With thanks to Jacob Arbeid, George Rosenfeld, Jacob Smith, Thomas Cohen, Jake Mendel (Hi-Med Oxford), Pauline Scheuber (Hi-Med Germany), Erik Jentzen (Hi-Med Germany) and Rahul Shah (Hi-Med Cambridge) for comments. 

6 months ago, we launched High Impact Medicine. In this post, we share an update on our progress and the lessons we learnt in running a community building organisation focussed on a particular profession. We hope that this might be relevant to others interested in community building, particularly in professional and workplace groups.

High Impact Medicine is a group whose goals are to bring together medics who want to have a wide reaching positive impact, alongside and learning from clinical practice, and explore the opportunities for them to do so. We have 3 main paths to impact: 

1. Outreach & community building: our chapters run talks and socials for medics of all grades, from students to doctors working in hospitals or outside of clinical medicine
2. Knowledge building around impact in medicine: we run a fellowship, a podcast and talks. We are planning to run follow up ‘senior’ fellowships as well.
3. Career advice: we help members explore how they can have a large impact alongside, and learning from clinical medicine

We set out to foster local, engaged communities of medical students and doctors including those not familiar with EA, focussing on outreach to new interested medics, working alongside EA Medicine who facilitate a global network of medics who are already EA aligned. 

Since launching:

• High Impact Medicine has grown to approximately 100-120 members, at least 60 of whom are moderately to highly engaged (definition).^[1] Our rough split has been 70% medical students and 30% doctors.
• Our inaugural fellowship attracted 7 cohorts with a total of 54 fellows
• We have run many talks and socials in Cambridge, Oxford and London with an average of 15 attendees per event, with speakers including Professor Sir Andrew Pollard
• We have launched our Podcast
• Several (≥4) members have taken the GWWC pledge, and ≥3 others have made changes in their career direction as a result of being part of the organisation.
• We have expanded significantly beyond our initial base in the UK:
  • We recently launched High-Impact Medicine Germany
  • We are running a cohort of our fellowship for medical students in Tehran, Iran
  • We have members in the USA, Australia and Singapore.

Our key lessons 

1. Having an open framing allows for effective outreach 

We chose to frame Hi-Med openly - a chance for medics to find out about ways to ‘have a widespread positive impact’ and explore areas such as ‘global health, health policy, biosecurity and mental health’. Our objective was to try and get a lot of people interested in considering their own personal impact and how they could do a lot of good alongside and learning from their medical backgrounds.  This was reflected in the fact that a significant number (approximately 25  out of 50) of the fellowship participants were entirely new to EA. Many of the ideas we discussed in the fellowship stem from the Effective Altruism community (e.g. ITN framework, EA-aligned cause areas) but we also drew on material from the wider scientific community ^[2]in our fellowship, talks and podcast. 

Our approach was intended to provide medics with information to make their own decisions and enable an honest approach.  Hearing ideas without them being exclusively attached to a wider philosophy and in more neutral (rather than persuasive) fashion may help avoid putting people off and allows individuals the freedom to pick aspects they found more meaningful to explore. This helps encourage a ‘truth seeking’ approach that focuses on ‘learning useful tools and asking important questions [... ] and helping [individuals] have the biggest impact they can’ rather than the impression that EA was a large, take-it-or-leave-it all-encompassing philosophy you must be persuaded of. The objective was not to subtly trick people into becoming more EA but to provide information about ideas that we thought were important, worthy of discussion and that people may be receptive to. We found that some of our members did in fact become more involved in EA more broadly, whilst several individuals took on board ideas that are common in EA but felt ambivalently or negatively towards EA as a wider movement. 

With an open, non-prescriptive framing, we found that many medical students and doctors (in fact, more than we had anticipated) are interested in maximising their impact. The success of this approach may be due to optics issues with EA as a wider movement as well as stem from the fact that EA’s current recommendations to those from medical backgrounds are suboptimal. Therefore, by not being solely ‘EA’ we can provide a wider set of recommendations, framed positively, as well as a framework for individuals to assess their own priorities - which we believe is both attractive and effective. 

2. Fellowships work very well and there should be more career focussed fellowships 

There is debate over the value of fellowships in EA  - we found that a career focussed fellowship worked very well to introduce many medics to ideas such as the impact of different cause areas, how to do a lot of good as part of your career and effective giving. 

Most of our impact so far has been from our fellowship - an 8 week reading group exploring high impact opportunities for medics to pursue alongside and learning from clinical practice - which individuals from first year medical students to junior doctors to senior doctors took part in. This took about ~3 months to write (approximately 250-300 hours of time)  but was less challenging than we thought and it has really accelerated our growth.

