教育学最新文献

{"title":"What Are We Teaching Medical Students and Physician Learners About the Social Determinants of Health? A Scoping Review.","authors":"Loel S Solomon, Robert S Nocon, Jazmin Jimenez, Robert E Johnson, Carla Lupi, Jacqueline Xu, Ashti A Doobay-Persaud, Abraham Gallegos, Caleb Cohen","doi":"10.1097/ACM.0000000000005795","DOIUrl":"10.1097/ACM.0000000000005795","url":null,"abstract":"<p><strong>Purpose: </strong>Curricula about social determinants (drivers) of health (SDOH) are becoming more common in medical education, reflecting increasing expectations from payers and accreditors that health care systems do more to address health-related social needs and close pervasive health equity gaps. Few previous reviews have addressed the content of SDOH-related curricula. This review examines the scope and focus of medical education on SDOH and adjacent concepts.</p><p><strong>Method: </strong>The authors screened 2,442 articles describing curricula delivered in undergraduate, graduate, and continuing medical education settings between 2010 and 2023 using PubMed and 2 field-specific databases, yielding 289 articles. Data on course duration, pedagogic approach, assessment methods, and curricular content were extracted and analyzed. Curricular content was categorized using the National Academies of Science, Engineering, and Medicine's (NASEM's) 5As framework, which recommends 5 key activities health care can undertake to mitigate social risk (awareness, adjustment, assistance, alignment, and advocacy).</p><p><strong>Results: </strong>A total of 289 articles were included in this review. Curricula covering SDOH-related concepts have increased over time. Of the included articles, 190 (65.7%) referenced at least 1 of NASEM's 5 key activities. Training on social risk screening and other awareness activities were noted most frequently [123 (42.6%)], followed by curricula on helping patients get social care [assistance; 86 (29.8%)] and providing social risk-adjusted health care [adjustment; 81 (28.0%)]. Curricula on system- and policy-level activities, including alignment of health care and social care organizations (alignment), and advocacy (advocacy) were described less frequently [43 (14.9%) and 49 (17.0%), respectively]. Ninety-four articles (32.5%) referenced only general information about SDOH without describing specific actions to adjust care or reduce social adversity.</p><p><strong>Conclusions: </strong>NASEM's 5As framework provides a useful construct for characterizing SDOH-related curricula. Medical educators should teach not only the prevalence and pathophysiology of SDOH but also what physicians can do to address these factors.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"103-112"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mean Delta Method: Quantifying Assessor Stringency and Leniency and Identifying Outliers in Workplace-Based Assessments.","authors":"Sebastian Dewhirst, Warren J Cheung, Timothy Wood, Nora D Szabo, Jason R Frank","doi":"10.1097/ACM.0000000000005802","DOIUrl":"10.1097/ACM.0000000000005802","url":null,"abstract":"<p><strong>Abstract: </strong>Assessor stringency and leniency (ASL)-an assessor's tendency to award low or high scores-has a significant effect on workplace-based assessments. Outliers on this spectrum have a disproportionate effect. However, no method has been published for quantifying ASL or identifying outlier stringent or lenient assessors using workplace-based assessment data. The authors propose the mean delta method, which compares the scores that an assessor awards to trainees with those trainees' mean scores. This novel, simple method can be used to quantify ASL and identify outlier assessors without requiring specialized statistical knowledge or software. As a worked example, the mean delta method was applied to a set of end-of-shift assessments completed in a large Canadian academic emergency department from July 1, 2017, to May 31, 2018, and used to examine the net effect of ASL on learners' assessment scores. A total of 3,908 assessments were completed by 99 assessors for 151 trainees, with a median (interquartile range) of 37 (12-39) completed assessments per trainee. Using cutoff values of 1.5 and 2 standard deviations, a total of 11 and 3 outlier assessors were identified, respectively. Moreover, ASL changed overall scores by more than the mean difference between years of training for nearly 1 in 4 learners. The mean delta method was able to quantify ASL and identify outlier lenient and stringent assessors. It was also used to quantify the net effect of ASL on individual trainees. This method could be used to further study outlier assessors, to identify assessors who may benefit most from targeted coaching and feedback, and to measure changes in assessors' tendencies over time or with specific intervention.