PEARLS (Perspectives on Equity Advancement: Research and Learning Symposium), a Case Report in Promoting DEI in a Medical School Setting

Round 1

Reviewer 1 Report

This is a very interesting and timely article. It is also inspiring, as it can be difficult to address DEI and belonging on a large scale.  The authors present an innovative approach.  One of the major advantages of it is the relateability of the scale and the content. 

 

Several changes are offered as suggestions to help the reader to follow the initiative and to link ideas/sections.

 

On p. 2 when 15% better initiative is discussed, it may be helpful to offer several examples.

 

On p. 3, it might be helpful to provide more context on the WIN theory of change, and why it was perceived as so relevant (and was ultimately chosen).

 

When the results of the 15% better project are presented on p. 5, it would be helpful to offer more detail on exactly how it was conducted. For example, some of the themes later addressed (such as  allyship on p. 8) could be explained here.

 

On p. 13, information is presented about engaging diverse learners.  It seems like this information would be wonderfully integrated much earlier in the paper, in the introduction.  It could build a rationale for the intervention, and could then be referenced in the later section as an explanation for the success.  

 

On p. 14, the goal of creating physicians with culturally responsive skill sets who value social justice was discussed.  This is powerful and vitally important.  It should also be introduced in the introduction, as a rationale for this initiative.

 

On a general note, there are places where the authors seem to speculate about how individuals felt, in an apparent absence of data.  The manuscript should be read through that lens, and those statements should either be omitted or should be noted as speculative.

 

The strength of the paper is in the attempt to create an  environment within medical training that discusses these issues, values these initiatives, and fosters belonging.  It serves as a bold example of how such initiatives might be developed, and how their impact might be assessed.

Author Response

 

Response to Reviewer 1’s Comments and Suggestions for Authors

We thank Reviewer 1 for their very positive and careful review of our manuscript. We have addressed all of the excellent suggestions as follows:

 

• On p. 2 when 15% better initiative is discussed, it may be helpful to offer several examples
  • A sentence has been added including several examples

 

• On p. 3, it might be helpful to provide more context on the WIN theory of change, and why it was perceived as so relevant (and was ultimately chosen).
  • A paragraph has been added that justifies the selection of the WIN theory of change and explains why it is so relevant to the mission and goals of PEARLS in promoting wellness and a space for belonging in medical schools.

 

• When the results of the 15% better project are presented on p. 5, it would be helpful to offer more detail on exactly how it was conducted. For example, some of the themes later addressed (such as  allyship on p. 8) could be explained here.
  • We thank Reviewer 1 for this great suggestion and have amended the manuscript to include details of how the themes were selected and explanation of the themes and rationale for their selection. We’ve also included a sentence on page 2 when the 15% Better Project is introduced that clarifies the objectives.

 

• On p. 13, information is presented about engaging diverse learners.  It seems like this information would be wonderfully integrated much earlier in the paper, in the introduction.  It could build a rationale for the intervention and could then be referenced in the later section as an explanation for the success.
  • We are grateful for this suggestion and have added a paragraph early in the manuscript (at the top of page 2), which cites studies showing that students who engage in a diverse learning environment develop more positive feelings about diversity.

 

• On p. 14, the goal of creating physicians with culturally responsive skill sets who value social justice was discussed.  This is powerful and vitally important.  It should also be introduced in the introduction, as a rationale for this initiative.
  • We have amended the introduction to include the following sentence: “In recent years, the need to cultivate physicians who participate in social justice as a part of their career is becoming clearer, as the field continues to critically examine medical education and the effects of systemic discrimination throughout the institution’s history [15].”

 

• On a general note, there are places where the authors seem to speculate about how individuals felt, in an apparent absence of data.  The manuscript should be read through that lens, and those statements should either be omitted or should be noted as speculative.
  • We agree with Reviewer 1’s observation and therefore have omitted several statements and added the word speculate to predicate others, particularly in the Discussion section.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

This is an important paper describing PEARLS, an innovative program launched by the Netter School of Medicine at Quinnipiac University. Papers such as this one that not only describes the components of the program, but evaluates it, is an important educational research communication itself, especially as the authors reflect on the promotion of this kind of DEI work at other medical schools, institutions, and in the community. Kudos to the authors for writing this up. 

The paper is strong. I do not have many overall comments. As you consider revising this piece, I would focus on clarifying a few points - there are a lot of acronyms to keep track of and I had to flip through the pages several time to remind myself what group or training was being referred to: faculty or students or something national. Perhaps an easy reference key would be helpful.  Additionally, it would be helpful to know if the same core faculty/students were a part of all three components of the program? If so, how does this lead to growth and/or sustainability of PEARLS? For example, it has been documented that when such programs are self-selected, the same “frequent fliers” tend to engage with them - who are not necessarily those who need the training. Additionally (although PEARLS takes the often hidden labor of DEI and makes it visible and valued), when a small number of people carry these initiatives at a university, it can lead to burnout. 

A point for clarification - how were the reflections submitted? Was it a discussion board or submitted assignment type of thing? Could students see each others’ reflections? If so, could they see them before they submitted their own, or only after? Were the reflections debriefed and discussed and if so, how? Could they comment on each other’s reflections? 

