Academic Medicine最新文献

{"title":"The LEAP Champion program: leveraging clinical champions to embed sustainable interprofessional education in the clinical learning environment.","authors":"Sara North, Jennifer Pratt, Sandi Mulliner, Melissa Martin, Monica McDevitt, Jodi O'Neill, Emily Johnson, Carolyn M Porta, Cheri Friedrich","doi":"10.1093/acamed/wvag334","DOIUrl":"https://doi.org/10.1093/acamed/wvag334","url":null,"abstract":"<p><strong>Problem: </strong>While interprofessional education (IPE) is widely recognized as a valuable and necessary component of collaborative practice training, significant gaps exist in identifying site-specific opportunities in implementing IPE in the clinical learning environment. This report presents an innovative academic-clinical partnership model rooted in the evidence base, designed to address gaps and challenges in advancing IPE in the practice setting.</p><p><strong>Approach: </strong>The Center for Interprofessional Health (CIH) at the University of Minnesota partnered with select local healthcare organizations to launch an innovative academic-clinical partnership model in 2024-25 and 2025-26, designed to leverage and support IPE champions employed within health systems. The cohort-based LEAP (Learning through Engaging Actively in Practice) Champion program provides a model for clinicians to advance the implementation of explicit, sustainable, coordinated integration of learners from a variety of health professions into on-site, authentic IPE experiences, with guidance and resources, both internal and from CIH. Program interactions, materials, and assessments/ deliverables are outlined.</p><p><strong>Outcomes: </strong>LEAP Champion outcomes include impacts on the organizations, learners, and individual champions. Outcomes demonstrated early advances in pilot site IPE infrastructure, IPE engagement of 170 learners from 9 professions, and high satisfaction of champions with the cohort-based mentorship and resources. Findings support the model's feasibility as a professional development experience alongside clinical roles. Key overall lessons learned are shared to guide future research.</p><p><strong>Next steps: </strong>By leveraging academic-clinical partnerships to drive system-level progress, the LEAP Champion model provides a robust foundational framework for continued study of strategies advancing IPE within the practice setting. Based on key lessons learned during the first two years of the LEAP Champion program, next steps are proposed to move toward broader system-level impact and replication, including developing a robust infrastructure for sustainability, expanding training and modalities, and enhancing a multi-source evaluation model.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225377","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":"Developing and evaluating a rubric to assess medical students' analytic thinking and predict academic risk.","authors":"Krisztina Fischer, David Furfaro, Alexander A Iyer, Jeremy B Richards, Johannah Mitchell, Amy M Sullivan, Richard M Schwartzstein","doi":"10.1093/acamed/wvag324","DOIUrl":"https://doi.org/10.1093/acamed/wvag324","url":null,"abstract":"<p><strong>Problem: </strong>Analytic reasoning requires learners to integrate knowledge, demonstrate analytical skills, and employ metacognition to avoid cognitive biases. Mechanism Maps (MMs), student-generated concept maps, support this process by requiring students to link clinical findings with pathophysiologic mechanisms. However, broader adoption of MMs has been limited by challenges in assessment: existing scoring approaches emphasize structural features rather than accuracy of reasoning, show variable interrater reliability and are time-intensive. Importantly, it remains unclear whether MM-based assessments can identify students at risk of difficulty in analytic reasoning before exam performance.</p><p><strong>Approach: </strong>The authors developed a five-domain rubric (comprehensiveness, analytical detail, organization, accuracy, overall quality) to assess MMs. First-year medical students (n = 134) in a systems-based physiology/pathophysiology course at Harvard Medical School in February-March 2019 created three MMs for clinical vignettes as ungraded exercises. Each MM was assigned one week before a course assessment.</p><p><strong>Outcomes: </strong>Rater training used an initial set of MMs, after which four trained raters, working in pairs, independently scored the remaining maps. Scoring showed good-to-excellent agreement between raters across most domains, with lowest inter-rater agreement for the accuracy domain. MM scores were associated with later exam performance. For Vignette 2, each one-point increase in score roughly doubled the odds of scoring in the top three exam quartiles rather than the bottom quartile, and this association held even after accounting for quiz performance. Vignette 3 scores showed a similar pattern, though the association was attenuated after adjustment for quiz performance.</p><p><strong>Next steps: </strong>The multidimensional rubric enabled reliable MM scoring, associated with exam performance and suggests potential early identification of lower-performing students. Future work should consider prospective validation in additional institutional contexts.