The Power of Convening Medical Specialty Societies
Healthcare faces numerous challenges that no single clinical specialty can solve in isolation. From improving access to care through managing complex, multi-system chronic diseases, multispecialty collaboration is increasingly necessary in U.S. healthcare.
As a coalition of more than 50 organizations representing more than 800,000 physicians, the Council of Medical Specialty Societies (CMSS) advances the expertise and collective voice of specialty societies in support of physicians and the patients they serve.
CMSS shares our members’ commitment to ensure that high quality, evidencebased healthcare is available and accessible to all patients. We believe in
the power of a diverse, shared learning community; a unified voice; and an expansive perspective to help shape the future of healthcare.
And our work drives unique approaches to multi-specialty collaboration among our member organizations – approaches that demonstrate the power of convening medical specialty societies.
Here we describe the impact of our recent work convening medical specialty societies to develop and disseminate resources and programs on diagnostic excellence.
Diagnostic Excellence
Getting patients’ diagnoses right is crucial for their well-being – and given the growing complexity of medicine, it is also one of the top challenges that can often most effectively be addressed through multi-specialty collaboration.
As medicine has advanced, the complexity of diagnosis has increased exponentially. Clinicians now navigate a vast landscape of potential conditions, sophisticated diagnostic technologies, biomarkers, and specialized treatment pathways that were unimaginable even a decade ago. This complexity is further compounded by increasing patient comorbidities and the explosion of available medical knowledge.
Diagnostic excellence encompasses a broad range of steps, including timeliness, accuracy, and communication with patients. The diagnostic process may involve multiple clinicians from different specialties working independently or in collaboration with one another, or may require clinicians from one specialty to draw upon resources developed by another.
The consequences of diagnostic errors are profound – leading to delayed treatment, unnecessary interventions, increased healthcare costs, and in worst cases, preventable patient harm or death.
With more than 1 billion doctor’s office visits, 100 million emergency department visits, and 30 million hospitalizations taking place each year, getting diagnoses right is a critical priority for American medicine and for individual patients.
Yet even as diagnostic challenges grow more complex, the traditional siloed approach to medical specialization can inadvertently create barriers to the cross-disciplinary collaboration that modern diagnosis increasingly requires.
A Collaborative Approach: Promoting Diagnostic Excellence Across the House of Medicine
With a grant from the Gordon and Betty Moore Foundation and additional support from The John A. Hartford Foundation, we awarded 22 grants of up to $100,000 to 20 medical specialty societies over a two-year period.
Work was focused on developing and disseminating educational materials through a wide variety of approaches, including toolkits, professional meeting content, podcast episodes, webinars, videos, peer-reviewed journal articles, news magazine articles, infographics, clinical decision support tools, interactive learning modules, curricula and training materials, and more.
Rather than dispersing grants to individual societies working in isolation, we brought grantees together on a quarterly basis and also provided opportunities for grantees to gather and present their
results at CMSS’s annual meeting, the premier annual convening of staff and leaders serving medical specialty societies and their members. This provided routine opportunities for societies to share lessons learned and identify opportunities to collaborate with one another.
Our unique ability to convene a group of medical specialty societies and create a collaborative ecosystem amplified impact, ensured that innovations reached beyond traditional medical specialty boundaries, and aligned key stakeholders.
The Multiplier Effect: Generating Outsized Impact Through Convening
When specialty societies work in isolation, they often develop excellent resources that remain within their professional silos. The CMSS model disrupts this pattern by creating a collaborative infrastructure that generates significant return on investment through shared resources, mutual accountability, and cross-pollination of ideas.
The American Academy of Ophthalmology (AAO) exemplifies this multiplier effect. Their project to improve the diagnosis of ocular infections was bolstered by teamwork and collaboration within the Academy and beyond, including with volunteer content creators. Perhaps more significantly, they learned from, and were inspired by, their fellow diagnostic excellence grantees, demonstrating how our convening role created spontaneous knowledge transfer that elevated all participants’ work.
While the diagnostic excellence grants were small, our convening provided an added incentive for societies to produce outsized results. Grantees produced 60 clinician educational modules or programs, 18 podcast episodes, 33 videos, 12 newsmagazine articles, 9 toolkits, 11 infographics, and 11 webinars – along with patient materials, EHR order sets and alerts, and clinician decision support tools.