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"12-18"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey.","authors":"Irene Alexandraki, Nora Osman, Temple Ratcliffe, Wendy Simon, Elexis McBee, Michael Kisielewski, Cindy J Lai","doi":"10.1097/ACM.0000000000005820","DOIUrl":"10.1097/ACM.0000000000005820","url":null,"abstract":"<p><strong>Purpose: </strong>Clerkship grades are important in the residency selection process but can be influenced by individual bias and grading tendencies. Although clinical competency committees are standard in graduate medical education, in undergraduate medical education, they have not gained widespread traction. This study describes structures and processes of grading committees in internal medicine (IM) clerkships and strategies used to mitigate grading bias.</p><p><strong>Method: </strong>From September to December 2022, the Clerkship Directors in Internal Medicine conducted its annual survey of IM core clerkship directors at 140 U.S. and U.S. territory-based medical schools. This study was based on 23 questions about grading committees in IM clerkships.</p><p><strong>Results: </strong>The survey response rate was 80% (n = 112/140). Forty-seven respondents (42%) reported using grading committees in their IM clerkship (median committee size, 7; range, 3-20) (primarily clerkship leadership and faculty). Responsibilities included determining grades for all students (31 [66%]) and students at borderline of failing (30 [64%]), adjudicating on students with professionalism concerns (25 [53%]), and reconciling discordant clinical evaluations (24 [51%]). To mitigate deliberation bias, committees most frequently used multisource assessments (38 [81%]) and adoption of a shared mental model (36 [77%]). Approximately one-third of grading committees \"rarely\" discussed gender (14 [30%]) and race or ethnicity (15 [32%]), and 7 committees (15%) \"never\" discussed gender and race or ethnicity. Clerkship directors perceived developing a shared mental model (60 [92%]), promoting consistency (59 [91%]) and transparency (57 [88%]) in the process, mitigating assessment bias (58 [89%]), improving student satisfaction (54 [83%]), and sharing grading responsibility (44 [68%]) as potential benefits.</p><p><strong>Conclusions: </strong>This study found that grading committees in IM clerkships are not widely used and that existing committees vary in structure and process. These findings highlight an opportunity for medical schools to consider using grading committees to improve grade assignment and address grading inconsistencies.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"78-85"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ongoing Teacher Support for Data-Based Individualization: A Meta-Analysis and Synthesis.","authors":"Emma Shanahan, Seohyeon Choi, Jechun An, Bess Casey-Wilke, Seyma Birinci, Caroline Roberts, Emily Reno","doi":"10.1177/00222194241271335","DOIUrl":"10.1177/00222194241271335","url":null,"abstract":"<p><p>Although data-based individualization (DBI) has positive effects on learning outcomes for students with learning difficulties, this framework can be difficult for teachers to implement due to its complexity and contextual barriers. The first aim of this synthesis was to investigate the effects of ongoing professional development (PD) support for DBI on teachers' DBI knowledge, skills, beliefs, and fidelity and the achievement of preschool to Grade 12 students with academic difficulties. The second aim was to report on characteristics of this support and explore whether features were associated with effects. We identified 26 studies, 16 and 22 of which examined teacher and student outcomes, respectively. Meta-analyses indicated that the weighted mean effect size for DBI with ongoing support for teachers was <i>g</i> = 0.86 (95% confidence interval [CI] = [0.43, 1.28], <i>p</i> < .001, <i>I</i>² = 83.74%, <i>k</i> = 46) and <i>g</i> = 0.31 for students (95% CI = [0.19, 0.42], <i>p</i> < .001, <i>I</i>² = 61.38%, <i>k</i> = 103). We did not identify moderators of treatment effects. However, subset effects were descriptively larger for ongoing support that targeted data-based instructional changes or included collaborative problem-solving. Researchers may improve future DBI PD by focusing on support for teachers' instructional changes, describing support practices in greater detail, and advancing technological supports.</p>","PeriodicalId":48189,"journal":{"name":"Journal of Learning Disabilities","volume":" ","pages":"3-18"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Leadership Academy Summer Program: Clerkship Transition Preparation for Underrepresented in Medicine Medical Students.","authors":"Denise M Connor, Alicia Fernandez, Sarah Alba-Nguyen, Sally Collins, Arianne Teherani","doi":"10.1080/10401334.2023.2269133","DOIUrl":"10.1080/10401334.2023.2269133","url":null,"abstract":"<p><strong>Problem: </strong>Enhancing workforce diversity by increasing the recruitment of students who have been historically excluded/underrepresented in medicine (UIM) is critical to addressing healthcare inequities. However, these efforts are inadequate when undertaken without also supporting students' success. The transition to clerkships is an important and often difficult to navigate inflection point in medical training where attention to the specific needs of UIM students is critical.