Journal of graduate medical education最新文献

{"title":"Using Implementation Science to Explore the Integration of Entrustable Professional Activities in Swiss Cardiology Residency Training: A Qualitative Study.","authors":"Fabienne Schwitz, Kübra Özoglu, Sharon Mitchell, Monika Brodmann Maeder, Eva K Hennel","doi":"10.4300/JGME-D-25-01019.1","DOIUrl":"10.4300/JGME-D-25-01019.1","url":null,"abstract":"<p><strong>Background: </strong>Implementing entrustable professional activities (EPAs) necessitates faculty development, assessment standardization, and feasibility within established curricula. However, guidance for stakeholders involved in the implementation of EPAs in residency training is still limited.</p><p><strong>Objective: </strong>This study aims to support EPA implementation by exploring the experiences of lead implementers from different training sites. The research question is: Using an implementation science approach, what are the barriers and facilitators to the successful implementation of EPAs in residency training?</p><p><strong>Methods: </strong>Adopting a theory-informed design, we conducted a qualitative interview study using frameworks from implementation science to inform the interview guide and data analysis following the framework method. In 2024, we interviewed one lead individual responsible for EPA implementation at each of the 5 cardiology pilot training sites in Switzerland, thus covering all sites in the national pilot project. We used the framework method to systematically analyze the data, combining deductive and inductive steps.</p><p><strong>Results: </strong>We identified 4 dominant cross-site themes centered on feasibility, roles, acceptability, and adoption, with \"resistance to change\" emerging as a prominent inductive finding. Additional Consolidated Framework for Implementation Research (CFIR)-aligned subthemes illustrated contextual determinants across sites.</p><p><strong>Conclusions: </strong>Accessible guidance, workflow alignment, and dedicated facilitators support the successful integration of EPAs and thus, competency-based medical education, while resistance to change and sustainability planning remain key challenges.</p>","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 5","pages":"546-558"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To the Editor: In Response to \"Making Clinical Reasoning Visible During Resident Use of Artificial Intelligence\".","authors":"Carl Preiksaitis","doi":"10.4300/JGME-D-26-00715.1","DOIUrl":"https://doi.org/10.4300/JGME-D-26-00715.1","url":null,"abstract":"","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"507"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What the MSPE Can Learn From Dungeons and Dragons.","authors":"Nicole M Deiorio, Richard Moberly, Benjamin Schneider","doi":"10.4300/JGME-D-25-01085.1","DOIUrl":"https://doi.org/10.4300/JGME-D-25-01085.1","url":null,"abstract":"","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"387-390"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging Choice Architecture: Interventions in the Emergency Medicine Standardized Letter (eSLOE 2.0) to Adjust Rater Behaviors.","authors":"Sharon Bord, Doug Franzen, Erin Karl, Cullen B Hegarty, Eric Shappell, Benjamin H Schnapp, Nicole M Dubosh, Caitlin Schrepel, Katherine M Hiller, Kevin Hamilton, Joseph House, Alexis Pelletier-Bui","doi":"10.4300/JGME-D-25-00865.1","DOIUrl":"https://doi.org/10.4300/JGME-D-25-00865.1","url":null,"abstract":"<p><strong>Background: </strong>Residency programs are utilizing standardized letters of evaluation with increasing frequency to obtain concise and discerning information about applicants. However, letters show a narrow distribution of ratings, leading to difficulties differentiating between applicants.</p><p><strong>Objective: </strong>To determine if choice architecture, through 2 interventions on the electronic emergency medicine Standardized Letter of Evaluation 2.0 (eSLOE 2.0), can increase the spread of ratings on letters written for emergency medicine applicants.</p><p><strong>Methods: </strong>On the eSLOE 2.0 Part B for the 2024-2025 application cycle, radio buttons were prepopulated to a \"3\" on a Likert scale of 1 to 5 (rather than blank), and a pop-up message prompted letter writers to provide narrative justification for ratings of \"1\" (lowest) or \"5\" (highest). Ratings of applicants after this intervention were compared with ratings from 2 prior application cycles.</p><p><strong>Results: </strong>A total of 17 727 letters (5938 from 2024-2025; 11 789 from 2022-2024) were analyzed. Post-intervention, there was a decrease in ratings of \"5\" across all domains in Part B, with the absolute difference in the percentage of students rated \"5\" ranging from -12.3% to -19.7%. There was a post-intervention increase in percentage of \"3\" and \"4\" utilization across all domains ranging from +3.9 to +11.0 and +7.2 to +11.0 respectively. Ratings of \"1\" and \"2\" remained stable post-intervention.</p><p><strong>Conclusions: </strong>Prepopulating SLOE Part B ratings to 3 out of 5 and pop-up messages prompting letter writers to justify top or bottom ratings led to a shift in the distribution of scores and a reduction in the percentage of top ratings in the 2024-2025 cycle, as compared to the prior 2 cycles.