When specialty societies work in isolation, they often develop excellent resources that remain within their professional silos. The CMSS model disrupts this pattern by creating a collaborative infrastructure that generates significant return on investment through shared resources, mutual accountability, and cross-pollination of ideas.
As they closed out work on their grants, multiple societies noted their intention to continue working on their projects and building on the materials developed under their grants.
“We would like to continue to encourage a patient-centered approach to the management of vascular diseases through the successful effort on this project.”
— Reva Bhushan, PhD Society for Vascular Surgery
“We want this to be a living and breathing thing that continues to be updated over the years.”
— Crystal Gadegbeku, MD, FASN American Society of Nephrology
“We’ll survey our members in two to three years to see if the toolkit had any significant uptake.”
— Susan Lacey, PhD, RN, CNL, FAAN, Society for Critical Care Medicine
Beyond Boundaries: Extending Reach Across Specialties
Perhaps the most transformative aspect of the CMSS model is its ability to extend the reach of specialty societies far beyond their traditional audiences. This cross-pollination ensures that diagnostic excellence innovations benefit the entire healthcare ecosystem rather than remaining confined to specialty silos.
The American Society of Nephrology learned this power firsthand, finding that the assessment of kidney function was relevant across many areas of
medical and surgical care. This knowledge informed their approach to implementing race-free kidney function measures, making it critical to include broad input into the development of educational materials, ensure that materials were useful and understandable for clinicians from other specialties, offer a learning experience that users can customize based on relevance and interest, and promote their toolkit to organizations outside of nephrology.
“We want to make sure that we can get our toolkit out to the entire medical community, and I’m sure CMSS will help us get it to the right people, the right places and the right societies.”
— Crystal Gadegbeku, MD, FASN, American Society of Nephrology
Similarly, the American Psychiatric Association discovered that primary care and pediatric clinicians had a strong need for, and interest in, their materials on improving diagnosis of eating disorders. This interest from beyond their specialty boundaries highlighted the value of our cross-specialty approach.
The American Urological Association’s (AUA) experience further validates this cross-specialty impact. Their work revealed that while primary care physicians often follow federal guidelines on prostate-specific antigen screening, many were unaware of guidelines produced by AUA. Through work under our
program, AUA gained valuable insights by collaborating with primary care physicians and discovered that primary care physicians are interested in learning from urologists.
With support from their grant, the American Gastroenterological Association received critical input and feedback from primary care physicians, the Association for Black Gastroenterologists and Hepatologists, and patients in their work on diagnosis of iron deficiency anemia. This diverse input ensured that their materials would be relevant and accessible to clinicians across multiple specialties, maximizing the impact of their grant.
“True innovation in healthcare begins where specialties intersect. By embracing cross-specialty collaboration we leveraged the unique expertise and experience of each subspeciality, and jointly worked towards improving diagnostic pathology communication to better enable patient engagement which could improve outcomes and reduce errors.”
—
Diana Cardona,
MD, MBA, College of American Pathologists
In their work on improving how cancer diagnoses are handed off from pathologists to treating clinicians, American Society for Clinical Pathology (ASCP) identified variations in the communication of critical and significant unexpected anatomic pathology diagnoses across various practices. In response, they convened a group of experienced practicing physicians to address these challenges. This collaborative effort resulted in the creation of a comprehensive document outlining best practice recommendations. These recommendations aim to ensure that patients are promptly informed of critical diagnoses, enabling timely and effective treatment.
“One of the key insights from this project is the potential for electronic health record (EHR) laboratory information systems vendors to incorporate these solutions effectively. We have initiated discussions with Epic and are collaborating with them to prioritize the development and implementation of processes for flagging critical findings, ensuring they capture the attention of treating clinicians.”
—
Sachin Gupta, PhD, MBA, PhD, MBA, MLS(ASCPi)MBi, LSSBB, CPHQ, American Society for Clinical Pathology
Alignment of Stakeholders: Bridging Patient and Clinician Perspectives
A third powerful aspect of our convening approach is its unique ability to align patient and clinician perspectives. The collaborative CMSS environment naturally encourages consideration of the patient experience and developing solutions that serve patients as well as clinicians.