</p><p><strong>Intervention: </strong>We describe the design, delivery, and three-year evaluation outcomes of a strengths-based program for UIM second year medical students. The program emphasizes three content areas: clinical presentations/clinical reasoning, community building, and surfacing the hidden curriculum. Students are taught and mentored by faculty, residents, and senior students from UIM backgrounds, creating a supportive space for learning.</p><p><strong>Context: </strong>The program is offered to all UIM medical students; the centerpiece of the program is an intensive four-day curriculum just before the start of students' second year. Program evaluation with participant focus groups utilized an anti-deficit approach by looking to students as experts in their own learning. During focus groups mid-way through clerkships, students reflected on the program and identified which elements were most helpful to their clerkship transition as well as areas for programmatic improvement.</p><p><strong>Impact: </strong>Students valued key clinical skills learning prior to clerkships, anticipatory guidance on the professional landscape, solidarity and learning with other UIM students and faculty, and the creation of a community of peers. Students noted increased confidence, self-efficacy and comfort when starting clerkships.</p><p><strong>Lessons learned: </strong>There is power in learning in a community connected by shared identities and grounded in the strengths of UIM learners, particularly when discussing aspects of the hidden curriculum in clerkships and sharing specific challenges and strategies for success relevant to UIM learners. We learned that while students found unique benefits to preparing for clerkships in a community of UIM students, near peers, and faculty, future programs could be enhanced by pairing this formal intensive curriculum with more longitudinal opportunities for community building, mentoring, and career guidance.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"113-126"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Blackbird\" and \"Dreams\".","authors":"Jonathan Goc, Justin C Cordova","doi":"10.1097/01.ACM.0001096092.58582.13","DOIUrl":"https://doi.org/10.1097/01.ACM.0001096092.58582.13","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 1","pages":"27"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cup of Tea?","authors":"Samantha E Smith","doi":"10.1097/ACM.0000000000005895","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005895","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 1","pages":"113"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The social construction of time and its influence on medical education.","authors":"Tasha R Wyatt, Edison Iglesias de Oliveira Vidal","doi":"10.1111/medu.15472","DOIUrl":"10.1111/medu.15472","url":null,"abstract":"<p><strong>Introduction: </strong>Few sociocultural constructs exist that are so deeply embedded in our daily lives and able to influence our thoughts, behaviours and interactions than time itself. Time spans all cultures, and yet many of us have not critically engaged with how time effects what we do, how we perceive and the ways in which we interact. As such, our relationship to time remains almost invisible running in the background nearly unnoticed until it is somehow brought into conscious awareness.</p><p><strong>Context: </strong>In this paper, we draw on Levine's concepts of clock time and event time as different perspectives on time, demonstrating how they play out in medical education and clinical practice within the United States and Brazil. Clock time treats time as something external to our lives, fixed by the natural world and measured by clocks. Event time is conceptualised more flexibly, where the duration of activities depends on internal cues related to the flow and progression of events rather than strict schedules.</p><p><strong>Discussion: </strong>By contrasting these differences, we hope to make visible the way that time influences our choices for educating physicians and provide a foundation for medical education to begin questioning how time is positioned, experienced and understood as a powerful force in the shaping of our profession. Additionally, we consider these perspectives within the concepts of Taylorism and Slow Medicine to better understand their links to medicine's formal and hidden curriculum in hopes of raising awareness and create new visions for medical education.