Academic Medicine最新文献

{"title":"Teaming to Revitalize the Morbidity and Mortality Conference.","authors":"Neela Nataraj, June Tome, Melissa H Bogin, Gretchen A Colbenson, Elizabeth W Beiermann, Abigail K Wegehaupt, John T Ratelle","doi":"10.1097/ACM.0000000000006090","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006090","url":null,"abstract":"<p><strong>Problem: </strong>Teaming is a conceptual approach to collaboration in dynamic environments. The internal medicine (IM) morbidity and mortality conference (M&M) is an environment where dynamic collaboration is essential to achieve educational and patient safety goals.</p><p><strong>Approach: </strong>Teaming principles were applied to revitalize the Mayo Clinic IM Residency M&M. All 104 Mayo Clinic postgraduate year (PGY) 2 residents participated in this curriculum in academic years July 2021 to June 2023. Rooted in project management and leadership principles, teaming fosters adaptation and collaboration, making it well suited for analyzing patient safety events (PSEs). A resident-led, faculty-mentored Quality Improvement and Patient Safety (QIPS) Council implemented a teaming-based M&M redesign in July 2021 that included a case selection tool, case vetting by the QIPS Council, and a structured timeline for M&M that ensured effective engagement with multidisciplinary stakeholders. These interventions culminated in a rebranded M&M in which interprofessional institutional leaders (i.e., special guests) were invited to discuss system-wide issues related to the PSE, creating a forum for discussion and identification of improvement opportunities.</p><p><strong>Outcomes: </strong>Evaluations on the M&M curriculum were completed by 74 of 104 PGY-2 residents (71.2%). Results showed significant improvements before vs after M&M in residents' ability to identify PSEs (57 [77%] vs 69 [93.2%], P = .002), confidence in reporting (50 [67.6%] vs 72 [97.2%], P < .001), analyzing PSEs (44 [59.5%] vs 70 [94.6%], P < .001), and belief that M&M would improve future patient care (58 [78.4%] vs 70 [94.6%], P = .004). Sixty-one residents (82.4%) agreed that participating in M&M would change their future practice.</p><p><strong>Next steps: </strong>Teaming has transformed the IM residency M&M by fostering effective collaboration among a diverse group of residents and institutional leaders. The next step is to apply the teaming framework to other areas of the residency curriculum where dynamic teamwork is needed.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081907","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 Data-Augmented, Technology-Assisted Medical Decision Making (DATA-MD) Curriculum: A Machine Learning and Artificial Intelligence Curriculum for Clinical Trainees.","authors":"Andrew Wong, Jeremy Sussman, Nicholson Price, Maggie Makar, Benjamin Li, Jun Yang, Cornelius James","doi":"10.1097/ACM.0000000000006089","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006089","url":null,"abstract":"<p><strong>Problem: </strong>Despite the rapidly expanding role of artificial intelligence (AI) and machine learning (ML) in health care, a significant knowledge gap remains among clinicians in their ability to evaluate and use AI and ML tools.</p><p><strong>Approach: </strong>The Data-Augmented, Technology-Assisted Medical Decision Making (DATA-MD) curriculum was developed to teach fundamental AI and ML concepts to clinical trainees. The curriculum contains 4 modules: (1) Introduction to AI/ML in Healthcare, (2) Epidemiology and Biostatistics in AI/ML, (3) Use of AI/ML to Augment Diagnostic Decisions, and (4) Ethical and Legal Considerations of AI/ML in Healthcare. The curriculum was piloted in May and June 2023 among University of Michigan internal medicine residents and delivered to 2 cohorts of 11 and 12 residents. All learners completed presession and postsession assessments on AI and ML knowledge before and after the curriculum and a retrospective pre-post survey to evaluate familiarity with AI and ML concepts, comfort with AI and ML literature appraisal, and attitudes toward AI and ML use.</p><p><strong>Outcomes: </strong>Twenty of 23 learners (87%) completed the presession knowledge assessment before participating in the DATA-MD sessions, and all 23 learners completed the postsession knowledge assessment and retrospective pre-post survey. Median knowledge scores significantly improved for modules 1 to 3 (module 1: 2.5 to 3.0, P = .008; module 2: 1.0 to 2.0, P = .049; module 3: 2.0 to 3.0, P < .001) but not module 4 (2.0 before and after testing; P = .80). Learners reported increased confidence in their abilities to appraise the AI and ML literature and use AI and ML tools in future practice.