On this episode of the Academic Medicine Podcast, author Hannah Kakara Anderson, PhD, MBA, Research in Medical Education (RIME) Committee member Binbin Zheng, PhD, MEd, and AAMC MedEdSCHOLAR Nicole Findlay, MD, MPH, discuss new research into how the physical and social context of the clinical learning environment shape power dynamics and influence equity in assessment for residents. Empowering clinician educators to actively address the forces of space, place, and pace, they argue, can help promote a more equitable learning and assessment environment.
This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available.
This episode is part of the 2025 series of discussions with RIME authors about their medical education research and its implications for the field. Listen to the other episodes in the series.
A transcript is below.
Read the article discussed in this episode:
- Anderson HLK, Balmer DF, Weiss A, et al. Power moves: An ethnographic investigation of how space, place, and pace influence equity in pediatric workplace-based assessment. Acad Med. 2025;100:e43–e51.
Transcript
Toni Gallo (00:03):
Welcome to the Academic Medicine Podcast. I’m Toni Gallo. Every year Academic Medicine publishes the proceedings of the annual Research in Medical Education or RIME sessions that take place at the AAMC’s Learn Serve Lead Meeting. Those RIME papers are available now to read on academicmedicine.org. As in previous years, I’ll be talking to some of the RIME authors on this podcast about their medical education research and its implications for the field. So far, we’ve explored undergraduate medical education including how medical students learn to navigate interprofessional interactions during clerkships and how medical student parents experience their dual identities as physicians in training and new parents.
(00:55):
Today for the final RIME conversation, we’re moving into graduate medical education. I’m joined by Dr. Hannah Kakara Anderson, one of the authors of Power Moves: An Ethnographic Investigation of How Space, Place, and Pace Influence Equity in Pediatric Workplace-Based Assessment. Also with us are RIME committee member Dr. Binbin Zheng and MedEdScholar Dr. Nicole Findlay. We’ll talk about the findings from Hannah’s study, including how both the physical environment and the unwritten rules in a pediatric emergency department affected residents’ learning and assessment opportunities, as well as the implications of those findings for fostering equity. With that, let’s do some introductions.
Hannah Kakara Anderson (01:46):
Hi everyone. I am Dr. Hannah Kakara Anderson. I am an instructor of pediatrics at the University of Pennsylvania Perelman School of Medicine, and an education scientist at the Children’s Hospital of Philadelphia.
Toni Gallo (01:59):
Welcome. Binbin?
Binbin Zheng (02:00):
Hi everyone. I’m Binbin Zheng. I’m an associate professor in the Department of Health Professions Education from the Uniformed Services University. I’m an educational psychologist by training and I’m entering my third year as a RIME committee member. And thanks for having me here.
Toni Gallo (02:18):
Thanks for being here. Nicole?
Nicole Findlay (02:21):
Hi everyone. My name is Nicole Findlay. I am an assistant professor and associate director for simulation education in the Department of OB-GYN at the University of Utah, Spencer Fox Eccles School of Medicine.
Toni Gallo (02:36):
Thank you for being here as well. I want to start with a little bit about Hannah’s study and what she and her co-authors did. So could you just give us some background and tell us a little bit about your paper?
Hannah Kakara Anderson (02:48):
Sure. Thanks for the opportunity to present some of this work. This paper is a really interesting and exciting paper for me personally as a researcher, and I think it’s having some really interesting and exciting implications for our local residency program as well. So I’m thrilled to talk about it on this podcast. This study is an ethnography of contextual equity. So contextual equity is the dimension of equitable assessment that refers to the entire learning environment in which assessments occur. So not only the assessments themselves, but all of the opportunities to be observed, to be evaluated and to be coached and supervised by senior learners, by peers, and by interprofessional team members. So contextual equity is a really complex construct. It’s very sticky, and in the past, studies have sort of examined other dimensions of equitable assessment but haven’t dug deep into context and what it means in the implications for equity and assessment.