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":"97-103"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"U.S. Medical School Participation in Nationally Funded Biomedical Research: A New Accounting of NIH Award Dollars.","authors":"Alexander G Geboy, Valerie M Dandar, Jordan Dutterer, Katherine Brandenburg, Hershel Alexander","doi":"10.1097/ACM.0000000000005778","DOIUrl":"10.1097/ACM.0000000000005778","url":null,"abstract":"<p><strong>Abstract: </strong>To better understand the amount of National Institutes of Health (NIH) funding received by U.S. medical schools with Liaison Committee on Medical Education-accredited medical education programs, the Association of American Medical Colleges (AAMC) developed a new methodology that crosswalks faculty NIH grants with medical schools and their affiliated organizations (e.g., teaching hospitals). This approach offers a more comprehensive and methodologically transparent accounting of NIH extramural funding to academic medicine than existing processes.The AAMC Crosswalk utilized publicly available grants data from the NIH and resources unique to the AAMC, such as the Faculty Roster and Council of Teaching Hospitals and Health Systems records. Using a multistep algorithm, the AAMC Crosswalk linked individual faculty with NIH grants, their organizations, and partner medical schools, aggregated at the level of the medical school and its affiliated organizations for fiscal year (FY) 2017-2021.The AAMC Crosswalk attributed, on average, $3.7 billion more per year in NIH funding to U.S. medical schools, representing a 24% increase compared to the NIH and Blue Ridge Institute for Medical Research (BRIMR) methodologies. In FY 2021, the AAMC Crosswalk attributed 60% of NIH funding to U.S. medical schools compared with 47% by NIH and 50% by BRIMR. An exploration of limitations showed that no medical school affiliations were missed by the AAMC Crosswalk among 90 randomly sampled organizations, and medical school affiliations for 30 randomly sampled principal investigator faculty members were attributed correctly.These findings indicate that academic medicine's contribution to biomedical research may be greater than historically reported. Systematically accounting for grants awarded to faculty across medical schools and their affiliated organizations provides a more comprehensive understanding of NIH funding to U.S. medical schools. The AAMC Crosswalk provides a new tool to better estimate the true investment and role of academic medicine in advancing biomedical research.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"19-25"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Curricular Structures in MD-PhD Programs in the United States.","authors":"Mary-Claire Roghmann, Lisa A Schimmenti, Christopher S Williams, Talia H Swartz","doi":"10.1097/ACM.0000000000005857","DOIUrl":"10.1097/ACM.0000000000005857","url":null,"abstract":"<p><strong>Purpose: </strong>This study describes the structure and timing of the clinical education components of MD-PhD programs to illustrate how variations in preclerkship curriculum correlate with the opportunity for early clinical exposure and other key program characteristics.</p><p><strong>Method: </strong>A survey was disseminated to U.S. MD-PhD programs on May 25, 2022, asking about the preclerkship curriculum length (long [> 18 months], medium [13-18 months], or short [12 months]), United States Medical Licensing Examination Step 1 timing (relative to the PhD training and clerkships), and opportunity for clerkships before the PhD phase. This survey was supplemented with data from publicly available sources to include 92 MD-PhD programs.</p><p><strong>Results: </strong>This study found a wide range of MD-PhD clinical curricula. A strong association was found between shorter preclerkship curriculum length and the opportunity for clerkships before the PhD (10 of 50 programs [20%] with long preclerkship curriculum, 19 of 35 programs [54%] with medium preclerkship curriculum, and 7 of 7 programs [100%] with short preclerkship curriculum; P < .001). Variations in United States Medical Licensing Examination Step 1 timing also exist based on preclerkship curriculum length and the opportunity for clerkships before the PhD. Shorter preclerkship curriculum length was associated with National Institutes of Health funding of the MD-PhD program (20 [40%] of long, 25 [69%] of medium, and 6 [86%] of short preclerkship curricula; P = .006) and larger MD-PhD program size (35 students with long, 70 with medium, and 86 with short preclerkship curricula; P < .001). Preclerkship curriculum length was not associated with public vs private medical schools, although the West had shorter preclerkship curricula.</p><p><strong>Conclusions: </strong>This study underscores the need for collaborative efforts to gain insights into the effectiveness and implications of educational interventions in MD-PhD programs, ultimately informing future training strategies and policies.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"72-77"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}