Similarly with the word cloud, because it was in real time, how would this affect the words submitted by participants at the beginning of the activity vs the end?

I really appreciate the focus on growth mindset collaboration, of the tie to professional identity formation and that PEARLS is approached collaboratively and in-step with both faculty and learners. I appreciate the reflection on limitations of the project and areas for future growth. I enjoyed reading this paper. Thank you.

Author Response

This is an important paper describing PEARLS, an innovative program launched by the Netter School of Medicine at Quinnipiac University. Papers such as this one that not only describes the components of the program, but evaluates it, is an important educational research communication itself, especially as the authors reflect on the promotion of this kind of DEI work at other medical schools, institutions, and in the community. Kudos to the authors for writing this up.

The paper is strong. I do not have many overall comments. As you consider revising this piece, I would focus on clarifying a few points - there are a lot of acronyms to keep track of and I had to flip through the pages several time to remind myself what group or training was being referred to: faculty or students or something national. Perhaps an easy reference key would be helpful. Additionally, it would be helpful to know if the same core faculty/students were a part of all three components of the program? If so, how does this lead to growth and/or sustainability of PEARLS? For example, it has been documented that when such programs are self-selected, the same “frequent fliers” tend to engage with them - who are not necessarily those who need the training. Additionally (although PEARLS takes the often hidden labor of DEI and makes it visible and valued), when a small number of people carry these initiatives at a university, it can lead to burnout.

 

• We thank the reviewer for the very helpful suggestions. We have added an acronyms key to the beginning. We would like to clarify that the core group of faculty and students provided input to all aspects, but were divided into 3 focus groups (of 4-5 individuals) responsible for the key planning and implementation aspects of 1 particular domain. A leader coordinated the 3 groups and arranged for them to report back to the whole group after meeting individually each week. The aspect of sustainability is a great point, and to ensure continuity, we engaged students from different medical school years, as 3^rd and 4^th year students are off-campus in their clinical work and have limited time. Following the launch of PEARLS in March, we recruited then 1^st year students to direct PEARLs in their 2^nd We are currently actively recruiting members of our new 1^st year medical school class. There is a date on the calendar for the 2023 PEARLS event, and we’ve been meeting regularly since the 1^st event to get the major planning underway. We have added an explanation to the discussion of these efforts to ensure sustainability.

 

A point for clarification - how were the reflections submitted? Was it a discussion board or submitted assignment type of thing? Could students see each others’ reflections? If so, could they see them before they submitted their own, or only after? Were the reflections debriefed and discussed and if so, how? Could they comment on each other’s reflections?

 

• The reflections were submitted via an electronic form, and students could not see each other’s reflections until they were distributed. The reflections were discussed by the PEARLS planning committee. The idea to have students comment on each others reflections is excellent, and we will take that suggestion and implement it going forward.

 

Similarly with the word cloud, because it was in real time, how would this affect the words submitted by participants at the beginning of the activity vs the end?

• Although the monthly word clouds were not in real-time, however, the Reviewer poses an interesting question about the live word cloud during the PEARLS event. Our thoughts were that the words submitted initially may influence some of those submitted at the end, although it was clear to participants that if something they saw especially resonated with them, they were free to enter it again.
  
  I really appreciate the focus on growth mindset collaboration, of the tie to professional identity formation and that PEARLS is approached collaboratively and in-step with both faculty and learners. I appreciate the reflection on limitations of the project and areas for future growth. I enjoyed reading this paper. Thank you.

 

• Thank you on behalf of our team for such a positive, supportive, and thoughtful review!!!!

Author Response File: Author Response.pdf

Reviewer 3 Report

My only concern is use of PEARLS

 

The Academy on Communication in Healthcare has been using PEARLS in it's teaching of communication for decades. Please see below.

"The goal is to RESPOND to the human emotion: anger, sadness, fear, shock, anxiety, or excitement. You want the speaker to know that you notice the emotion by responding actively with PEARLS© and waiting until you fully understand the issues to ask more questions or offer support. Respond to emotions with empathy by dropping PEARLS©. " (2017 blog by Maysel Kemp White 2017)

 

Author Response

Reviewer 2’s Comments and Suggestions for Authors

My only concern is use of PEARLS

The Academy on Communication in Healthcare has been using PEARLS in its teaching of communication for decades. Please see below.

"The goal is to RESPOND to the human emotion: anger, sadness, fear, shock, anxiety, or excitement. You want the speaker to know that you notice the emotion by responding actively with PEARLS© and waiting until you fully understand the issues to ask more questions or offer support. Respond to emotions with empathy by dropping PEARLS©. " (2017 blog by Maysel Kemp White 2017)

Response To Reviewer 2

We thank Reviewer 2 for their time and careful consideration in review of our manuscript. Reviewer 2 had a single point of clarification, mentioning that the name ‘PEARLS’ has been used previously by the American Academy on Communication in Healthcare. In investigation of the literature, we found that ‘PEARLS’ has been used previously by numerous organizations. In consultation with copyright law, we confirmed that the use of a previously copyrighted name is acceptable for non-profit, educational purposes, which applies to its use in the manuscript.

 

 

 

Author Response File: Author Response.pdf