</p><p><strong>Next steps: </strong>The DATA-MD curriculum pilot demonstrates that a standardized AI and ML curriculum can improve trainees' knowledge and attitudes about clinical AI and ML. Next steps include expansion to learners from different medical specialties, health professions, and academic institutions.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081972","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":"State Laws on Reproductive Health and Graduating Medical Students' Choice of Specialty and Residency Location.","authors":"Laura Baecher-Lind, Jeffrey B Bird, Samara B Ginzburg, Stephanie Mann, Elizabeth M Petty, Courtney A Schreiber, Amy S Gottlieb","doi":"10.1097/ACM.0000000000006092","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006092","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the relationship between state restrictions on reproductive health access and students' decision-making regarding specialty choice and residency location.</p><p><strong>Method: </strong>The authors analyzed 2024 Graduation Questionnaire (GQ) data from medical students graduating from U.S. MD-granting medical schools pursuing all specialties. Abortion restrictiveness classifications were based on the Guttmacher Institute's US Abortion Policies and Access After Roe map.</p><p><strong>Results: </strong>Over half (7,855/15,513; 50.6%) and one-third (5,255/15,520; 33.9%) of all students reported state laws about reproductive health services influenced where they applied for residency and their choice of specialty, respectively, to some degree. Women were approximately twice as likely to report reproductive laws influenced their decisions, compared with men (specialty choice: relative risk [RR], 2.04; 95% confidence interval [CI], 1.94-2.15; residency location: RR, 1.70; 95% CI, 1.64-1.77; both P < .001). Students completing medical school in abortion protective (RR, 1.15; 95% CI, 1.12-1.19) or intermediate (RR, 1.14; 95% CI, 1.07-1.21) states were more likely to report being influenced by state laws when deciding where to pursue residency, compared with students in restrictive states (both P < .001). Students pursuing obstetrics and gynecology (ObGyn), family medicine (FM), or emergency medicine (EM) residencies were more influenced by state laws when choosing their specialty (ObGyn: RR, 2.45; 95% CI, 2.35-2.56, P < .001; FM: RR, 1.65; 95% CI, 1.56-1.74, P < .001; EM: RR, 1.11; 95% CI, 1.02-1.20, P = .02) and where to apply for residency (ObGyn: RR, 1.87; 95% CI, 1.83-1.93, P < .001; FM: RR, 1.30; 95% CI, 1.25-1.36, P < .001; EM: RR, 1.08; 95% CI, 1.02-1.15, P = .01), compared with students pursuing other specialties.</p><p><strong>Conclusions: </strong>This study provides further evidence that restrictions on abortion care are likely to impede efforts to develop a future physician workforce capable of reducing health care inequities and improving maternal health outcomes.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081884","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":"Navigating Expectations in the Transition to the Pass/Fail Step 1 Exam: Tensions and Recommendations From Student Leaders of the NEXT Step 1 Project.","authors":"Paige A Romer, Ryan B Ko, Dhweeja Dasarathy, Olivia R Negris, Alyson K Win, Lynn A Leveille, Bianca A Duah, Joseph R Geraghty","doi":"10.1097/ACM.0000000000006088","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006088","url":null,"abstract":"<p><strong>Abstract: </strong>The transition of the United States Medical Licensing Examination (USMLE) Step 1 from 3-digit to pass/fail scoring set the stage for one of the most significant changes in medical education in several decades. Although originally designed for a binary competency decision around licensure, the Step 1 exam score was famously used as a major criterion for residency interview selection. The transition to pass/fail grading sought to address the issue of students focusing on Step 1 exam preparation at the expense of their formal medical school curriculum and their well-being. However, trainees, advisers, faculty, and residency program directors quickly identified several unintended consequences of this decision. In response, a collaborative grassroots effort was formed among multiple stakeholders, including an extensive network of trainees. The Navigating Expectations in the Transition to Pass/Fail Step 1 (NEXT Step 1) project aims to study this scoring change and develop consensus recommendations for all shareholders affected. In this study, student leaders of the NEXT Step 1 project use their lived experiences as trainees and members of this collaborative project to identify key tensions that arose due to the scoring change. Tensions were described within 3 domains: curriculum, student advising, and residency applications. The authors discuss each tension and provide recommendations for medical schools, faculty, residency programs, and students to consider moving forward in the era of the pass/fail Step 1 exam. Although most students involved in the project think the transition to pass/fail scoring on the Step 1 exam has been positive, there are many downstream consequences that need to be addressed to improve student well-being and fairness in the residency application process. The authors provide student-centered recommendations for these challenges and aim to provide an example of meaningful trainee engagement in academic medicine.