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185895","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 role of a longitudinal coach in medical students' specialty choice and application to residency process: a qualitative research study of students', coaches', and deans' perspectives.","authors":"Lauren Boehm, Maria Blanco, Victoria Hayes, Sara W Nelson, Alex Sugerman, Thomas Risoleo, Taimur Dad","doi":"10.1093/acamed/wvag322","DOIUrl":"https://doi.org/10.1093/acamed/wvag322","url":null,"abstract":"<p><strong>Purpose: </strong>With adequate preparation, academic coaches can provide meaningful support to medical students in choosing a specialty and navigating the residency application process. However, the specific contributions of medical student coaches to specialty choice, residency applications, and the transition to residency remain insufficiently understood. This study sought to understand the role of a longitudinal coach on these three processes from the perspectives of students, coaches, and deans of students.</p><p><strong>Method: </strong>An interpretative descriptive qualitative study was conducted involving focus groups with graduating medical students, coaches, and deans of student affairs, Tufts University School of Medicine, April through July 2025. Discussions explored the role coaches play in specialty selection, the residency application process, and the post-Match transition to residency. Transcripts were analyzed using thematic analysis to develop core themes.</p><p><strong>Results: </strong>Participants described four key interventions that characterize the role of a coach: facilitating values-based reflection, offering emotional support, respecting student agency, and encouraging students to engage a broader village when seeking advice. Students, coaches, and deans consistently emphasized the unique role of longitudinal coaches in validating students' experiences and helping them remain connected with their values during specialty decision-making, the application process, and the transition to residency.</p><p><strong>Conclusions: </strong>The findings of this study highlight that longitudinal coaches provide an added role in student specialty choice, residency application process, and the transition to residency within the existing advising ecosystem. Participants' perspectives informed the development of coaching interventions across these three phases. These insights can guide coaching practices across medical schools.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172322","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":"Setting the table for empathy.","authors":"Elisha Y Pinker","doi":"10.1093/acamed/wvag320","DOIUrl":"https://doi.org/10.1093/acamed/wvag320","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149855","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 contribution of Caribbean medical schools to the U.S. physician workforce.","authors":"Philip A Gruppuso, Xiaomei Pei, Katie Arnhart, William W Pinsky, Aaron Young, Sean O Hogan, Eli Y Adashi","doi":"10.1093/acamed/wvag317","DOIUrl":"https://doi.org/10.1093/acamed/wvag317","url":null,"abstract":"<p><strong>Purpose: </strong>The physician shortfall in the U.S. has given rise to increasing reliance on international medical school graduates (IMGs), including those graduating from what are referred to as off-shore Caribbean medical schools. These schools, which offer instruction in English, draw primarily on U.S. and Canadian citizens while affording students clinical training opportunities in the U.S. The purpose of the present study was to characterize the magnitude and nature of the contribution being made by Caribbean medical schools to the U.S. physician workforce.</p><p><strong>Method: </strong>Off-shore Caribbean medical schools were identified based on the aforementioned characteristics as provided by several sources, including schools' websites. Residency training data from 2013 to 2023 for off-shore Caribbean medical school graduates (CMGs), U.S. and Canadian medical school graduates (USMGs), and other IMGs were provided by the Accreditation Council for Graduate Medical Education. Medical licensure and physician demographic data were provided by the Federation of State Medical Boards.</p><p><strong>Results: </strong>CMGs pursued training in family medicine at a rate more than double that of USMGs and other IMGs. Licensure data showed a contribution of CMGs to the U.S. physician workforce that went from 33 CMGs first licensed in the U.S. in 1980 to 2,768 in 2024. By 2024, a total of 49,256 CMGs held a medical license, comprising 5% of licensed U.S. physicians. CMGs holding licenses in 2024 were younger (44.1 years old) than USMGs (51.5 years old) or other IMGs (55.2 years old). The proportion of CMGs certified in family medicine was more than twice that of USMGs and other IMGs.</p><p><strong>Conclusions: </strong>Off-shore Caribbean medical schools are making a substantial and growing contribution to the U.S. physician workforce that is disproportionately in the primary care arena. Given the magnitude of this contribution, enhancing accreditation-mandated transparency around student outcomes could inform policy development relating to these schools.