We intend to write up the feedback from our fellowship with all our data separately, but in general: 

• We had reasonably strong attendance ( > 80% at all sessions, with 3 out of 57 participants dropping out through the fellowship), and strong engagement
• Level of familiarity with effective altruism significantly increased in the group before and after the fellowship
• Of the 42 fellows who completed our end of fellowship survey, 90% (n = 38) said the fellowship had a moderate to major effect on their knowledge of high impact opportunities related to medicine, 83% (n= 34) said it had a major to moderate effect on the way they think about their career, 64% (n=27) said it had a moderate to major effect on how their donation habits.
• Specifically, a number of individuals are actively pursuing or have changed their current work to be more impactful, or have taken a giving pledge.

 We believe it would be valuable if there were more similar fellowships for careers and/or paths to impact from other (vocational) subjects like law, engineering, computer science, journalism as well as other subjects which do not necessarily require university degrees. The impact landscape for professionals can be somewhat specific to vocation with the dynamics and nuances of considering your personal impact, giving and future plans specific to career. For example in medicine, people are already likely to believe that career choice is an ethical issue and they understand the use for potentially uncomfortable impact calculations given the prevalence of unpleasant cost benefit decisions in healthcare  - different careers are likely to have features which lead to certain discussions being easier and others more challenging. 

We are writing up the lessons from our fellowship in a subsequent article, including our novel design of fellowship reading documents with insights from readings integrated and summarised, as well as the feedback we collected from fellows. 

3. Funding speeds things up but you can also do a lot on a little (and avoid most of the ‘free spending’ issues) 

In the wake of the recent debates on the EA forum about issues of free-spending in EA, we felt the need to share our 2 cents (pun intended)

We found that we didn’t need much money to have a large impact in community building and therefore could avoid issues with free spending EA organisations others have raised. We received a grant from EAIF (approx $10,000) and this helped give the project significant impetus for which we were very grateful and for which we’d 100% encourage others to apply in similar circumstances. Money helped drive certain projects - such as website design or podcast creation - but in total these expenses were <£200 over our first 6 months. More broadly, people were generous with time - most of the fellowship was created without paying experts for their time, and whilst we offered some financial incentives to fellows (in the form of meal vouchers) we do not think that lack of these financial incentives would have resulted in fewer applicants. Although we are only somewhat confident of this claim, we think it is likely that any further incentives may have been actively negative, as showering food and money on privileged fellows is highly incongruous with discussing some of the world’s biggest issues. 

An additional important consideration is that the optics of free spending is important across EA but may represent an even greater risk in certain areas. Many medics feel uncomfortable spending large amounts of money^[3], in part stemming from lived experiences of healthcare systems struggling due to chronic lack of funding  - so an organisation for medics such as Hi-Med must consider its expenditure seriously, considering both the optics and inherent issues that may exist when spending publicly on e.g. salaries, retreats for medical students.

In general some funding is definitely valuable and having small amounts of funding (a few £100s) can provide significant marginal value in the initial stages of new project start-ups compared to having none. However, diminishing returns may start to occur far sooner than one may think and it is important to think carefully about where there is value in spending money - especially given the potential issues which may arise as a result.

4. Don’t forget about Giving Pledges

With the vastly changed funding landscape in EA, it is important we don’t neglect personal giving. The Giving What We Can Pledge is highly impactful and with the huge influx of money, as well as the shift in many peoples’ values towards longermism and career changes more generally, it should receive more attention than it currently does. We think it should be foregrounded and encouraged for a few reasons. 

Firstly a single giving pledge can result in £10,000s going to highly effective charities, which categorically does good in the world and is valuable in isolation. Secondly, specific to professional groups, it allows professionals to show dedication to EA values who are not able to make career changes in the near term - this is valuable as it allows the EA community to be more inclusive and benefits general optics on what EA ‘is’. Thirdly, and relatedly, a giving pledge may be an effective way of preventing value drift. This is especially important in medicine where people are likely to spend many years in studying/ further training before making significant choices based on impact considerations. Therefore encouraging pledges from individuals keen on doing good early on in their studies is particularly important. For pledging to be able to achieve this, it is important that giving pledges (and those taking them) are appropriately valued - so individuals feel excited about pledging rather than inadequate about their commitment to having a large impact. 

We found pledges were the most immediately accessible way for fellows to actualise the content of the previous 8 weeks (in the sense that it could be taken at the end of the fellowship without significant extra commitment, as opposed to applying for a job, which may take several weeks to months) - and even when pledges were very much a secondary focus compared to career changes (being discussed only in week 7), several fellows subsequently pledged. Let’s not lose sight of the value of emphasising and encouraging pledging. 

5. Move fast and do stuff 

We were initially hesitant to move ahead with projects quickly. For instance, we created public-facing chapters in Oxford, Cambridge and London immediately after launching, and began our fellowship just three months afterwards. Initially, we worried that this wasn't enough time to have the level of organisation required for a public-facing organisation (and therefore an organisation with higher reputational risk and where making a positive first impression was more important than a more inwardly focussed org). And in the last few months, we have launched in Germany, are running our fellowship for 11 EAs in Iran, and are planning a senior fellowship and further career planning workshops.

