Academic Medicine最新文献

{"title":"Mission-Aligned Funds Flow and the Primary Care Mission.","authors":"Richard L Kravitz, Russell S Phillips, Deborah J Cohen","doi":"10.1097/ACM.0000000000006045","DOIUrl":"10.1097/ACM.0000000000006045","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"877"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701999","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":"Empirical Assessment of Well-Being: The Stanford Model of Occupational Well-Being.","authors":"Bryan D Bohman, Maryam S Makowski, Hanhan Wang, Nikitha K Menon, Tait D Shanafelt, Mickey T Trockel","doi":"10.1097/ACM.0000000000006025","DOIUrl":"10.1097/ACM.0000000000006025","url":null,"abstract":"<p><strong>Purpose: </strong>The Stanford Model of Occupational Well-Being (Stanford Model) hypothesizes that occupational well-being is driven by 3 reciprocally related domains: workplace efficiency, culture of wellness, and individual factors. The current analysis assesses the key elements of this model with cross-sectional empirical data.</p><p><strong>Method: </strong>In fall 2020 and spring 2022, well-being surveys were distributed to all Stanford School of Medicine clinical faculty working at 50% or more of full-time equivalent. A total of 1,909 clinical faculty were invited to complete the 2020 survey and 2,251 to complete the 2022 survey. The survey assessed burnout and professional fulfillment, along with 9 hypothesized determinants, as occupational well-being outcome indicators. Exploratory factor analysis was used to determine whether these determinants grouped well into the 3 domains described by the model. Domain scores were created based on factor analysis groupings of the scores for the determinants in each domain.</p><p><strong>Results: </strong>Of 1,909 clinical faculty invited to complete the 2020 survey, 1,479 (78%) participated. Of the 2,251 clinical faculty invited in 2022, 1,552 (69%) participated. The associations of the 3 domain scores with burnout and professional fulfillment were moderate for workplace efficiency ( r = 0.42-0.49; P < .001) and large for culture of wellness ( r = 0.51-0.63; P < .001) and individual factors ( r = 0.52-0.72; P < .001). Domain scores accounted for 45% and 50% of the variance in professional fulfillment and 56% and 58% of variance in burnout in 2020 and 2022 data, respectively.</p><p><strong>Conclusions: </strong>These results provide empirical evidence to support a widely adopted conceptual model of occupational well-being, including categorization of the hypothesized determinants of well-being into 3 domains, correlations among the domains, and association of the domain scores with burnout and professional fulfillment. Further research is needed to test causal relationships hypothesized by the model.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"960-967"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631036","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":"Association Between Electronic Health Record Use Metrics and Clinical Performance in an Outpatient Primary Care Resident Clinic.","authors":"Katherine M Jennings, Michelle I Knopp, Benjamin Kinnear, Eric J Warm, Margaret V Powers-Fletcher, Sally A Santen, Daniel P Schauer","doi":"10.1097/ACM.0000000000006056","DOIUrl":"10.1097/ACM.0000000000006056","url":null,"abstract":"<p><strong>Purpose: </strong>Electronic health records (EHRs) can provide valuable insights into workflow, clinical reasoning, and personal attributes; however, the indicators for how an individual acts within the EHR (EHR use metrics) are not frequently analyzed. This study examines whether EHR use metrics are associated with internal medicine resident clinical performance.</p><p><strong>Method: </strong>In this retrospective cohort study, data on EHR use metrics and achievement of 22 clinical performance measures (CPMs) were collected between November 2021-October 2022 from University of Cincinnati internal medicine residents during a year dedicated to ambulatory care. The CPMs were sorted on an attribution-contribution continuum for subgroup analysis. The EHR use metrics were used for agglomerative hierarchical clustering to group residents with similar EHR behaviors.</p><p><strong>Results: </strong>Thirty residents (11 [37%] male and 19 [63%] female) were included. Clustering with a subset of 10 EHR use metrics resulted in 3 clusters with different clinical performance as indicated by achievement of CPMs. The clusters were characterized as lower-performing (n = 5; mean [SD] CPMs achieved, 11.4 [2.3]; 95% CI, 9.4-13.4), middle-performing (n = 23; mean [SD] CPMs achieved, 15.8 [2.1]; 95% CI, 14.9-16.6), and higher-performing (n = 2; mean [SD] CPMs achieved, 22 [0]; 95% CI, 22-22). After sorting the CPMs on an attribution-contribution continuum, the clusters performed differently in actions (F 2 ,27 = 7.73, P = .002) and screenings (F 2,27 = 9.60, P < .001) but not lab testing (F 2,27 = 2.88, P = .07) or disease control (F 2,27 = 1.01, P = .38). The lower-performing cluster had longer response times and incomplete work, whereas the higher-performing cluster was most responsive and communicative.</p><p><strong>Conclusions: </strong>Hierarchical cluster analysis of EHR use metrics can identify EHR use patterns associated with resident clinical performance. Clustering provides a framework that will enable programs to apply EHR use metrics to augment resident assessment and feedback.