The College of American Pathologists (CAP) exemplifies this alignment. The survey they conducted of patients with their grant revealed that 80% of respondents found it difficult to understand a pathology report, 93% found it difficult to understand report terminology, and more than half found it difficult to identify the diagnosis within the report.
Rather than creating separate solutions for patients and clinicians, CAP discovered remarkable alignment: Patients did not want their pathology reports to use vocabulary that was different from the vocabulary that is used by clinicians. Rather, most patients thought it would be helpful to have their cancer diagnosis in bold at the top of the report, a brief explanation of their cancer diagnosis, and a glossary of medical terms. As a result, CAP’s updated recommendations for pathology reports were able to respect both clinician workflow and patient needs.
The Society for Vascular Surgery (SVS) similarly discovered powerful alignment between patients and clinicians through our convening approach. Their work revealed that patients with chronic limb-threatening ischemia thought they should have been referred to a vascular surgeon earlier than they were. This insight aligned perfectly with the society’s goal of improving timely and accurate diagnosis. SVS also found it very valuable to include patients and their values, preferences, and expectations in an in-person session at a physician conference session.
“We held an educational session at our annual meeting; it was a groundbreaking session bringing chronic limb-threatening ischemia patients on the panel along with world-renowned experts in the field of chronic limb-threatening ischemia (CLTI).”
— Reva Bhushan, PhD Society for Vascular Surgery
The American Academy of Pediatrics (AAP) further highlighted this alignment, noting that patient representatives brought their lived experience to AAP’s project. These representatives stressed the importance of listening to and communicating with patients and families/ caregivers, emphasizing that this approach establishes trust and promotes patient/family willingness to actively partner with clinicians on their care. This alignment of patient and clinician goals exemplifies how our convening model creates solutions that meet the needs of both groups.
The CMSS Advantage: Why Convening Works
Having CMSS as a convener for the Promoting Diagnostic Excellence Across the House of Medicine grant program resulted in outsized impact compared to the size of the grants made to individual societies, extended reach across multiple medical specialties, and alignment of patient and clinician perspectives.
What makes our convening model so effective? Experience from this grant program suggests several key factors:
• Encouragement to leverage relationships: we amplify existing relationships and help medical specialty societies create new connections that support the program’s goals.
• Shared accountability: When societies work together under CMSS’s coordination and have period check-ins, natural peer-to-peer accountability develops.
• Knowledge transfer: our convening power accelerates cross-pollination of ideas and innovation.
• Patient-centered focus: The collaborative environment that we build naturally leads to a patient-centered approach to specialty society work.
The CMSS model offers an unparalleled approach to driving collaborative change across multiple medical specialties. Convening societies via CMSS leads to:
• Investments that generate substantially greater return through hosted collaboration;
• Innovations that reach far beyond specialty boundaries to benefit the entire healthcare ecosystem;
• Natural alignment between clinician and patient needs; and
• Sustainable momentum that continues long after initial funding ends.
The diagnostic excellence initiative demonstrates that convening specialty societies creates impact greater than societies would achieve on their own. Our convening model catalyzes collaborative innovation that no single specialty could achieve alone, creating lasting change that benefits clinicians and patients across the entire healthcare landscape.
LESSONS LEARNED FROM PROMOTING DIAGNOSTIC EXCELLENCE ACROSS
THE HOUSE OF MEDICINE GRANT PROGRAM
The Power of Convening Medical Specialty Societies
DIAGNOSTIC EXCELLENCE
Patient Engagement LESSONS LEARNED
The integration of patient perspectives about the diagnostic process emerged as a crucial theme across multiple grantees in CMSS’s Promoting Diagnostic Excellence program. Societies found that involving patients in their initiatives enriched the educational content they created and provided insights that might otherwise have been overlooked. The grantees’ experiences demonstrate both the value of patient engagement in developing educational resources and specific strategies for effectively incorporating patient voices into clinical education.
Understanding Patient Perspectives on Medical Communication
The College of American Pathologists (CAP) gained valuable insights into communications through their work on how patients interact with their cancer pathology reports. Their survey revealed that 80% of patients found pathology reports difficult to understand, with 93% struggling to understand report terminology. However, they also learned patients did not want their pathology reports to use simplified or “dumbed down” language. Instead, patients preferred to receive the same technical vocabulary used by clinicians, supplemented with explanations of medical terms.