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139075","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":"Theory-informed redesign of clinical reasoning education in the era of generative artificial intelligence.","authors":"Verity E Schaye, Andrew S Parsons, Andrew P J Olson, Raja-Elie E Abdulnour, Michelle Daniel","doi":"10.1093/acamed/wvag318","DOIUrl":"https://doi.org/10.1093/acamed/wvag318","url":null,"abstract":"<p><p>Clinical reasoning is a foundational competency that develops over the course of training and comprises two sub-components. Diagnostic reasoning classifies a patient's condition and assigns a diagnostic label, whereas management reasoning weighs multiple defensible plans with consideration of patient preferences and contextual constraints. Clinical reasoning education has historically emphasized \"in-the-head\" cognitive processes, such as information gathering, hypothesis generation, problem representation, and differential prioritization, over \"out-in-the-world\" contextualized processes, such as system navigation, use of tools, and interprofessional management. Generative artificial intelligence (GAI), itself a tool \"out-in-the-world,\" is changing where, with whom and what, and how trainees learn to reason. The unit of reasoning educators must attend to shifts from the individual learner to the learner-AI dyad. This shift creates opportunities for upskilling alongside risks of never-skilling, mis-skilling, and deskilling. Drawing on \"in-the-head\" information processing theories and \"out-in-the-world\" situativity theories, the authors propose a redesign of clinical reasoning education. They share learner vignettes to illustrate the upskilling potential and skilling risks most concerning at each stage of training before proposing five cross-cutting strategies for redesign: introduce GAI tools early in the curriculum, preserve reasoning-first GAI-assisted workflows, promote graduated autonomy for GAI use in clinical care, equip faculty to supervise GAI-assisted reasoning, and rethink clinical reasoning assessment. If GAI is integrated deliberately in a theory-informed way, the next generation of learners can be better prepared to incorporate GAI skillfully and responsibly into clinical reasoning.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139102","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 intimate dance of life and death.","authors":"Tyler D Johnson","doi":"10.1093/acamed/wvag315","DOIUrl":"https://doi.org/10.1093/acamed/wvag315","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139129","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":"Trumpet up there.","authors":"Octavian C Ioachimescu","doi":"10.1093/acamed/wvag313","DOIUrl":"https://doi.org/10.1093/acamed/wvag313","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129059","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":"I held a brain and my daughter today.","authors":"Caroline S Beit","doi":"10.1093/acamed/wvag311","DOIUrl":"https://doi.org/10.1093/acamed/wvag311","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129122","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":"Climate-related health and sustainable healthcare activities of U.S. professional medical societies: a mixed-methods analysis.","authors":"Sara Locke, David Han, Thomas Bush, Tamiko R Katsumoto, Nicole Duritz, Sawyer Hall, Jeannette R Ickovics, Hardeep Singh, Lucy Walker, Lisa Patel, Jodi D Sherman","doi":"10.1093/acamed/wvag277","DOIUrl":"https://doi.org/10.1093/acamed/wvag277","url":null,"abstract":"<p><strong>Purpose: </strong>The authors characterize how U.S. professional medical societies are addressing climate-related health impacts and sustainable healthcare practices, and identify barriers and priorities for advancing a climate-fit healthcare system.</p><p><strong>Method: </strong>Ninety-five U.S. medical societies were invited to participate in semi-structured interviews (September 2024-February 2025); websites of all 95 societies were reviewed for publicly available content (July-August 2025). Both sources were assessed for engagement across 6 domains: member education, patient education, sustainable clinical practice guidance, research and innovation, policy and advocacy, and governance. Interview responses were scored from 0 (none) to 2 (robust) and summed into an engagement index (range 0-12); open-ended responses were analyzed thematically.</p><p><strong>Results: </strong>Twenty-eight of 95 invited societies participated, yielding 34 interviewees. Most reported activity in at least one domain, but few demonstrated comprehensive engagement; total scores ranged from 1 to 11 of 12 (Mdn = 6.5). Member education was most common (25/28 [89.3%]), while fewer societies reported research initiatives (6/28 [21.4%]) or patient education (3/28 [10.7%]) initiatives. Thematic analysis identified six needs: mobilizing members to support cultural change, strengthening the evidence base for specialty-specific actions, improving specialty-specific education for clinicians and patients, increasing collaboration and knowledge sharing across societies, establishing policy frameworks and enforceable standards, and building internal capacity through staffing and resources. Website review revealed limited public visibility relative to reported activity: member education appeared on 48.4% (46/95) of websites, patient education on 10.5% (10/95), and climate-related content on just 2.1% of homepages (2/95).</p><p><strong>Conclusions: </strong>Medical societies are beginning to engage with climate-related health and healthcare sustainability, but efforts remain nascent and fragmented. With clearer professional standards, collaboration, and institutional support, societies could advance organized action to prepare for a changing climate and promote sustainable healthcare practices.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118201","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}