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"968-974"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784638","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":"Curriculum Research Solutions: Shifting From \"Did It Work Locally?\" to Contributing to a Scholarly Conversation.","authors":"David A Cook, Karen E Hauer, Arianne Teherani, Andrea N Leep Hunderfund, Steven J Durning, Jorie M Colbert-Getz","doi":"10.1097/ACM.0000000000006072","DOIUrl":"10.1097/ACM.0000000000006072","url":null,"abstract":"<p><strong>Abstract: </strong>Health professions educators frequently seek to study their curriculum (e.g., a new or revised curriculum for a degree-granting program, a component of that curriculum, or a stand-alone course). Despite local enthusiasm, curriculum-focused studies are often hard to publish and have been repeatedly discouraged. Yet, few authors have proposed practical solutions. The purpose of this article is to articulate common problems with curriculum research and to propose specific ways in which curriculum research can be accomplished (and published) successfully. The authors define \"research \" as the rigorous, systematic pursuit of new knowledge with the intent to disseminate findings in a peer-reviewed forum. They delineate 5 problems with curriculum-focused research as it is typically done: redundancy (failing to build on prior research), context-specificity, confounding and dilution, superficiality (using data sources of convenience), and conceptual obscurity (failing to employ a relevant conceptual framework). To address these problems, they encourage researchers to stop focusing on their local curriculum and instead join and contribute meaningfully to a global scholarly conversation. Engaging in a scholarly conversation involves listening to the conversation (the literature) to understand what is already known, identifying a gap the researcher can fill with a useful observation, and asking and answering a question that other people will find relevant (to their own local needs), novel (not already known), insightful (shedding light on future action), and credible (well-supported by chosen methods). The authors outline 6 prototypical potentially successful curriculum-focused research studies, including quantitative and qualitative approaches, and cite published examples. They also highlight studies to avoid. They conclude by discussing practical considerations: appraisal of research quality, funding of education research, accessing and acquiring needed research skills, measuring provider behaviors and patient outcomes, ethical issues associated with learners as study participants, and tensions between basic and applied research.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"896-908"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027088","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":"Artist's Statement: Silent Blooms, Silent Struggles.","authors":"Cherise Kwok","doi":"10.1097/ACM.0000000000006081","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006081","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 8","pages":"909"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755060","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":"Ode to Small Towns: Tyree Daye.","authors":"","doi":"10.1097/ACM.0000000000006013","DOIUrl":"10.1097/ACM.0000000000006013","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"910-911"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517200","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":"This Academic Life.","authors":"Julia Meade","doi":"10.1097/ACM.0000000000006077","DOIUrl":"10.1097/ACM.0000000000006077","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"993"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004450","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":"Three Good Questions for Faculty and Their Mentors in Support of Academic Career Development.","authors":"Deborah G Freeland, Jennifer Verbsky, Stewart Babbott","doi":"10.1097/ACM.0000000000006009","DOIUrl":"10.1097/ACM.0000000000006009","url":null,"abstract":"<p><strong>Abstract: </strong>Faculty mentorship is essential for a successful career in academic medicine, and effective support includes a commitment between a faculty member and mentor to navigate through competing interests and priorities. Many faculty mentorship programs have been described. However, the program content, including guidance tools and guiding questions, is less often defined. To address this gap, the authors draw on their faculty mentor-mentee experience in academic medicine to propose a set of guiding questions in this Commentary called \"3 good questions.\" This supplemental tool encourages mentors to ask of their mentees: (1) Are you doing what you love? (2) Are you making it count twice? and (3) Are you staying focused? These questions can be incorporated during mentorship discussion sessions and can be answered in a stepwise approach to reflect, confirm, and explore a mentee's needs in the short and long terms for a successful career in academic medicine.