discrimination are key drivers of health disparities in the general population. Medical education focused on introducing these concepts using case-based learning has led to effective learning of health equity terminology. However, a significant gap exists in identifying optimal teaching approaches to develop skills to recognize these factors in actual clinical cases. This begs the million-dollar question: can case-based learning help trainees acquire the skills needed to identify the main factors contributing to health disparities in the MHS? A longitudinal case-based curriculum was developed in which clinical cases from the Internal Medicine Wards, Medical Intensive Care Unit, or General Internal Medicine Clinic at the National Capital Consortium were solicited from trainees and analyzed for evidence of health care provider bias and systemic forms of discrimination using small groups. The National Capital Consortium Internal Medicine Residency Program implemented this pilot study in November 2021. A retrospective pretest-posttest survey assessing trainee reactions to the curriculum and changes in self-reported confidence in skills was used for curriculum assessment. Survey data were analyzed using a paired samples t-test. The survey was administered during the last session of the 2022-2023 academic year, with 14 of the 23 available trainees completing it: a 60.8% response rate. Overall, 93% reported that the cases selected that academic year were engaging; the skills they were taught were practice-changing, and the educational value of the curriculum was good, very good, or excellent. Confidence ratings, assessed via a 5-point Likert Scale, demonstrated a statistically significant increase in self-reported confidence in the following skill domains with large effect sizes: identification of bias and systemic discrimination in clinical cases—change in mean: 1.07 (Pre: 3.29, Post: 4.36), P < .001, g = 1.38; recognizing and mitigating personal biases—change in mean: 0.71 (Pre: 3.50, Post: 4.21), P <.001, g = 1.10; participating in a discussion about health care provider bias and systemic discrimination—change in mean: 0.79 (Pre: 3.57, Post: 4.36), P = .001, g = 1.06; and leading a discussion about bias and systemic discrimination—change in mean: 1.00 (Pre: 2.93, Post: 3.93), P = .002, g = 0.98. As the need to address health disparities in the United States becomes more pressing, so does the need for military physicians to recognize the drivers of these disparities within the MHS. Results from this pilot study of Health Equity Rounds suggest that case-based learning may be an optimal teaching approach to improve the skills of military Internal Medicine trainees in identifying and recognizing the impact of health care provider bias and systemic discrimination on clinical cases from the MHS.

Phenomenon: While professionalism is largely understood to be complex and dynamic, it is oftentimes implemented as if it were static and concrete. As a result, policies and practices reflect dominant historical norms of the medical profession, which can cause tension for trainees from marginalized groups. One such group comprises those who identify as first-generation physicians - those whose parents have not earned an associate's degree or higher. This group is highly diverse in terms of gender, race, ethnicity, and socioeconomic status; however, their experiences with institutional professionalism policies and practices has not yet been fully explored. In this study, our aims were to understand the ways in which these participants experience professionalism, and to inform how professionalism can be more inclusively conceptualized. Approach: In November 2022-March 2023, we conducted semi-structured interviews with 11 first-generation medical students, residents, and physicians and analyzed select national and institutional professionalism policies in relation to key themes identified in the interviews. The interviews were designed to elicit participants' experiences with professionalism and where they experienced tension and challenges because of their first-gen identity. Data were analyzed using thematic analysis through a critical perspective, focused on identifying tensions because of systemic and historical factors. Findings: Participants described the ways in which they experienced tension between what was written, enacted, desirable, and possible around the following elements of professionalism: physical appearance; attendance and leaves of absence; and patient care. They described a deep connection to patient care but that this joy is often overshadowed by other elements of professionalism as well as healthcare system barriers. They also shared the ways in which they wish to contribute to changing how their institutions conceptualize professionalism. Insights: Given their unique paths to and through medicine and their marginalized status in medicine, first-generation interviewees provided a necessary lens for viewing the concept of professionalism that has been largely absent in medicine. These findings contribute to our understanding of professionalism conceptually, but also practically. As professionalism evolves, it is important for institutions to translate professionalism's complexity into educational practice as well as to involve diverse voices in refining professionalism definitions and policies.

Undergraduate medical learners from historically marginalized groups face significant barriers, which was made concrete at our institution when a student presented her research indicating that Black students felt unsure about which faculty members to approach. To better support our students, we used Kern’s model for curriculum development and a critical pedagogy approach to create a Faculty Allyship Curriculum (FAC). A total of 790 individuals attended 90 workshops across 16 months and 20 individuals have completed the FAC. A majority of participants reported they felt at least moderately confident in their ability to teach learners who are underrepresented in medicine, mentor learners who are different than they are, and teach allyship topics. An informal content analysis of open-ended responses indicated changes in awareness, attitude, insight, and use of language and being more likely to display advocacy. For others considering creating a similar program, partnering with an existing program allows for rapid implementation and reach to a wide audience. We also recommend: beginning with a coalition of willing learners to quickly build community and culture change; ensuring that the curriculum supports ongoing personal commitment and change for the learners; and supporting facilitators in modeling imperfection and upstanding, ‘calling in’ rather than ‘calling out’ learners.

Background: Requirements for faculty development for clinician‐educators continue to increase. The number of faculty with experience delivering faculty development, however, remains limited. To overcome our deficit of faculty developers, we created a train‐the‐trainer programme. We recognised, however, that our plan would not meet the ultimate goal for our programme: Creating faculty developers to meet the faculty development needs of a large, dispersed system. We report on the creation and nurturing of faculty development community of practice (CoP), which we believe could be a solution for many academic systems struggling to engage busy clinicians, mature the teaching abilities of clinician educators, and meet the needs of their accrediting institutions. Approach: We developed a faculty development CoP with a mission of promoting educational expertise and excellence and ensuring continuous growth of the members of our COP and broader faculty. Evaluation: A programme evaluation was performed consisting of two elements: The impact on the organisation (workshop and learner related metrics) and the impact on the CoP members (survey). We observed notable outcomes: Delivery of high quality workshops to faculty, attainment of leadership positions, and increases in motivation, networking, skills, confidence, and opportunities available to members. Implications: Innovations to create and sustain structured faculty development programmes for clinician‐educators are needed. The development and nurturing of a CoP of faculty developers resulted in benefits both for the organisation and CoP members and may be a solution for large academic systems struggling to meet their faculty development demands.