CAP’s project also revealed specific patient preferences for how information is presented in pathology reports. Patients wanted to have their cancer diagnosis in bold at the top of the report (endorsed by 58%), a brief explanation of their diagnosis (74%), and a glossary of medical terms (58%). These preferences demonstrate that patients want complete information presented in an accessible way, rather than simplified information in their pathology communications.
Patient Input on Clinical Interactions
The Society for Vascular Surgery (SVS) found that patients with chronic limb-threatening ischemia (CLTI) provided valuable insights about clinical care to inform their work on diagnostic excellence. Patients emphasized the importance of clinician patience, kindness, and collaboration. They specifically advised clinicians to remember that patients are not feeling well, be patient in explaining information, repeat information as needed, and maintain a kind demeanor.
SVS also learned that patients valued specialty care and wished they had been referred to vascular surgeons earlier in their care journey, an insight that has implications for both clinical education and care coordination.
Patient Engagement |
Impact of Patient Perspective on Educational Materials
In their work on gastrointestinal evaluation of iron deficiency anemia, the American Gastroenterological Association (AGA) learned valuable lessons about patient reactions to educational materials. While the project team had anticipated that medical images of conditions like ulcers and polyps would be helpful, patients instead found these images scary and distracting, prompting revisions to AGA’s patient materials and highlighting the importance of testing educational materials with patients.
The American Academy of Pediatrics (AAP) found that incorporating patient and family voices into their educational modules brought lived experience to their video content on reducing harm to children by decreasing outpatient diagnostic errors. Patient representatives particularly emphasized the importance of listening to and communicating with patients and their families, building trust, and encouraging patients and family members to actively partner with clinicians.
Recommendations
Based on these grantees’ experiences, Societies seeking to incorporate patient voices and perspectives into clinical education about diagnostic excellence may wish to:
• Understand what additional information patients and their families may need, such as explanations of diagnoses or glossaries of medical terms;
• Test assumptions about what patients want, as their preferences may differ from clinician expectations;
• Engage patients early in the development process rather than waiting for them to review completed materials; and
• Consider patient emotional reactions to educational content, including images.
The experiences of these grantees demonstrate that meaningful patient engagement requires careful planning and a willingness to adjust based on patient feedback. However, the resulting improvements in educational materials and increased relevance to patient needs make this effort worthwhile.
Communicating Effectively with Clinicians
One of the most significant challenges in advancing diagnostic excellence is effectively communicating with clinicians about sensitive topics such as diagnostic errors, bias, and the need for changes in clinical practice. Through CMSS’s grant project, multiple Societies identified effective ways to present information so that it improves clinician receptiveness and engagement.
Take a Non-Blaming
Approach
Several Societies noted the importance of using non-blaming communications approaches when discussing diagnostic excellence. Clinicians are highly competent professionals and are used to being treated as such, so negatively highlighting areas for improvement has the potential to lower receptivity to new information.
In their work on improving the accurate diagnosis of ocular infections, the American Academy of Ophthalmology (AAO) learned that using a non-blaming communications approach that highlighted diagnostic excellence rather than errors was productive.
Similarly, the American College of Physicians (ACP) project on the impact of implicit bias on diagnostic decision making anticipated potential negative reactions to these sensitive topics. ACP addressed this by creating psychologically safe learning environments where clinicians could feel comfortable examining their practice patterns. ACP delivered content with a neutral, non-blaming tone and started with a general discussion of cognitive bias before narrowing to a focus on bias related to racial/ethnic/gender identity.
The Society of General Internal Medicine (SGIM) took a nuanced approach in their work focused on equity in the diagnostic process. They explicitly acknowledged that all clinicians are doing their best, while noting that clinician training often focuses on a limited patient demographic (white, male, cisgender, middle class). This framing helped clinicians understand how unconscious and unintentional biases might develop, while encouraging empathy for both themselves and their patients.
Use Clear, Concise Messaging and Segment Content
The American Academy of Allergy, Asthma & Immunology (AAAAI) learned valuable lessons about message clarity when addressing penicillin delabeling. When they encountered resistance from clinicians who were skeptical about changing their practices, they responded by developing more concise messaging which proved more effective than their initial approaches.