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"880-883"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473276","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":"Effect of Coaching on Trainee Burnout, Professional Fulfillment, and Errors: A Randomized Controlled Trial.","authors":"Ritika S Parris, Zhiyong Dong, Alicia Clark, Margaret M Hayes, Amy M Sullivan, Carrie Tibbles, Kerri Palamara","doi":"10.1097/ACM.0000000000005999","DOIUrl":"10.1097/ACM.0000000000005999","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines the effect of coaching on errors and burnout on graduate medical education trainees and mechanisms of this effect.</p><p><strong>Method: </strong>In this explanatory, sequential, mixed-methods randomized controlled trial at a large, urban academic medical center, trainees and faculty were randomized to coaching with mentorship or mentorship alone from September 2021 to December 2022. Trainees randomized to coaching (coachees) were paired with faculty coaches from different specialties, who were trained in a novel coaching curriculum. Burnout was measured with the Stanford Professional Fulfillment Index subscales of professional fulfillment, work exhaustion, interpersonal disengagement, and overall burnout. Medical errors in the past 3 months were self-reported. Focus groups were conducted for each of the 4 cohorts (faculty control, faculty intervention, trainee control, and trainee intervention) to allow for an in-depth exploration of the coaching program experience.</p><p><strong>Results: </strong>A total of 184 trainees and 150 faculty were randomized to standard mentorship with or without coaching. Paired analysis included 83 trainees (59% female) and 77 faculty (60% female). Difference-in-difference analyses showed reduced burnout among coachees compared with control trainees, with a score difference of -0.37 (95% CI, -0.64 to -0.09). Professional fulfillment improved in coachees, with a score difference of 0.50 (95% CI, 0.16-0.83) compared with control trainees. There were no significant differences in resilience or self-valuation. Coachees had 2.18 times greater odds of reporting no medical error than control trainees (not significant) and were less likely to report being \"unsure\" about medical error involvement. Qualitative analysis highlighted the importance of specialty discordance in coaching pairs and a coach's holistic awareness of coachee well-being and demonstrated successful uptake and use of coaching skills, particularly positive reframing and normalization.</p><p><strong>Conclusions: </strong>Coaching improved trainee burnout and professional fulfillment, likely through aspects of the relationship and teachable skills, which provided psychological safety and holistic support.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"940-949"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441919","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":"From Quiet Quitting to Open Dialogue in Medical Education: Longitudinal Student Perspectives on the Factors Shaping Student Engagement.","authors":"Annemieke G J M Smeets, Annelies E van Ede, Marc A T M Vorstenbosch, Petra J van Gurp","doi":"10.1097/ACM.0000000000006059","DOIUrl":"10.1097/ACM.0000000000006059","url":null,"abstract":"<p><strong>Purpose: </strong>A healthy work-life balance and an environment where students feel valued are goals of increasing importance in medical education. When these essential elements are absent or lacking, educators run the risk of losing their trainees, either physically or mentally, via a silent \"check out,\" referred to as \"quiet quitting.\" This study examined the maturation of value-based student engagement and students' tendency to disengage from academic tasks during their first year of college and shortly before graduation.</p><p><strong>Method: </strong>This longitudinal mixed methods study was conducted at the 6-year Doctor of Medicine program at the Radboud University Medical Center, Nijmegen, the Netherlands, 2017-2023. Scales for the Assessment of Learning and Performance in Students questionnaire data were connected with qualitative insights from focus group interviews from 10 student participants at 3 key points in their academic progression: the beginning and end of their first academic year and shortly before graduation. Through concurrent, exploratory, inductive analysis, the authors examined patterns, relationships, and discrepancies among the data, comparing and contrasting to ultimately draw overarching conclusions.</p><p><strong>Results: </strong>Data analysis revealed a transformation in students' learning and performance motivation, becoming more intrinsically driven and connected to personal values. The willingness to invest effort was not a constant, varied among individual students over time, and became less pronounced when considering future employment prospects. Intellectual analysis on desired future work-life balance prompted students to consider a plan B for their career choice. Work-life balance concerns were mainly discussed within close-knit social circles.</p><p><strong>Conclusions: </strong>Student engagement or disengagement appeared to be a dynamic construct. Workplace learning seemed to trigger committed action. However, healthy work-life balance concerns grew stronger as students got closer to graduation. When drivers and barriers of engagement are not discussed, potential talent could be lost, quietly or openly.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"931-939"},"PeriodicalIF":5.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784639","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}