Tag: Building Trust

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

I set the microwaved cup of instant coffee on the table so hard that it sloshes. He looks at me with guarded eyes. Despite trying to stay positive, this is not exactly an ideal start.

Working with refugees seeking asylum has taught me that trust is not easily won, and nor should it be. For someone who has lost so much to tell you their stories, it requires the willingness to try establishing a connection over and over again.

“David,* you need a root canal due to the deterioration of your teeth,” I explain the procedure to him and its importance to his health, but he shakes his head vigorously to make me understand.

“They will sell my teeth to the government. They will use it to track me down or frame me for a crime.”

David’s fears are far from unfounded. His deep mistrust of the medical system is borne from experiences in his home country, where the government arrested people for crimes they did not commit, and health care providers turned over patients to the police. His misinformed beliefs are rooted in conversations with other refugees that have warned him that people may pretend to help him only to send him back to his home country.

He has little reason to trust me after our few hours of meetings over the past few weeks. My eyes settle on his knuckles glowing white as he clutches the coffee cup.

I soften my voice. “I know it is scary. This procedure is completely safe. All they will do is…”

He cuts me off, exclaiming in frustration. “No! Too many words! I don’t want it, I told you.”

Instead of immediately responding, I take a moment. My mind wanders to my niece, remembering her eyes brimming with tears as she screamed that she didn’t want to go to the dentist because it would hurt. We showed her a video, explaining what each tool did until her tears subsided. Maybe combating misinformation isn’t just the information itself but finding the best way to communicate it to the other person.

I pull up a video on YouTube that explains the procedure. I watch as his tense shoulders relax, smoothing into gentle curves just as the frown of his lips settles.

I ask a little too cheerfully, “So… what do you think?”

He looks at me for a moment. He is still unsure, but I can see his grip on the Styrofoam cup loosening. I allow myself a moment to hope.

“Not today, I think.” He hitches his jacket over his shoulder as he prepares to leave the appointment. I feel the familiar stone of disappointment settle in my stomach as I shuffle the stack of papers stained with coffee.

He pauses at the door. “Next week? Next week we can watch the video again?” he asks.

I smile wider. Nod. “We can watch again next week. Maybe I’ll even write a song to convince you.” David nods back at me. Not exactly a smile, but an affirmation we will try again next week. And the week after. And as many weeks as he will let me try to earn his trust.

Misinformation is a door that offers a peek into the corners of another person’s mind. Although these conversations may be fraught with tension and disagreement, they are also an opportunity to understand more deeply. Building trust is a series of small steps that do not always arrive at a solution. Although it may not have the outcome I hope for, it is still as valuable as an appointment where mutual trust comes quickly.

I believe the most difficult piece is accepting that agreement is not always promised. My first months of medical school were energized with idealism and the belief I could win over every patient. Now, I have a more subdued approach. I sit beside the patients. I listen without judgment. I wonder about the amalgamation of life experiences that have led them to their beliefs, ingrained value systems, and this very conversation.

I do not pretend to have all the answers. Perhaps this is ultimately what draws us together. Even at odds, reaching out to each other across a vast divide, we can all acknowledge that we are doing our best to find meaning amidst the messy beats of life. So that even if our conversation does not end with agreement and a handshake, there is a promise to keep reaching across the divide, listening and sharing thoughts over a lukewarm cup of coffee.

Meher Kalkat is a third-year student at the Johns Hopkins School of Medicine and is originally from West Palm Beach, Florida. She is passionate about medical education, physician and trainee wellness, and combating mental health stigma. In her free time, she loves to sing karaoke, bake, and take photographs.

*Note that name and any identifying information have been changed.

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

“Are you sure?” The question was to my preceptor, but his gaze was on me, like he was searching for a second, differing opinion.

If we’re being honest, I’m usually not sure. The abundance of information available at our fingertips can be overwhelming. As a first-year medical student, I often struggle to trust myself, but I trust the process of my training. Since starting my pre-clinical years, my knowledge base has been tested, stretched, and built upon at an exceeding rate. Every other Tuesday, I get to see real patients, practice interview skills, and apply new material through a clinical preceptorship program. It’s in these clinical encounters that I learn about more than the organ system of the block. It’s in these clinical encounters that I witness fear and vulnerability turn into trust. It was also in one of these clinical encounters that I met Sergio.