LEARNED
Communicating Effectively with Clinicians | continued
SGIM found that careful attention to cognitive load is crucial when presenting complex information. They learned that content related to health equity needed to be discussed separately from content about the basic diagnostic process, as combining the two overwhelmed participants.
Similarly, in their work on implementing recommendations for a race-free approach to estimating kidney function, the American Society of Nephrology found that it was important to make their toolkit easy for busy clinicians to read, with options to access more in-depth information if needed.
Employ Multiple Communications Channels
The AAO successfully reinforced their messages by using a combination of website content, news magazine articles, videos, podcast episodes, interactive cases, and peer reviewed journal articles.
Other Societies used these communications channels and also held workshops, presented content at regional and national meetings, and used social media outlets and targeted emails to reach clinicians.
In its work on diagnosing skin disease across a spectrum of skin color, the American Academy of Dermatology (AAD) successfully used its “Question of the week” format, which are online cases with images, multiple-choice self-assessment questions, learner feedback, and references for further study. This format, using a phone app, gamification, and feedback, proved very popular.
Connect to Clinician Priorities and Pain Points
Several organizations found success by explicitly connecting their diagnostic excellence initiatives to issues that clinicians already care about. The AAO, for instance, linked their work to tangible clinician concerns, such as malpractice insurance costs, to ensure the relevance of their work to clinicians.
The American College of Emergency Physicians (ACEP) learned the importance of clearly demonstrating the need for clinician education. When addressing ruptured abdominal aortic aneurysm diagnoses, they encountered resistance from clinicians who believed they “don’t miss” these diagnoses. ACEP then shared data to help clinicians revisit this assumption in order to encourage them to engage with educational content on this rare condition.
Communicating Effectively with Clinicians | continued
In its work on improving sepsis diagnosis and sepsis-related communication between referring and receiving physicians, the Society for Critical Care Medicine (SCCM) found that improving communications was important to clinicians. They learned that most referring physicians would like to receive feedback from receiving physicians on how diagnosis and management could be improved in the referring unit – and that most receiving clinicians want to provide such feedback.
The American Urological Association (AUA) identified awareness and understanding of prostate-specific antigen (PSA) screening as a concern for primary care physicians, noting that primary care physicians worry about what may happen to patients after a urology referral for an elevated PSA. By connecting their work to this concern and partnering with the American Academy of Family Physicians, they were able to share their resources with a broad group of primary care physicians.
Recommendations
Based on these grantees’ experiences, Societies seeking to communicate effectively with clinicians about diagnostic excellence may wish to:
• Frame messages positively, emphasizing excellence and improvement rather than errors and deficiencies;
• Create psychologically safe environments for discussing sensitive topics;
• Use clear, concise messaging that resonates with clinical practice;
• Employ multiple communication channels to reinforce key messages; and
• Connect initiatives to existing clinician priorities and concerns.
These approaches can help to more effectively engage clinicians in diagnostic excellence initiatives while maximizing receptivity to change.
LEARNED
Leveraging Existing Infrastructure and Relationships
The success of CMSS grantees’ diagnostic excellence projects was often dependent on Societies’ efforts to leverage existing infrastructure and relationships. Their experiences provide valuable insights about how to maximize existing resources while implementing new initiatives.
Building on Established Infrastructure
Having existing materials to draw on provided an advantage when working on diagnostic excellence projects.
The American Academy of Ophthalmology (AAO) demonstrated the value of utilizing existing infrastructure from the outset. The core of their strategy involved analyzing data from the IRIS® Registry (Intelligent Registry in Sight), a comprehensive eye disease clinical registry that includes data from more than 15,000 clinicians and 73 million patients. Their IRIS Registry was already in place and had been developed through ophthalmologists’ shared commitment to improving the delivery of eye care. This established system provided a foundation for AAO’s diagnostic excellence work on ocular infections.
At the same time, the American College of Physicians’ (ACP) work on health equity found that when reviewing older educational materials through a new lens, they identified some assumptions and biases that could be corrected with updated materials.
Several other Societies drew on valuable previous experience with similar initiatives, drawing on resources such as past educational materials, previous project work, and successful collaborations.