(03:55):
So in this study, we wanted to understand and get our hands around context in all of its complexity, and we chose ethnography as the method to do that. So ethnography comes from the field of anthropology and it’s a method that’s entirely dedicated to understanding culture and context and to investigating these really complex influences that can happen in learning environments and places where people come together and work and learn. So we chose ethnography to help us understand context a little better, and we wanted to ask the question, what are the influences, the contextual influences that act upon equity and assessment? And we worked within one learning environment in our pediatric residency program, and that was the pediatric emergency department at the Children’s Hospital of Philadelphia. This is a really large urban pediatric emergency department that sees a huge range of acuity and a large volume of patients.
(04:58):
And we focused on two team workplaces within this emergency department because it’s the place where all of our pediatric residents at some point in their training rotate through. And so we thought, what better place to directly see context in action and to see equity and assessment in action. So ethnography basically just means collecting three triangulated sources of data to really develop a deep understanding of context. And those data sources are observations, close prolonged observations in the real world context of the thing that you’re studying, interviews with participants in that environment and document review of artifacts and things that are written about that environment. So we conducted about 144 hours of observation spread across team one and team two of the pediatric emergency department. We interviewed both pediatric resident learners and pediatric supervising attendings, and we investigated their ideas, their understandings of context as well as watch how equity unfolds in the real world workplace. And we also collected documents related to assessment forms, assessment policies, procedures, et cetera, anything that really influenced or pertained to assessment in this rotation.
(06:17):
And what we found were that there were three major contextual forces that influenced equity in assessment in this clinical learning environment. And the first was a force of space and space referred to the physical or material realities of the clinical environment, sort of the material things, objects, spaces that were the boundaries of where working and learning happened in the emergency department. We also found that place was another contextual force that influenced equity. Place referred to how people moved and positioned themselves within that physical space. And finally, we explored the dimension of pace, which refers to the volume of patients, the acuity, sort of the energy you could think of in the clinical learning environment. So all three of these forces really dynamically worked together to either balance power dynamics and produce equity in assessment or to imbalance power dynamics and in turn produce inequitable assessments for learners. So this was really fascinating, really interesting, and looking forward to getting into some of the results with you.
Toni Gallo (07:25):
Great, thank you. Yeah, I’m hoping we can talk more about space, place, and pace and some of what you found from the interviews and the observations that you did. And one of the quotes that stood out to me was from an attending who was interviewed who said “the biggest difference on team one is the residents are further away unless they sit next to me, we talk a whole lot less and I just see less of them.” And this idea of the attendings seeing more or less of the residents came up in a couple of different ways in the findings that you describe. And I’m hoping we can dig into that physical proximity and what implications that might have for the learning that happened and the assessment opportunities. So anybody is welcome to jump in here and share their thoughts.
Nicole Findlay (08:17):
Yeah, I thought that was really interesting. Dr. Anderson, I’d love to hear a little bit more about your thoughts on this because one of those things that, just thinking back on my own residency training. As residents, we all know that those power dynamics exists and whoever has closer proximity or a better relationship with the attending because of that proximity kind of gets different benefits both from a learning and an assessment perspective or even just with which patients they get to see and all of that. And so it’s this unspoken rule, but it’s really interesting to see how you were able to actually study that in a scholarly way and document all of that because people can talk about it and gripe about it, but to see it in scholarly work to say, no, this is really a thing and it really does affect equity and education is just really, really interesting. I’m really glad that you did this study.
Hannah Kakara Anderson (09:10):
Yeah, thank you. And I totally hear your reflection, Nicole, because residents in this study told me the same thing and attendings told me the same thing, right? It is sort of an unspoken reality, but it’s also weirdly something that we don’t talk about that much in the context of workplace-based assessment, which is really interesting because all of the evidence we have around workplace-based assessment tells us that direct observation is foundational to being able to make an appropriate assessment of a learner. And yet what we saw in this study is that particularly the physical space, the environment in which people worked and learned could create barriers to that exact observation.
(09:53):
So there’s a figure in the paper drawn by one of the attendings that we interviewed, and it’s a drawing of the workspace in team one. And this attending placed a little star next to the attending workstation where she spent almost all of her time and then directed my attention to the row of resident workstations on team one. And the resident workstations extended down this very narrow hallway in the emergency department. There weren’t enough workstations for the number of residents that were on shifts, and only one resident workstation was close to the attending workstation, was directly across from it. So whoever sat in that seat received the most observation face-to-face time. And like you mentioned Nicole, not even just the direct observation of performance, but the kind of chit chat and conversation and proximity and closeness really only extended to that one resident.