Sergio was a year younger than me. A week prior he was helping a neighbor with a construction project where he inhaled some dust and debris. The exposure was brief and limited, but he was nonetheless concerned. He read online that vigorous exercise was the best thing he could do to “clean out his lungs following exposure.” Not only did it not help, but for the first time in years, it exacerbated his asthma. The next day, he noticed a new pain in his back right where his lung would be. He came to us anxious and convinced that lung scarring from the exposure would lead to a serious disease. As my preceptor worked through his list of concerns, reassuring him along the way, he’d push back.

“Yes, I understand, but…” he’d circle back to something else he read. It’s pulled up on his phone. He can show us.

The issue with online information is that it’s often out of context. Internet searches tend to identify rare or worst-case outcomes. Misinformation and misinterpretation often go hand-in-hand, and it’s hard to navigate this space alone. Caring for vulnerable patients requires trust, comfort, and thoughtful communication to help alleviate the anxiety often experienced by patients in these settings. Teachable moments in the clinic are an opportunity for these values to shine.

My preceptor is good at teachable moments. I’ve watched her pull up diagrams on her computer to show patients exactly what she is talking about when referring to anatomy. With Sergio, I watched her do what his online searches couldn’t. I followed along as she connected his medical history, experience, and story to his current symptoms. I listened as she walked us through her line of thinking.

We found out that he’s not usually that active and swinging a hammer in that manner was a new motion for his body. Most importantly, we were able to pinpoint a muscle group that aligned with where he felt the pain. To his relief, it wasn’t his lung.

We no longer have a stronghold on medical information, but we have the skills of empathy, connection, and context. The ability to assess, interpret, and contextualize signs and symptoms is a gift. For Sergio, it provided the reassurance he desperately needed in that moment. The amount of information available online can be overwhelming, but teachable moments can build trust for medical students and patients alike. It’s moments like this that engage patients in their own care and rebuild the foundation of trust and partnership.

Elina Kurkurina is a first-year medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University. She is interested in the intersection between emergency medicine, geriatrics, and primary care. Prior to medical school, she worked in quality measurement and holds an MPH degree in Social and Behavioral Sciences from the Yale School of Public Health. In her free time, she can be found on a hiking trail with her husband and rescue dog. 

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

As the tip of the syringe moved toward his shoulder, I witnessed an ever-expanding fear grow in the eyes of Teddy, a 6’ 6”, 260-pound Police Officer at New York City Health + Hospitals (NYC H+H), in Harlem.

Teddy, a Harlem native, was supported, loved, and grew up in the surrounding community, and he now returns the favor every day, taking care of his community in a space meant to be safe. As the needle pierced his skin, its protective contents pushed into his body, he immediately looked at me. Teddy asked me to be with him for his first COVID-19 vaccination. Seeing doubt and fear in his eyes, questioning what he had just done, was, for lack of a better word, painful. However, Teddy receiving that life-saving (for many) vaccine, trusting what he was taught, and relying on the information he learned, was motivating.

When I reflect on this moment, I feel somewhat selfish and uncomfortable with what I describe as a feeling of personal victory. I convinced Teddy to get his first COVID-19 vaccine! But then I remember who Teddy is, and why his decision to get vaccinated is so important to me.

Teddy was born and raised in Harlem, a permanent resident of the “Black Mecca,” a loving husband, and a proud father. During COVID-19 first wave, he was a transporter of lives lost, stored in refrigerated containers due to a lack of space in the morgue. Throughout the pandemic, Teddy was steadfast in protecting his community, a pillar in his post, often unmasked due to the limited availability of N-95’s. As a health care worker (HCW), his risk of testing positive for COVID-19 is 11.6 times higher than the general community, and as a Black male, he is 2.1 times more likely to be hospitalized due to COVID, and 1.6 times more likely to die from COVID-19 compared to white, non-Hispanic persons. Teddy was also one of 542 HCW’s at NYC H+H/Harlem who took part in the Community Activation Model: COVID-19 Vaccine Educational Seminar (CAM). Teddy getting that vaccine was a victory!

On August 16^th, 2021, New York Governor Andrew Cuomo announced that all HCW’s in the state must be vaccinated against COVID-19 by September 27^th, 2021. This preventative measure was needed due to a growing deficit in HCW availability, combined with hospitals being overwhelmed by the influx of non-COVID-19 patients due to delayed care, compounded by the Delta Variant spreading across the City. For systems like NYC H+H, where approximately 20% of its 42,000 employees had yet to receive their first vaccine, meeting this requirement would be no small task.