Leveraging Professional Networks and Organizational Collaboration
Multiple Societies found success by tapping into established professional relationships:
• The American Psychiatric Association (APA) utilized staff relationships to secure an exhibit booth at the American Academy of Pediatrics annual meeting, extending the reach of their work on promoting diagnostic excellence regarding eating disorders.
• The American College of Surgeons (ACS) partnered with organizations and audiences they had engaged with for many years in their work on diagnosing dementia and cognitive impairment in the surgical setting, contributing to their project’s success.
LEARNED
Leveraging Existing Infrastructure and Relationships | continued
• The American Thoracic Society (ATS) built on their relationship with an investigator who had developed their framework for their project on improving ICU-to-ward handoffs and was already a trusted society member.
Some Societies built on partnerships that spanned clinical specialties, leveraging these relationships in multiple ways:
• The AAO’s project work was bolstered by teamwork and collaboration within the Academy and beyond, and they learned from and were inspired by their fellow diagnostic excellence grantees.
• The American Society of Nephrology (ASN) found that their work on implementing a toolkit to support implementation of race-free approaches to estimated kidney function was relevant across a broad array of medical and surgical care specialties. This made it important for them to have broad input into the development of educational materials, to ensure that materials were useful and understandable for clinicians from other specialties, and to promote the Toolkit to organizations outside of nephrology.
• The American Gastroenterological Association (AGA) received crucial input for their work on diagnosis of iron deficiency anemia from their established partnerships with primary care physicians and specialty organizations.
These existing relationships provided credibility, promoted mutual buy-in, and facilitated project implementation. In addition, several Societies, including the AAO and APA, benefited from their established volunteer networks, engaging volunteers to develop and review materials.
Recommendations
Based on these grantees’ experiences, Societies implementing new initiatives may wish to:
• Audit assets to identify existing infrastructure and materials and identify needed updates or modifications to support new initiatives; and
• Build on relationships with trusted partners and volunteers who may support their efforts; and
• Use the value of their CMSS membership to collaborate on shared priorities, building on the power of CMSS convening to facilitate sharing learning, building relationships, and identifying potential partnerships to advance collective work.
These approaches to leveraging existing assets and relationships can support organizations in their work to achieve diagnostic excellence among their members and beyond.
LESSONS LEARNED
Managing Change
Successfully implementing updated practices that contribute to diagnostic excellence requires carefully managing change processes and resistance to change. Multiple CMSS Society grantees had experiences that provide valuable insights into effectively leading change across a variety of settings.
Demonstrating the Need for Change
In their work to improve diagnosis of ruptured abdominal aortic aneurysms (rAAA), the American College of Emergency Physicians (ACEP) faced a challenge with clinicians who did not believe change was necessary, because they felt that they did not miss such diagnoses. To address this, ACEP needed to give clinicians a reason to revisit this rare disorder, helping clinicians understand that screening for rAAA occurs in only 4 to 26 percent of individuals for whom it is appropriate, with disparities for individuals of color and with lower socioeconomic status. By ensuring that clinicians understood the need for change, ACEP paved the way for the success of their rAAA diagnostic content, delivered via podcast, webinar, newsmagazine article, and educational course content.
Addressing Clinician Resistance
The American Academy of Allergy, Asthma & Immunology (AAAAI) encountered significant resistance in their work on delabeling patients as allergic to penicillin when they can safely tolerate it. They found that clinicians were resistant to changing their existing practices because of both skepticism about the simplicity of the delabeling process and expectations that patients would resist delabeling. AAAAI addressed these concerns by:
• Simplifying their messaging to make it more concise (“Penicillin Allergy? Think again);” and
• By emphasizing benefits for vulnerable populations and presenting delabeling as a simple way to impact patients who stand to gain the most from delabeling, including pregnant and geriatric patients.
Institutional-Level Change Considerations
In their work on communicating new cancer diagnoses, the American Society of Clinical Pathology (ASCP) identified several factors at the institutional level that were crucial in implementing systematic changes. These included taking the time needed to gain institutional buy-in; securing approval from institutional leadership; and carefully planning for changes to infrastructure such as laboratory information systems.