(10:50):
And what was super interesting about observing in this environment was seeing that dynamic unfold. And then I could walk around the emergency department to the other team, team two, and see a completely different dynamic where the workstations were set up more in a circle and residents were never more than three feet away from the attending workstation at any time. Completely different space and completely different dynamic, power dynamics really that influenced equity.
Binbin Zheng (11:19):
I think this is really striking because it captures how something as simple as physical proximity can actually profoundly shape learning and assessment because when residents sit further away, those kind of informal micro moments of feedback of observation or conversation disappear. So from that sense, it’s not just about the distance, it’s actually about their access to being seen and being known by attendings. And in this case, space itself becomes a form of power, like who sits near the attending gets more visibility and feedback while those further away risk being invisible in assessment.
(12:04):
So also interesting to me is what you described in the article about how junior and female presenting residents often defer to others when choosing where to sit while senior and male presenting residents tended to take available workstations immediately, sometimes even the attendings’. So what really stood out to me in this observation is how deeply this kind of hierarchy and gender norms seem to shape even the most ordinary aspects of the team life, like where people sit, and the difference between taking a seat and asking to take a seat may not seem large, but it actually reflects who feels entitled to claim space and who feels they must earn permission to belong.
(12:52):
So I was wondering about how these implicit norms are transmitted and learned. Are they consciously reinforced by attendings or peers or do they simply persist because no one calls attention to them?
Hannah Kakara Anderson (13:08):
That was beautifully said and so impactful on the resident learners who I talked with and observed in this study. So particularly junior learners and female presenting learners like you mentioned, often felt that they had to ask permission to take a seat. And I saw this happen constantly throughout shifts where a learner would approach the desk and ask the attending or ask the nursing supervisor if they could sit down, and such a strong contrast with more senior learners and male presenting learners who seemed to have a great deal more comfort in the space and a willingness to carve their own way perhaps in the space. And what that really speaks to which you mentioned is the social dynamics of who feels that they deserve space and that they can have space, that who is allowed to just take a chair versus who is forced to stand during rounds or during a conversation is fraught with power dynamics.
(14:16):
So what I will say is that although in this study it wasn’t always clear where these dynamics were coming from historically, what people learned about their social hierarchy before they entered the clinical learning environment. But what we did see inside the clinical learning environment itself was how these power dynamics were either perpetuated or reinforced. So the most clear examples of that that I can give are times when someone either corrected a resident learner for sitting in the wrong chair, “the wrong chair,” or when residents were sort of left standing in the hallway without anywhere to sit, and this disproportionately affected certain residents over others. I interviewed one resident who was pregnant at the time of the study and disclosed that to me and disclosed that because there were a lack of workstations, that it was disproportionately impacting her ability to work and perform in that rotation.
(15:14):
So these things, while they seem minor, and while they may be not always visible to us, they really do impact people’s ability to work and learn. The other thing that I saw that actually helped rebalance power, that called out these social dynamics when they happened was often done by attendings who either consciously or unconsciously would shift power, and they would do that by oftentimes identifying the areas of the space that they were working in and calling attention to it. So for example, one attending made a very interesting choice that I never saw any other attending do during my time observing, and they asked everyone to sit down for rounds and they themselves got up and found an extra chair for the extra resident to sit down so that everyone could sit down during rounds. And that simple act of suggesting that we all sit down and making sure everyone had chairs balanced the power dynamic in a way that sign out and that rounds happened in a much more accessible and face-to-face type of environment. So those are two examples I can see of ways that they were either perpetuating power dynamics or directly confronting and sort of rebalancing power dynamics.
Toni Gallo (16:28):
It’s interesting to juxtapose that with the attendings reporting that they couldn’t or they didn’t know if they could change the power dynamics in a situation. I think that was one of the things somebody mentioned. And you’re talking about something very simple as asking everybody to sit down, finding an extra chair, making sure everybody could hear the conversation. So how do you think about those? How do you think the attendings, I guess, saw those two things?