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990606","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":"Should Medical School Grading Be Tiered or Pass/Fail? A Scoping Review of Conceptual Arguments and Empirical Data.","authors":"Alexander A Iyer, Cameron Hayes, Bernard S Chang, Susan E Farrell, Anne Fladger, Karen E Hauer, Richard M Schwartzstein","doi":"10.1097/ACM.0000000000006085","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006085","url":null,"abstract":"<p><strong>Purpose: </strong>Medical school grading has implications for student well-being, motivation, equity, and residency selection. However, despite more than 50 years of debate, there remains no consensus on whether grading should be tiered or pass/fail, particularly in core clerkships. This scoping review examines conceptual arguments, empirical data, and knowledge gaps regarding tiered versus pass/fail grading in medical school.</p><p><strong>Method: </strong>OVID MEDLINE, Embase, Web of Science, and ERIC were searched on November 15, 2023, for articles published from 2000 to 2023 focused on (1) conceptual arguments regarding tiered versus pass/fail grading in U.S. medical schools and/or (2) empirical data relevant to this debate. Two reviewers independently assessed eligibility. The authors performed meta-synthesis to group arguments into domains and cross-reference them with relevant data, appraising empirical studies using the Medical Education Research Study Quality Instrument (MERSQI).</p><p><strong>Results: </strong>Forty articles met the inclusion criteria, including 22 empirical studies of variable quality (MERSQI scores, 8.5-13.5 of 18). Conceptual arguments and empirical data spanned 10 domains. Better-supported arguments included the association of pass/fail preclerkship grading with improved short-term well-being and preserved academic performance, low reliability of individual tiered grades, and racial and ethnic disparities in clerkship grading. Areas of uncertainty included the effects of pass/fail clerkship grading on well-being, motivation, learning, and achievement; potential stress displacement with pass/fail grading; validity of tiered clerkship grades; residency application concerns; and subinternship grading considerations.</p><p><strong>Conclusions: </strong>Significant controversy about grading exists across 10 domains. Cross-cutting challenges include the diverse purposes of grading leading to conflicting opinions and data interpretations, limited study quality, and overreliance on opinion over data or theory. Recommendations include caution when interpreting small numbers of tiered grades, transparency and research regarding potential clerkship grading disparities, and consideration of all relevant dimensions in system-level assessment approaches. The authors hope these steps encourage assessment that benefits learners and patients.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056051","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":"Perceptions of the Learning Environment Among Medical Students with Disabilities and the Impact of Program Access.","authors":"Christopher J Moreland, Melissa Plegue, Zoie C Sheets, Karina Pereira-Lima, Neera R Jain, Erene Stergiopolous, Ben Case, Amy Addams, Lisa M Meeks","doi":"10.1097/ACM.0000000000006086","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006086","url":null,"abstract":"<p><strong>Purpose: </strong>Negative learning environment experiences may contribute to burnout for medical students with disabilities (MSWD). This study explores MSWD's perceptions of the learning environment and the effects of program access (having received or not needing accommodations).</p><p><strong>Method: </strong>The authors analyzed Association of American Medical Colleges Year Two Questionnaire data from 2019 and 2020, comparing non-disabled students, MSWD with program access, and MSWD without program access (having not received or requested an accommodation, despite a need). Three learning environment measures were examined: how schools fostered students' personal and professional development; a shortened Medical School Learning Environment Scale (MSLES); and subscales on emotional climate, student-faculty interactions, and student-student interactions. Responses were compared across the 3 groups using chi-square and ANOVA tests with post-hoc pairwise comparisons.