Moving fast has helped the Hi-Med community grow, bring in a large number of new members quickly, and maintain the organisation’s momentum. This does increase the propensity for small mistakes or oversights, but learning from mistakes is more time effective than trying to predict and mitigate those same issues. Our key learning is that it is often helpful not to overthink and over-strategize, and to worry less about every google doc, email or publicity post being ‘perfect’. Furthermore, the fact that our approach primarily focussed on providing information to facilitate individuals coming to their own decisions reduced the need to carefully tailor every bit of messaging. As long as the essential framing and top-line messaging is clear, unambiguous and positive we could move quickly and achieve more in a relatively short time frame. 

It is important to note that this learning may not be widely applicable - in situations where reputational risks are higher, there are information hazards, or where sensitive messaging is key, slow and steady may indeed win the race. However, there is a huge learning value in trying things, even if they fail - and in incidences where EV is particularly high, and there is a low to moderate downside and optics risk, this strategy is  applicable. 

6. Medics are a good fit for EA ideas (but are also likely to be put off by some EA messaging)

Medical students and doctors are in some ways a natural fit for EA ideas - as a group of altruistic individuals, who applied for a long degree and training pathway to ‘help people’ and come from a strong scientific background where evidence-based decision making is common and individuals are used to thinking deeply about ethics.^[4]

We found that this was the case during our fellowship, as there was less debate than we expected on the key moral and epistemic premises that ground EA. We also found that a number of EA cause areas, in particular global health and development, biosecurity, and AI and technology, resonated strongly with fellows. 

However, any medics looking to find out about EA are likely to be put off pretty easily for a few reasons. Perhaps primarily is that initial readings are often based on the idea that being a doctor - a career they have likely invested significant time and effort in -  is not particularly valuable owing to the counterfactual and they are advised to consider changing careers if possible.^[5]  Other factors include

• That fact that many medics are motivated by emotional reasons whilst EA narratives, although grounded in compassion, may seem too ‘cold’ in comparison
• Medics are more motivated to help people in their immediate surroundings with their hands and find generalising to those far away challenging
• Medicine is fairly neartermist (helping patients now), meaning longtermism is far less intuitive

These factors that may put a medic off often do not reflect fundamental differences in values but result from intuitive aversion from the framing of these unfamiliar ideas. 

As a result, when medics come across EA for the first time they may be unlikely to want to engage deeply for a combination of reasons. We have heard this colloquially many times whilst community building, leading to a neglect of a large group of potentially aligned and talented people. Providing a space to provide information about and discuss ideas related to impact and medicine openly and positively is therefore potentially important and valuable. 

7. Building and fostering a strong management team and community is important

The more time people in the management team (and in the community more widely) are able to spend getting to know one another the better. Through social events, 1:1s and casual small group conversations you can quickly and easily foster effective management teams and local communities. It helps those in management support one another and know each other’s strengths, motivations and needs. Furthermore, we found having 1:1 calls with individuals who wanted to engage in the community highly productive in the early stages of community building - as it enabled us to support new members proximally and better encourage them to take part in subsequent activities of particular interest to them. 

Conclusion 

As EA continues to evolve as a movement and a philosophy, it will inevitably engage a more diverse base of people who may have increasingly different cause prioritisations, beliefs and priors. Our experience is that there is an increasing role for organisations that specifically support subgroups; carrying out outreach, providing tailored advice and building welcoming communities. These will form one part of big tent Effective Altruism and provide an important platform to provide ideas and opportunities in a positive way, whilst remaining committed to rigorous thought, worldview diversification and inclusivity.


 

1. ^{^}

   We define moderate to highly engaged as at least one of 

   • Participated in fellowship
   • Contribute to Hi-Med on an organisational level
   • Attended multiple events 
   • Are involved with other Hi-Med projects
2. ^{^}

   e.g. Hosting speakers pursuing what we consider impactful work although they are not aware of EA; considering and openly discussing neo-colonial undertones of global health work; focussing on health policy as a cause area beyond biosecurity; thinking about how clinical practice could be more impactful in and of itself, among others.

3. ^{^}

   We think that this perception is likely to vary somewhat depending on which country the medical professionals are working in. In our experience, especially in the UK, where doctor salaries and funding for the NHS more broadly are a pain point, this seems especially true. This has also held true in other countries where Hi-Med has operated where there are relatively higher salaries for doctors, including in Australia and Germany.

4. ^{^}

   In the UK’s NHS, there is a strong tradition of cost-benefit analysis which is likely to support utilitarian thinking. However it may more broadly be the case that medics are more deontological than average with strict rules on avoiding harm prevalent within the field

5. ^{^}

   1. https://80000hours.org/career-reviews/medical-careers/ 2. https://medium.com/@gjlewis/how-many-lives-does-a-doctor-save-4641349b7da0