Hannah Kakara Anderson (16:58):
Yeah, this is one implication that I wish we had more time to talk about in the discussion. I actually think it’s really critical for frontline educators and frontline clinician educators to think about. So many of the attendings that I interviewed were aware of the impact of bias and the impact of interpersonal bias, maybe their own heuristics or their own ways of thinking that might impact assessment, but they weren’t aware necessarily of the fact that they had autonomy to change that or that they had autonomy to shift power and actually create equity in their learning environment. And I think this is maybe a way that medical education as a research field could in future ways support clinician educators better, because I think many of us, myself included, have heard the message that rater bias and interpersonal bias influences assessment, but we haven’t yet fully empowered people to take charge of shifting power and actively addressing it. And I saw so many examples of attendings, again, I think mostly unconsciously, not fully recognizing what they were doing, but responding in the moment to something that didn’t feel right or that just was uncomfortable for them, or they saw that it was uncomfortable for a learner and shifted power and made the change. So many, there’s so opportunities that maybe attendings can take and can really help advance equity. And I hope that in future research we can help empower attendings to do that more often.
Binbin Zheng (18:37):
And Hannah, I think you have beautifully said how these simple acts can actually make a big difference because the real challenge for educators is to make these invisible hierarchies visible in a constructive way. And that could start with awareness, like noticing or naming them openly. So noticing who speaks first, who gets interrupted, who sits closest to the attending or who consistently fades into the background. So when faculty acknowledge those patterns out loud, even briefly, it actually gives permission to question and reshape them. And hierarchy is not inherently negative. It can also provide some kind of structure and safety, but it becomes harmful when it limits participation or voices.
Nicole Findlay (19:28):
I have a question for Dr. Anderson. So adding on to this idea of how the attendings can basically set the tone for what the power structure is and just for how useful the workplace based assessment will be. You had talked about in the paper how there’s some attendings that work more consistently from their workstation, and then there’s other attendings that kind of move around. And again, reflecting on my own training, that’s also a thing where you have some attendings that are easy to find and others that you spend half the time just looking for them. And it was very interesting, even though this was a pediatric setting, I’m an OB GYN, but yeah, some of those same things are kind of universal.
(20:14):
And I was just wondering how that power dynamic of just how do you even find your attending, how do they even know what you’re doing and how to assess you? How did the residents see that and did they feel like they were at a disadvantage if they happened to be assigned to an attending that was more mobile versus an attending that was more consistently in one spot? Did they feel like that was luck of the draw in terms of what their assessment was going to end up being if they really cared about that rotation because of their future career aspirations? Were they jockeying for the attending that would be more consistently in a certain place? So I just was curious about how that kind of affected the resident dynamic and on the attending side, if the attendings knew that their work pattern was to move around if they actually did anything to try to equalize the power dynamics there.
Hannah Kakara Anderson (21:09):
Yeah, that’s a great question because again, it returns to something that individual clinician educators and attendings can actively do. So I saw one really striking example of how inequity can happen because of what you’re describing, sort of attendings with their own personal style. Again, maybe not consciously trying to disadvantage or harm any residents, but there was an observation, a shift where the attending right after rounds immediately left the workstation and didn’t really say where he was going or how he could be located or where he would be. And the group of residents who were rounding with him really did not know what to do next. They were new to the rotation, many junior learners, and there was discussion amongst the group, okay, what do we do? Do we go find him? A good half an hour of really struggling to know what the workflow was going to be. And when the attending finally did return, again about 30 minutes later, he seemed just shocked that no one had gone to see patients and was looking up charts and had started the workday. And he sort of lightly scolded the residents, you should be already seeing patients, you should be already doing things.
(22:29):
And that is a great example of how sort of unconscious personal style and just maybe your habitual ways of moving through the clinical environment can actually disproportionately affect learners. So in that scenario, learners were not only struggling to figure out the unspoken rules that were left when the attending just left, but they also weren’t contributing to patient care. And they also had this really difficult experience at the beginning of their workday of being sort of called out and scolded by their supervisor, and it was a difficult shift. Learners really struggled after that, and I saw examples of that that were so different, and again, totally personal style, but this is something that clinician educators could do really simply.