After my third year of medical school, I took a gap year to work at NYC H+H, and was part of a team responsible for reducing the potential downstream impacts of this mandate on the care we provide. A majority of my work was completed at NYC H+H/Harlem, where 22% of the workforce was unvaccinated.

Alongside other efforts I developed the CAM as an intervention to retain employees and to increase vaccination rates among the workforce. The foundation of the CAM is centered on respecting the individuality and unique needs of the population you seek to serve. Therefore, as part of designing the CAM, we conducted key informant interviews with hospital staff, in order to identify key drivers of vaccine hesitancy at NYC H+H/Harlem, which included:

1. Lack of trust in the vaccine due to difficulty in accessing information that is easy to understand.
2. COVID-19 no longer being a threat – “we lived through the first two waves without a vaccine.”
3. The importance of personal agency – disregard for autonomous decision making.

Respecting the unique needs of the Harlem community, I designed a teaching curriculum to answer the questions and concerns related to the population, and provide accurate knowledge to enable informed decision making. Simplifying immunology, virology, and vaccine history and development to a middle school reading level, and requiring every unvaccinated employee to take part in the seminar over a 3-week period.

The results were tremendous, with a reduction in unvaccinated employees by September 27 from 22% to 4.4% (NYC H+H average of 7.8%).

While I recognize the mandate as a critical driver of vaccine adherence, the efforts of the CAM played a major role in vaccine understanding, comfortability, and acceptance. While misinformation will always have an enormous impact on healthy and informed decision making, we learned through this experience that it is just as important to increase accessibility to understandable and accurate information that anyone can use to combat misinformation.

Dr. Christopher R. B. Montgomery’s professional journey has spanned various roles and responsibilities. After serving as Assistant Health Care Program Planner and Analyst at NYC Health + Hospitals, he is now an intern at the UCLA Reagan/Olive View Emergency Medicine Residency. His academic journey began in Germany, where he received a Baccalaureate of Science from the University of Mainz and a Bachelor’s degree in Biology from the Technical University of Kaiserslautern. He then pursued an MD with distinction from the University of California, San Francisco, preceded by a Master’s in Public Health with a focus on Global Health, Epidemiology, and Biostatistics at Loma Linda University. His experience extends to the San Bernardino Department of Public Health, where he worked as an epidemiologist, contributing to systems improvement, resource optimization and community engagement.

• Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, Mehta RS, Warner ET, Sikavi DR, Lo CH, Kwon S, Song M, Mucci LA, Stampfer MJ, Willett WC, Eliassen AH, Hart JE, Chavarro JE, Rich-Edwards JW, Davies R, Capdevila J, Lee KA, Lochlainn MN, Varsavsky T, Sudre CH, Cardoso MJ, Wolf J, Spector TD, Ourselin S, Steves CJ, Chan AT; COronavirus Pandemic Epidemiology Consortium. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020 Sep;5(9):e475-e483. doi: 10.1016/S2468-2667(20)30164-X. Epub 2020 Jul 31. PMID: 32745512; PMCID: PMC7491202.
• CDC (2022, December 28). Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity. CDC Center for Disease Control and Prevention. Retrieved March 1, 2023, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

Misinformation

• Sheng, A., Gottlieb, M., Bautista, J., et al. The Role of Graduate Medical Education in the Fight Against Health Misinformation. Journal of Graduate Medical Education. February 2023.
• Lalani, H., Laine, C. The Credibility Conundrum: Can Social Media Companies Define Credibility for Users? Annals of Internal Medicine. March 2023.

Trust in Healthcare

• Chokshi, D. Vicious and Virtuous Cycles in Health. JAMA Health Forum. February 2023.
• Baron, L. Gaslighting and dismissal: the consequences of invalidating patients’ concerns. Kevin MD. February 2023.
• Mainous, A., Kelliher, A., Warne, D. Recruiting Indigenous Patients Into Clinical Trials: A Circle of Trust. Annals of Family Medicine. January/February 2023.