</p>","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"483-488"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel 5-Item Survey Tool to Assess Psychological Safety Among Graduate Medical Education Trainees.","authors":"Raya Tcheroyan, Michael Roberts, Amit R T Joshi, Stephen Trzeciak, Brian Roberts, Alyssa Nuzzo, Vivek T Kulkarni","doi":"10.4300/JGME-D-25-00666.1","DOIUrl":"https://doi.org/10.4300/JGME-D-25-00666.1","url":null,"abstract":"<p><strong>Background: </strong>Psychological safety is a critical component of effective learning and team performance in medical education. However, no tool with validity evidence currently exists to measure it specifically among graduate medical education (GME) trainees.</p><p><strong>Objective: </strong>To develop a concise, trainee-centered survey tool to measure psychological safety in GME settings and to examine its content and internal structure among graduate medical trainees.</p><p><strong>Methods: </strong>We created 9 candidate items based on existing literature and expert feedback. These were incorporated into an annual institution-wide trainee survey at a single academic health care system. Responses were randomly divided into derivation and validation cohorts. Exploratory and confirmatory factor analyses were conducted to produce and obtain validity evidence for the most effective and concise set of items.</p><p><strong>Results: </strong>Of the 480 trainees invited to take the survey, 400 (83%) returned completed responses. During the derivation phase (n=200), 4 items were removed for low tolerance, improving model fit. The final 5 items showed strong loading on a single factor. The 5 items assessed trainees' comfort level with sharing ideas, giving and receiving feedback, expressing uncertainty, and viewing mistakes as learning opportunities. In validation testing (n=200), confirmatory factor analysis supported a unidimensional structure (Comparative Fit Index=0.99, Tucker-Lewis Index=0.97, and standardized root mean squared residual=0.02). The composite score correlated positively with an external measure of psychological safety (r=0.67) and demonstrated high internal reliability (McDonald's omega=0.91).</p><p><strong>Conclusions: </strong>The scores on this 5-item scale demonstrated evidence of validity and reliability for assessing psychological safety among trainees.</p>","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"407-414"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Standardized Individual Learning Plan for Graduate Medical Education: A Modified Delphi Approach.","authors":"Charles A Brown, Kevin R Scott, Patricio Riquelme, Bailey A Pope, Lalena M Yarris","doi":"10.4300/JGME-D-25-01041.1","DOIUrl":"https://doi.org/10.4300/JGME-D-25-01041.1","url":null,"abstract":"<p><strong>Background: </strong>The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to support residents in developing individualized learning plans (ILPs) to promote self-reflection and continuous improvement. However, there is no standardized ILP template available for programs and residents to use, making implementation and evaluation across programs variable and time-consuming.</p><p><strong>Objective: </strong>To develop a consensus-based ILP template for use in graduate medical education.</p><p><strong>Methods: </strong>A modified Delphi process was performed between February 2022 and May 2023 to create consensus on essential components of an ILP. A literature review informed panelist recruitment and item generation. A panel of 14 experts in ILPs from several specialties and disciplines in the United States and Canada participated in 3 rounds of surveys. Consensus was defined as more than 80% agreement.</p><p><strong>Results: </strong>Fourteen of 28 invited experts (50% response rate) agreed to participate in our study. All panelists completed Round 1, 93% (13 of 14) completed Round 2, and 100% (14 of 14) completed Round 3. Panelists identified key outcomes for ILPs, including self-reflection, needs identification, goal setting, and progress tracking. Key ILP content included long-term planning, feedback and assessment, strengths and areas for growth, personal and career goals, and structured goal planning. Expert recommendations were used to refine the template for clarity and usability. All panelists endorsed the final ILP template as ready for dissemination.</p><p><strong>Conclusions: </strong>This modified Delphi study of ILP researchers and educators identified consensus-based recommendations for content for an ILP designed to be implemented in any graduate medical education specialty.