</p><p><strong>Results: </strong>Of the 23,898 respondents, 10.2% (2,438) self-reported a disability. Among those, 83.6% (2,039) reported program access, 13.9% (340) lack of program access. Students without disabilities (21,008) reported higher agreement that their school fostered their development as a person (72.2%, 15,172) and physician (90.9%, 19,089) compared with MSWD with access (65.6%, 1,312 and 89.0%, 1,778, P < .001). MSWD without access reported lower agreement than both groups (43.7%, 149 and 80.1%, 273, P < .001). There were no differences regarding the MSLES statement about high-performance standards (F(2, 23742) = 2.35, P = .095). For the 8 remaining MSLES statements and for all 3 subscales, non-disabled students reported significantly higher agreement than MSWD with and without access and MSWD with access had higher agreement than those without.</p><p><strong>Conclusion: </strong>This nationally representative study demonstrates that MSWD perceive the learning environment less favorably than their non-disabled peers. Program access partially mitigates these differences, underscoring the critical role of accommodations and the need to address structural barriers to access.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049625","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":"In reply to Cohn et al.","authors":"Emily Hawes, Lori Rodefeld, Debra Weinstein","doi":"10.1097/ACM.0000000000006084","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006084","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030821","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":"Aligning Competencies Without Abandoning Personal and Professional Development.","authors":"Timothy Kuchera, Jillian Zavodnick, Gretchen Diemer","doi":"10.1097/ACM.0000000000006082","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006082","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040198","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":"Investigating the Impact of a National Institutes of Health Loan Repayment Program Preparedness Program.","authors":"Megan G Flores, Annah J Chollet, Stephanie A Rolin","doi":"10.1097/ACM.0000000000006083","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006083","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014248","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":"Length of Service of Medical School Deans: The Long and the Short of It.","authors":"Robert N Golden","doi":"10.1097/ACM.0000000000006080","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006080","url":null,"abstract":"<p><strong>Abstract: </strong>The median length of service for medical school deans has remained at approximately 4 years since 1959. This relatively short duration of leadership may limit growth and innovation in the academic and clinical missions. Several factors may account for short deanships, including a mismatch between the institution's selection criteria and the requisite personal characteristics that promote successful leadership; divergence in the institution's expectations and the resources and structures it provides to the new dean; and problematic relationships and misaligned priorities of the medical school and its primary clinical partner organization or organizations. The relationship and personality match between the dean and the chief executive officer (CEO) of the major clinical affiliate or affiliates is vitally important in advancing the goals of each organization. In instances where a single individual serves as both the dean and the health system CEO, it is essential that their direct reports share a degree of responsibility for the overall success of both the clinical and academic portfolios. Otherwise, the all-too-common tension between dean and health system CEO simply moves downstream to the clinical and academic portfolio leaders.Despite the challenges confronting academic medicine, service as a medical school dean remains an incredibly satisfying opportunity to make a profound difference to the patients and populations served by academic medical institutions. The author offers a few personal reflections on how to develop a relatively long and hopefully impactful deanship and, more importantly, promote progress in advancing the medical school's mission and vision.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047188","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}