Health Equity

• Santos, P., Shah, K., Gany, F., Chino, F. Health Care Reform and Equity for Undocumented Immigrants — When Crisis Meets Opportunity. The New England Journal of Medicine. March 2023.
• Cain Miller, C., Kliff S., Buchanan, L. Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds. The New York Times. February 2023.
• Collar, A. Indigenous Peoples’ Limited Access to Reproductive Care. Annals of Internal Medicine. February 2023.
• Miller, B. The Intersection of Black History, Queer Studies, and Medicine. Lown Institute.  February 2023.

According to Nielsen, Latinos in the U.S. are more likely to receive, consume, and share “fake news” and misinformation online compared to the general population. Considering that tens of millions of Latinos use Spanish as a primary language, the absence of any organization devoted to rebutting false Spanish-language claims in traditional and social media presented a significant gap in our ability to address misinformation. Factchequeado has stepped into that breach.    

Co-founders Clara Jiménez-Cruz, CEO of Maldita.es, and Laura Zommer, editor-in-chief of Chequeado, the first major fact-checking organization in South America, paired up to form the organization in 2021. Factchequeado not only aims to create verified content in Spanish, but ultimately to build partnerships with local and national U.S. media and the Latino community to limit the impact of mis- and disinformation.

As the first-place winner of the ABIM Foundation’s 2022 Misinformation Grant Challenge, Factchequeado received $80,000 to help correct the scourge of medical misinformation, which experienced a resurgence during the pandemic. The project has also received financial support from the Google News Initiative, the Knight Foundation and ICFJ.

Factchequeado has established more than 30 alliances with organizations across the U.S. that serve Latino communities, including media and institutional partners. These partners can republish Factchequeado’s content and access its training materials, and help it connect with Spanish-speaking audiences.

In an effort to create a bond of trust, Factchequeado created a WhatsApp chatbot that allows individuals to directly share misleading information or make requests for factchecks. Factchequeado shares information collected through the tool with its partner organizations to alert them about misinformation in circulation and enable them to create proactive and timely responses in their communities. (Spanish speakers commonly use WhatsApp for news consumption and sharing.)

In collaboration with Mediawise and The Poynter Institute, the team at Factchequeado is also training Hispanic journalists to mitigate misinformation in Spanish. Participants are taught skills to produce timely and accurate fact checks on health issues, including images and videos. They also learn methodologies that help them recognize disinformation.

The program has also created a toolbox with resources to help Spanish-speaking individuals learn to identify misinformation in the content they see on an everyday basis, empowering ordinary people to identify and counter the spread of misinformation.

Misinformation

• Gruzd, A., Abul-Fottouh, D., Song, M., Saiphoo, A. From Facebook to YouTube: The Potential Exposure to COVID-19 Anti-Vaccine Videos on Social Media. Social Media and Society. February 2023.
• Graham, G., Lee, T. What’s Up with Health Misinformation? NEJM Catalyst. January 2023.

Trust in Healthcare

• Burras-Sando, J., Jensen, M., Wong, K. Help me stay afloat. Nursing Management (Springhouse). February 2023.
• Rangel, E. Work-Life Integration in Medicine: A Movement, Not a Mandate. JAMA Network Open. January 2023.
• Reardon, J., Lee, S., Goering, S., et al. Trustworthiness matters: Building equitable and ethical science. Cell. January 2023.

Health Equity

• Fung, V., Price, M., Nierenberg, A., et al. Coverage Parity And Racial And Ethnic Disparities In Mental Health And Substance Use Care Among Medicare Beneficiaries. Health Affairs. January 2023.
• Escobedo, L., Cervantes, L., Havranek, E. Barriers in Healthcare for Latinx Patients with Limited English Proficiency—a Narrative Review. Journal of General Internal Medicine. January 2023.

As medicine becomes politicized, trust in our physicians matters more than ever. High professional standards help them earn it.

“How can I find a doctor I can trust?” I keep hearing this question—from those feeling confused about a vaccination decision to those looking for an ob/gyn who shares their personal values. There’s unprecedented angst, uncertainty, and mistrust. During two decades as a patient and citizen advocate, I’ve encountered the mistrust that arises when systems that are supposed to protect us cause harm. I’ve learned that trust is an asset our health system cannot do without. It is at the heart of our relationships with our physicians and care teams and an essential foundation for the institution of medicine. Yet as our social fabric continues to fray, even the most trusted relationships come under strain. Our relationships with our physicians feel more fragile when the practice of medicine is politicized, and misinformation compounds our uncertainty and confusion about our health choices. 