Managing Change |
Making Change Sustainable
Multiple Societies learned important lessons about implementing sustainable change:
• The College of American Pathologists (CAP) learned that patients receiving their pathology reports wanted to have resources and glossaries of clinical terms included in their pathology reports. Since resources and the terms included in reports change over time, CAP was unsure who would be responsible for ensuring these would be updated after their initial development, posing a challenge to sustainability.
• ASCP found that pathologists were aware of policies around pathologistclinician communication, but did not have details on how to implement these policies or potential implementation barriers. This posed a barrier to the sustainability of ASCP’s work on communication of new cancer diagnoses.
• In their work on diagnosing iron deficiency anemia, the American Gastroenterological Association (AGA) initially planned for their clinician intervention to focus on EHR-based health maintenance alerts. Following clinician feedback that they already receive too many alerts, AGA changed their intervention to be a standardized order set with an alert only for patients who truly need one. This shift helped ensure the sustainability of their initiative.
Recommendations
Based on these grantees’ experiences, Societies implementing new initiatives may wish to:
• Assess readiness for change by evaluating current practices and attitudes, identifying potential sources of resistance, and gathering data to demonstrate the need for change;
• Develop a plan for garnering institutional buy-in and support from leadership; and
• Plan for sustainability, including long-term maintenance needs, planning for updates and adjustments, and monitoring implementation challenges.
These approaches to change management can support lasting positive change in clinical practice.
LEARNED
Addressing Equity and Bias
The CMSS Diagnostic Excellence grant program included a significant focus on equity as one core component of diagnostic excellence. Grantees’ experiences highlight important insights in this area.
Approaching the Topic of Equity
The way that content is organized and delivered can affect clinicians’ ability to engage on topics of bias and equity. In its work on mitigating racial disparities in diagnosis, the Society for General Internal Medicine (SGIM) found that content about health equity needed to be discussed separately from basic diagnostic process content to avoid overwhelming participants. Similarly, the American College of Physicians (ACP) found in its work on promoting health equity that it was helpful to begin educational modules with a general discussion of cognitive bias before narrowing to a focus on bias based on race/ethnicity/gender identity.
Creating a Supportive Learning Environment
SGIM developed a non-blaming approach to their work on equity. Their framework acknowledged that clinicians intend to provide quality care to all their patients; recognized that clinician training often focuses on patients who are white, male, cisgender, and middle-class; focused on the ways that clinician training may unconsciously and unintentionally lead to biased behavior; and emphasized that clinicians should have empathy for their patients. This approach supported clinicians in engaging with the SGIM materials.
ACP took a similar approach, noting that learners can sometimes have sensitive or defensive reactions to discussions about unconscious bias. To address this, ACP aimed to promote psychological safety and offer a safe setting in which learners could fail. As with SGIM, they delivered their content with a neutralnon-blaming tone.
Moving Beyond General Guidance
SGIM knew they needed to do more than to ask clinicians to “be better” or “be nicer.” Rather, they provided specific behaviors for clinicians to model and practice, and were explicit about how their equity-focused framework differed from other patient-centered care frameworks.
Addressing Equity and Bias |
Obtaining Input on Educational Materials
In its work to develop and review materials to improve clinician use and interpretation of electroencephalograms (EEGs), the American Epilepsy Society (AES) found that while they had retained experts in EEGs and education for content development, these individuals were not comfortable assessing materials for biases in language and images. They ultimately engaged their Diversity, Equity, and Inclusion committee members for this review.
The American Gastroenterological Association (AGA) sought critical input for their work on diagnostic evaluation of iron deficiency anemia from the Association for Black Gastroenterologists and Hepatologists. This input, combined with feedback from primary care physicians and patients, helped shape their clinician intervention and patient-focused educational handout.
Recommendations
Based on these grantees’ experiences, Societies working to reduce bias and increase equity may wish to:
• Consider how to structure content by separating equity content from other complex topics;
• Create a supportive learning environment focused on acknowledging good intentions, avoiding shame, and promoting psychological safety;
• Provide concrete, actionable guidance; and
• Obtain a broad range of input on the content of educational materials.
Organizations that thoughtfully implement these lessons can help advance equity through more effective educational initiatives.
The Power of Convening Medical Specialty Societies