</p>","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"470-476"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing Qualitative Data: Challenges, Strategies, and Opportunities.","authors":"Meihsi Chiang, Bo Kim, Jonathan Schwabish","doi":"10.4300/JGME-D-26-00687.1","DOIUrl":"https://doi.org/10.4300/JGME-D-26-00687.1","url":null,"abstract":"","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"495-496"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Program Directors With International Medical Graduates: Apply a Global Lens.","authors":"Halah Ibrahim, Satid Thammasitboon, Julian Varas Cohen, Lyuba Konopasek","doi":"10.4300/JGME-D-26-00673.1","DOIUrl":"https://doi.org/10.4300/JGME-D-26-00673.1","url":null,"abstract":"","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"497-498"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where Are We and Where Are We Going? A GME Program Scorecard for Continuous Programmatic Improvement.","authors":"Pooja M Varman, Nicole E Brooks, Kathleen Bauer, James K Stoller, Judith C French, Jeremy M Lipman","doi":"10.4300/JGME-D-25-00843.1","DOIUrl":"https://doi.org/10.4300/JGME-D-25-00843.1","url":null,"abstract":"<p><strong>Background: </strong>Graduate medical education (GME) leaders face challenges in evaluating program performance due to fragmented data systems and limited resources. Dashboards have been proposed, but few are scalable, participant-informed, and feasible without new infrastructure.</p><p><strong>Objective: </strong>To develop and implement a centralized, participant-informed GME Program Scorecard (GPS) that enables continuous program evaluation and improvement using existing data systems without new data entry.</p><p><strong>Methods: </strong>The GPS was developed at a large academic medical center in 2022-2023. A consensus development panel of 20 GME administrators identified 42 candidate metrics across 13 systems. Program directors (PDs) from the largest residency programs were surveyed (11; 9 responses, 81.8%) to rate each metric's value. The 17 most supported metrics were integrated into a Tableau-based dashboard. The GPS was piloted with 4 programs (3 Accreditation Council for Graduate Medical Education [ACGME]-accredited, 1 non-ACGME-accredited), involving 8 PDs and program coordinators. Feedback was collected via structured forms and a focus group. Metrics were rated on a 1 to 5 scale, with lower scores indicating higher priority.</p><p><strong>Results: </strong>Pre-intervention survey results guided prioritization, with 92.9% of metrics receiving a mean score <3. Pilot users reported high acceptability and identified design refinements incorporated before institutional launch. Development required 2920 analyst hours and $1,600 in licenses. Since launching in January 2024, 309 users (61.4% of 503 potential users) have accessed the GPS with 3933 total views.</p><p><strong>Conclusions: </strong>The GPS demonstrated feasibility, requiring 2920 analyst hours and $1,600 in licenses, and with 61.4% of potential users accessing the dashboard within 22 months of launch.</p>","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"448-457"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Workplace-Based Telemedicine Simulation Program to Assess Clinical Skills After Transitions of Care.","authors":"Daniel J Sartori, Renee Heller, Hannah Park, Sondra Zabar, Rachael W Hayes","doi":"10.4300/JGME-D-25-00644.1","DOIUrl":"https://doi.org/10.4300/JGME-D-25-00644.1","url":null,"abstract":"<p><strong>Background: </strong>The transition from hospital discharge to home is a critical period prone to gaps in care. Telemedicine has potential to smooth this transition; however, few educational interventions assess the unique skills required for high-quality telemedicine care at this critical juncture.</p><p><strong>Objective: </strong>To develop and integrate <i>in situ</i> standardized patient (SP) encounters in internal medicine residents' actual clinics to assess telemedicine skills in the post-discharge period.</p><p><strong>Methods: </strong>We developed 2 cases portraying recently discharged patients, designed behaviorally anchored assessment checklists, created mock electronic health record entries, and scheduled telemedicine visits in residents' clinics throughout the 2023-2024 academic year. SPs assessed skills as \"not done,\" \"partly done,\" or \"well done\" across 5 skill domains: Information Gathering, Relationship Development, Education and Counseling, Telemedicine-Specific Skills, and Care Transition Skills. We analyzed differences in the percentage of \"well done\" items, fit an ordinal mixed-effects model to assess for performance by case and postgraduate year (PGY) level, and surveyed residents.</p><p><strong>Results: </strong>All 42 (100%) PGY-1s and PGY-2s in our program participated in 79 total encounters. Residents performed well in core communication domains but struggled with Telemedicine-Specific Skills, Care Transition Skills, and Education and Counseling skills. PGY-2 performance was stronger than PGY-1 performance in these domains. Among residents who completed both cases, performance in case 2, which took place 6 months after case 1, was stronger; this effect was driven by PGY-1 performance. Twenty-nine of 31 residents (94%) reported this intervention improved their telemedicine skills.</p><p><strong>Conclusions: </strong>We report a high-fidelity strategy that captures telemedicine skill development in the context of patient care.</p>","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"18 4","pages":"464-469"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}