As an independent volunteer public (non-physician) member of the Board of Directors of ABMS (the American Board of Medical Specialties), a nonprofit organization that oversees the standards for physician certification across 24 medical specialties (the American Osteopathic Association is another), I have a window into what happens inside the network of institutions that oversee the practice of medicine in the United States. The medical profession is dealing with its own trust challenges as it negotiates the tensions between freedom, regulation, and professionalism. In recent months, certifying boards have taken further steps to uphold their accountability by addressing unprofessional behavior and pledging to withdraw or deny certification to physicians who publicly share information that is directly contrary to the prevailing medical evidence.

While some physicians are uniting to defend their ability to take care of their patients and protect those patients’ reproductive freedom and bodily autonomy, others are asserting a questionable freedom to prescribe unproven treatments or disseminate misinformation that leads to medical harm or death. Some physicians are rejecting the institutions that enact and enforce standards of performance and conduct and oversee physicians’ accountability to the public. Efforts by these institutions to overcome mistrust should be welcomed. Self-regulation is a privilege that makes physicians accountable to their peers and importantly, the public. It is grounded in a set of agreed-upon standards and behaviors based on a common set of values and ethical commitments. It represents a social contract between physicians and the community that includes a promise to put the interests of patients first. 

But when mistrust in institutions manifests itself as legislative interference in that professional self-regulation, the politicization of the practice of medicine becomes an assault on medicine itself. The assault is already happening in states where state legislatures have told the state boards that license and regulate physicians that they may not take disciplinary action against physicians who disseminate misinformation or disinformation about COVID-19, vaccination, or scientifically valid treatments. The effects are harmful to physicians, nurses, and patients alike. In some states, physicians no longer have the freedom to provide the care they are trained to provide.

As patients, we are left wondering who we can turn to as trusted navigators as we make sense of our medical choices. As medicine becomes politicized, the answer to that initial question “How can I find a doctor I can trust?” is not as simple as reading patient reviews or going to a top-rated hospital. It’s important to know how to recognize a physician who has gone through rigorous and objective assessment of their knowledge, skills, judgment, and competencies.

The fourteen years I spent with the nonprofit Consumer Reports taught me to recognize a rigorous testing process and the ways it helps to build trust. That rigor is critical for the process of physician board certification. I’ve been reassured to find it at the American Board of Medical Specialties and its member boards: the research underlying every step, the collaborative process of standard-setting, the scientific methods that inform assessments, the secure examinations, the evaluation of ethics and professionalism, the verification that a physician is clear of any professional wrongdoing, the requirement to contribute to improving health and health care, and the cycles of continuing certification to stay current and maintain competency throughout a physician’s career. As a result, specialty board certification is one of the strongest signals that we can trust our physician. It represents a commitment to both learning and accountability.

Patients choosing a physician for themselves or loved ones would be wise to check online if a physician is currently board-certified. But if we want to help build a culture of trust in medicine, based on facts and not ideology, there are things we need to do as citizens to push back against the assault on the medical profession as well. We can communicate our support to elected representatives and candidates who oppose legislative interference in the practice of medicine and its self-regulation. As civic-minded community members, we can ask to be appointed as “public members” of the state boards that regulate medical practice or join a local hospital board as an advocate for patient safety and physician wellbeing. We can run for school boards where we can participate as champions of science education and children’s health. Civic engagement is as critical for building trust in medicine as it is for strengthening our democracy.

The ABIM Foundation’s Building Trust initiative is bringing attention to the need for greater trust in relationships throughout health care, including trust in organizations. The initiative has created a repository of trust-building examples, all conducted at the meso or macro level of organizations and made possible by some level of organizational sponsorship (whether it be financial support or buy-in from the leadership team).

We would like to call attention to organizational trust-building at the micro level, which can be initiated by anyone, requires no extra resources, and can take place within existing work structures and processes. All that’s required is a bit of awareness, intention, and courage.

Trust building at the micro-level is all about creating culture. Whether we are aware of it or not, we are all creating culture in every moment by the way we treat each other as we do our work. Culture is the aggregate of what happens in all the little moments of every day.

The phrase “whether we are aware of it or not” makes a crucial point. If we are not aware of and intentional about relationships, problematic patterns – and toxic cultures – can arise accidentally. Consider, for example, a scenario in which an honest misunderstanding or a problem that crops up suddenly causes tension and anxiety, resulting in some some harsh words being spoken. Others observe this and out of friendship or loyalty they take sides. Before long, there is a pattern of conflict – us versus them – that draws people into it and keeps itself going, sometimes for years after the initiating event. The fact that no one intended this to happen doesn’t matter; the damage is done. In the absence of active ongoing attention to the quality of relationships, a bad pattern has been established and performance will suffer.