(23:22):
So I had many positive examples of attendings who also had the same style of being very mobile and moving around the clinical environment, liked to be up and moving and not necessarily tied to their desk. But what made these attendings different is that they were so upfront and clear about their expectations and to let residents know to expect that they would be away from their desk, how to find them, permission to message them, to text them, explicit acknowledgement that this is my style, this is how I like to practice emergency medicine, and it’s just my style. Don’t take it personally. That was just sort of a statement that a lot of attendings made. But what went even further was when attendings were able to explicitly lay out expectations for what residents should do.
(24:10):
So there’s a great quote in the paper, and I am not going to recall it perfectly, so I encourage you to look it up, but to paraphrase, this attending essentially gave really short concise directions for residents to know what to do next. So it was at the end of rounds, they said, this is my style. This is how to find me. I expect you to come up with a learning goal throughout the shift, and in the next hour, I’m going to ask you about that learning goal. If you ever want feedback on anything, you have to ask me. Just these very explicit directions about what to do. And while that may seem unnecessary to a lot of attendings, I think those explicit directions allowed learners to actually learn and to show up and perform in ways that they didn’t otherwise. So that kind of explicit acknowledgement and invitation to actually learn during a shift then enabled this really more level playing field, which was really cool to see.
Nicole Findlay (25:12):
Yeah, that’s really great because I think there … in medical education, there’s this tension between learning and asking questions when you have questions but not being annoying and not being found to look stupid. And so you’re trying to learn and you’re going to have questions, but at the same time you’re like, is it okay for me to ask, is this something that I’m supposed to know? Can I ask this question and not look stupid? How often do I contact my superior in an appropriate way to not annoy them but still keep that contact? It’s a very delicate balance, especially for junior learners to navigate. So I think this is really interesting of you just calling it out for what it is. I said it’s like this unspoken thing that a lot of junior learners go through, or even people who rotate off of service.
(26:04):
So like an emergency department, I’m sure there’s pediatric residents, but there might be residents from other services that rotate through there. And because it’s not really their main area, they don’t know the culture, it can be challenging. So I think this is really important to call it out for what it is and hopefully can incorporate things like this into faculty development and how do we as faculty try to create a more equitable learning environment for not just the senior learners that have been there before, but the junior learners, the off service learners.
(26:40):
And you’d mentioned that I think when you presented this work at the AAMC that there were some steps being taken to actually act on some of the results from your paper. Can you share some of that with us here?
Hannah Kakara Anderson (26:54):
Yeah, so first I have to give a shout out to one of my co-authors on this paper, Dr. Anna Weiss, who is a pediatric emergency physician here at Children’s Hospital of Philadelphia. And something that Anna does religiously when she’s on shift and what she’s now developing faculty development around is this idea of giving a pre-brief. So what we were just talking about, attendings setting expectations for how learning and assessment is going to happen during a shift or during a rotation or any time period that you work together with a learner, making it really simple and accessible for attendings to do that, to kind of have a script about this is my style and this is how I want you to learn and how I invite you to learn and ask questions during this shift. And so the faculty development that she’s done around that I think is fantastic, and it’s really helping our local educators take the insights from this study and practice it, put it into action.
(27:53):
The second thing that is also really exciting is that we have the opportunity to remodel parts of our emergency department in the upcoming years. And so some of the findings that we made around the size of hallways, the availability of seating and the friendliness of a space to educational activities and to equitable educational activities, all of those insights, we have the opportunity to help inform the remodel and the blueprinting of a new space. So that’s incredibly exciting, and I’m really grateful for the Department of Emergency Medicine here that has been so open and willing to learn from this study and in turn willing to share their own insights and respond to this study. So for me, it is tremendously satisfying and encouraging to see research being put into action.
(28:53):
And I think this study, I had no idea, I had no way of knowing and expecting that we would have insights about physical space that might inform something like a blueprint, but I am really grateful that my mentors and co-authors on this team and all the learners and participants that I worked with, these kinds of insights were just so valuable and are something that our leadership in the hospital hasn’t heard from other places. So this research is really moving things forward, and that’s exciting to see.
Toni Gallo (29:27):
Yeah, that’s great. I also wanted to ask about if you had shared back the findings with anyone in the emergency department, so I’m excited to hear that the impact that this is already having. One thing that we haven’t touched on is the pace force that you mentioned, and something I thought was interesting in your findings was sort of this dichotomy of when things were really busy in the emergency department, some residents, the response was like, this is not the place for learning. It was just too busy, there wasn’t time for learning. And then others found that really valuable saying like, oh my gosh, I learned so much when things were busy. And so I’m hoping you all can sort of reflect on that and that difference in how pace kind of came out in the work that you did.
Nicole Findlay (30:18):
It’s really interesting because I think in the paper, the attendings were nervous about their ability to teach when there was increased pace and feeling like they didn’t really have much time to teach. But the learners on the other hand were saying, no, this is great. I think some of that too comes because when things are slower, the attendings may have more time to feel like they have the bandwidth to talk more about a case and to kind of break things down. But when things are slower, only certain residents get certain cases. And so if you’re the attending’s favorite or you’re a more senior learner or whatever that dynamic is, you’re sitting closer to the attending, you may get the more interesting case or the more fun thing to do, but when the sky is falling and everything is happening all at once, it’s just everybody find a patient, everybody take care of somebody.
(31:10):
And so the people who may have been lower down on the totem pole and didn’t really get a chance to get the more interesting case by chance may actually get some of those interesting cases because things are so busy that there isn’t time to cherry pick things, you just kind of get what you get. And so I can see how especially lower level learners who may just get whatever’s left when things are pretty slow or not get anything at all, it may get a lot more interesting things to learn, cases to learn from when things are busier. I curious though, if did the learners, like they said they’ll have more interesting patients to take, but did they feel like their attendings were giving them enough feedback on those things, on those … with them being busier?
Hannah Kakara Anderson (31:55):
Yeah, that’s an interesting question, and I am trying to think back to what residents talked about this dynamic because you’re right, I mean, in a lot of ways the increase in pace would level the playing field so people could take whatever case was coming in, and that kind of access to opportunity was a little bit more stifled and a little bit more prone to power dynamics when things were slow and when people had the opportunity to make these power moves and take on patients to take precedence over other learners. So a lot less of that happened when there’s a lot of patients and the volume’s high and acuity is high and people just need to get things done.
(32:36):
What I still wonder about, and a question that I still have from the results of this study is the connection then to the eventual assessment. So I heard from attendings that when the pace is quicker, more brisk, it is harder to observe more and to actually take in what learners are doing. On the other hand, learners having the opportunity to do more, they felt like they had the chance to demonstrate actually more. And so maybe it’s a unresolvable tension there. What I do know though is that some of the interesting, most interesting dynamics around pace, if you think about in the emergency department where there’s a trauma bay, a resus bay, everybody has to know their role and has to know expectations of them going into the trauma bay in ED. And so while I wasn’t observing directly in the trauma bay in times of really high pace, and when the trauma bay was in action, people knew what was expected of them and were able to work in ways that were perhaps more of a level playing field or perhaps more of explicit expectations of what they needed to do and why.
(33:52):
And I do think that that relates back to our earlier conversation of having explicit expectations and knowing what you need to do and where you need to be and why you need to be there is actually really important for people to learn and perform at their best. And so maybe taking a cue from emergency department from other areas of the emergency department, and we could think about in lower acuity or times when the pace is not as quick, how do we keep that sense of equal opportunity and access to cases and learning and explicit expectations about your role and the reasons why you’re doing what you’re doing. So a lot more to be learned there. And I am still really curious about this force as well and hope to explore that in future research.
Binbin Zheng (34:42):
So I’m also thinking about how this tells us something important that learning or assessment are not just these cognitive processes, they’re also emotional, and it’s about the psychological safe environment we’re providing for the trainees because in the context of the emergency department, all this pace can actually act as an emotional amplifier because the high stakes environment does activate a lot of emotions. It could be stress, urgency, or even excitement. And these emotions can either help or hinder the trainees reasoning depending on how they’re recognized. For example, when learners feel supported that there is this psychological safety and clear communication between attendings and themselves that can kind of heighten the activation and can sharpen their attention and promote their deeper reasoning. But if the same pace is combined or coupled with fear or exhaustion, it could narrow thinking and could potentially lead to some defensive decision making.