It is extraordinarily rare for a problematic culture to be created deliberately. Almost always it results from neglect – a lack of awareness, a lack of active tending.

Now replay that scenario, this time with an awareness of relational quality and an intention to maintain trust and respect. The harsh words might be toned down or retracted with an apology after a moment’s reflection. The recipient of those words or a bystander, recognizing the underlying anxiety, might offer some empathy to help everyone feel supported and to lower the emotional temperature. With these small actions, delivered intentionally to maintain trust, the group can avoid a long-standing conflict that would likely sap commitment and divert energy from the real work.

We all have the power to be intentional about the kinds of relational patterns we create and our direct contributions to organizational culture. More than that, we can encourage and help others to learn how to do it, too. One step higher, organizations can encourage a culture of trust through recruitment, selection, and onboarding processes that favor emotional intelligence; equitable values and practices; individual and team development programs; meeting practices that encourage inclusivity, psychological safety, reflection and dialog; and meaningful behavioral standards and accountability processes.

Even as these organizational interventions can help us become more heedful and skillful, the ultimate responsibility for culture always remains in our hands. It’s about what we do in every moment. There’s much to gain and no extra work if we can approach each interaction with an awareness of relationships and the intention to create trust.

A substantial early-bird discount is available for registrations received by December 23, 2022.  

The spread of misinformation became rampant in 2020, during the COVID-19 pandemic, but deceitful and false medical claims have historically plagued physician-patient relationships and caused harm. Vineet Arora, MD, MAPP, dean of medical education at The University of Chicago Pritzker School of Medicine, is acting to prepare students to mitigate medical misinformation.

A newly-created interdisciplinary science communications course, offered to advanced students in medicine, nursing, and pharmacy at Pritzker, helps enrollees harness the power of storytelling and social media-friendly educational infographics to dispel misinformation. The course also teaches students how to effectively communicate scientific evidence to the public.

In addition, the course outlines empathetic communication strategies to cultivate better relationships with patients. Future clinicians are trained not only how to identify trusted sources but also how to share these strategies with their patients, with the goal of decreasing the spread and impact of misinformation.

Dr. Arora teaches the course with Sara Serritella, a former journalist who serves as director of communications for the UC Institute for Translational Medicine. Together, they help students develop a communication style that is not simply a presentation of facts, but rather an engaging dialogue that is more captivating and easily understood by patients. The course’s ultimate goal is to foster more meaningful patient and clinician engagement, thereby increasing trust in the health care system.

In March 2020, as an early response to the COVID-19 pandemic, Dr. Arora cofounded the Illinois Medical Professionals Action Collaborative Team (IMPACT) to amplify trusted sources, dispel medical misinformation, and improve equity of vaccination across communities in Illinois. Over the past two years, IMPACT has engaged thousands of health care workers, and the public, to identify where they can improve health care delivery. Group members have focused on creating clear, educational messaging regarding health that is shared at the same time, across various platforms. (The group has reached over 69,000 adults and over 3,000 children through their efforts to date.) In February 2022, the Association of American Medical Colleges and Centers for Disease Control and Prevention awarded Dr. Arora and IMPACT third place in the 2022 Innovations That Bolster Community Trust in Science Award and a grant to launch the science communication course.

In 2017, Dell Medical School at the University of Texas at Austin and Costs of Care Inc., in partnership with the ABIM Foundation and the Josiah Macy Jr. Foundation, created the Choosing Wisely STARS program to catalyze grassroots, student-led initiatives to advance health care value in medical education. Based on a model developed in Canada, the program, which began with a cohort of 50 first-year medical students from 25 medical schools across the U.S., has grown to include more than 500 medical students from more than 50 medical schools.  

Now the STARS program is expanding to include an explicit focus on trust, with an emphasis on the role of trust in conversations and efforts to reduce overuse. Program directors are in the process of defining learning objectives related to building trust in health care, with the goal of introducing curricular components to the STARS program that aim to achieve these learning objectives. Medical students will also be encouraged to lead or participate in initiatives that contribute to advancing the Building Trust initiative.