Hannah Kakara Anderson (35:56):
Yeah, thank you for calling that out. It’s interesting to me that emotions are so tied up in assessment, both the emotion of the person who’s evaluating and assessing and the emotion of the person who’s being assessed. It’s a really complex dynamic, and what you said that I really think this study draws attention to is how the material environment that you’re in can actually influence that. If you don’t have a place to sit or you’re struggling to hear someone who’s presenting information to you, or if you’re a learner struggling to hear feedback given to you, that material environment is then shaping your emotional experience of that encounter. And sometimes equity and inequity are not straightforward static states like you had an equitable day or you had an inequitable day. It’s not like that really, I think in the real world, it’s much more like moment to moment, encounter to encounter. Equity and inequity are constantly in shift. They’re constantly responding to power. So I’m so glad you called that out.
Toni Gallo (37:08):
Okay. I’m hoping we can finish our conversation today. We’ve talked about some things that clinician educators can do or leaders in medical education, whether it’s thinking about the physical space, thinking about being intentional, about how you interact with learners. I’m hoping everybody can go around and just if you have any other takeaways or things you want to share with listeners from this study that you think would be helpful to think about or to … changes that could have a positive impact and really foster an equitable environment. Nicole, you want to go first?
Nicole Findlay (37:47):
I think one of my takeaways from this study as clinical faculty is to be aware of the actual physical space that I’m in with my learners, making sure that everyone can hear, everyone has somewhere to sit. And also just as just talking about expectations, we’re so used to sometimes we get kind of into the flow of what we do every day. The reality for a lot of clinical faculty is that most of the learners in the room know what the expectations are, there’s usually a smaller percentage of them that don’t know. And so you take that for granted sometimes that the senior residents will tell the junior residents what their expectations are. So just reiterating that and making sure that at all levels, everybody knows what’s expected of them, and that everybody has reasonable access to me to ask questions to get what they need from me. And being able to be a part of faculty development for other attendings to also kind of get those reminders too.
Toni Gallo (38:47):
Thank you. Binbin.
Binbin Zheng (38:49):
Yeah, and for me, I think the paper really pushed me to think about assessment not just as a tool for measuring performance, but as a social practice that is shaped by power, space and cultural. So I think it invites us to think around or to look around literally and ask who is visible, who gets access, and how can we redistribute that access more intentionally? So in that sense, equity in assessment is about attending to those kind of quiet and everyday dynamics that either amplify or silence learning.
Toni Gallo (39:28):
Great. And Hannah.
Hannah Kakara Anderson (39:30):
Well, it’s hard to follow up both of those comments because I think you both hit the dual nails there, that there’s both the personal social element of what clinician educators do every day and how learners respond to that. And there’s the bigger dynamics of who has access in what spaces, when, where, and why. I think my takeaway as a researcher from doing this study is overall that it’s complicated my ideas about what assessment is and particularly about what equitable assessment can be. I often in research, and I think this is true for a lot of workplace-based assessment research, we focus on the timeframe in which an attending is directly observing and then sort of filling out a form or doing some type of feedback that reflects their assessment and their judgment of the learners’ performance. And that narrow window of assessment as happening only in the context of a form or in the context of a formal feedback session or direct observation is so narrow. What I learned in the study was that everything about the learning environment can influence the ultimate equity of an assessment that comes from that learning experience. So it’s really sort of opened the aperture of what I think about of equity and assessment, and it’s complicated my more straightforward notions of what assessment is and what it can be.
Toni Gallo (41:01):
Well, I want to thank you all again for being on the podcast today. I want to encourage our listeners to check out Hannah’s paper and all of the RIME papers this year. They’re available on academicmedicine.org. And if you haven’t yet, please listen to the other two episodes in our RIME podcast series this year. You’ll be able to find them on this feed. So thanks. I appreciate everybody being here today.
Nicole Findlay (41:25):
Thank you for having us.
Hannah Kakara Anderson (41:27):
Thanks for having us.
Binbin Zheng (41:27):
Thank you.
Toni Gallo (41:28):
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