Academic Medicine最新文献

{"title":"You Get What You Reward: A Qualitative Study Exploring Medical Student Engagement in 2 Different Assessment Systems.","authors":"Joshua Jauregui, Adelaide H McClintock, Caitlin Schrepel, Tyra Fainstad, S Beth Bierer, Sylvia Heeneman","doi":"10.1097/ACM.0000000000005848","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005848","url":null,"abstract":"<p><strong>Purpose: </strong>Educational impact is dependent on student engagement. Assessment design can provide a scaffold for student engagement to determine the focus of student efforts. Little is known about how medical students engage with assessment. Therefore, we asked the following research question: How do medical students engage with the process of assessment and their assessment data in 2 clinical assessment systems?</p><p><strong>Method: </strong>This multi-institutional, cross-sectional constructivist grounded theory study of fourth-year undergraduate medical students at the University of Washington and Cleveland Clinic Lerner College of Medicine assessed 2 different assessment systems: traditional tiered grading, in which clerkship grades were summative, and programmatic assessment, in which students received low-stake, narrative feedback across clerkships with progress based on aggregated performance data in student portfolios. All fourth-year students were invited to participate in one-on-one semistructured interviews guided by student engagement theory between September 2022 and January 2023. Verbatim transcripts underwent iterative, qualitative analysis.</p><p><strong>Results: </strong>Twenty-two medical students were interviewed, 13 from a traditional grading assessment system and 9 from a programmatic assessment system. Three major ways in which assessment systems affected how students engaged with their assessments were categorized into the affective, cognitive, and behavioral domains of engagement: as a sociocultural statement of value, as the cognitive load associated with the assessment system and practices themselves, and as the locus of power and control in learning and authentic practice.</p><p><strong>Conclusions: </strong>Medical students' beliefs about assessment goals, cognitive burden of assessment, and relationships with others significantly affected their engagement with their assessments. In assessment systems that reward grading and an archetypal way of being, students report engaging by prioritizing image over learning. In programmatic assessment systems, students describe more fully and authentically engaging in their assessment for and as learning. Systems of assessment communicate what is rewarded, and you get what you reward.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143476","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 Potential of Using ChatGPT-4 Vision for Detecting Image Manipulation in Academic Medicine Articles.","authors":"Lingxuan Zhu, Haoran Zhang, Peng Luo","doi":"10.1097/ACM.0000000000005873","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005873","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143474","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":"A Critical Look at Racism in the Clinical Learning Environment and the Erasure of DEI Efforts.","authors":"Patricia Poitevien, Sylk Sotto-Santiago","doi":"10.1097/ACM.0000000000005872","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005872","url":null,"abstract":"<p><strong>Abstract: </strong>Academic medicine has long acknowledged the importance of diversity, equity, and inclusion in the pursuit of health equity. Despite this recognition, the clinical learning environment (CLE) has struggled to foster an equitable and inclusive ecosystem that supports diverse learners and faculty.Efforts to dismantle racism in medicine represent an important approach to supporting diverse learners and faculty in the CLE, but they have fallen short of their intended impact. The reasons for this failure are complex and may include a limited understanding of the impact of racism and a misguided conviction that knowledge of harm suffered by minoritized groups is a sufficient driver of change.To advance understanding and increase motivation to dismantle racist systems within academic medicine, this paper posits 2 frameworks, Interest Convergence (IC) and Critical Whiteness Study (CWS). IC asserts that racial equity progresses only when it aligns with the interests of the majority, while CWS examines how Whiteness as a social construct upholds power and privilege, often to the detriment of White individuals themselves.Utilizing these frameworks, the authors detail how Whiteness negatively impacts the health of White people and impedes entry to medical school for low- and middle- income, first-generation White students. The authors illustrate how practices-such as patient- and family-centered care and competency-based medical education-which are intended to improve care and medical education for all, are fully aligned with and integral to diversity, equity and inclusion (DEI) principles. The authors conclude that racism and upholding Whiteness causes harm to majority as well as minoritized peoples while DEI principles provide the foundation for best practices in the CLE and improve outcomes for all.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143466","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":"Simulation vs RISE UP: A Comparative Study of Approaches for Teaching Emergency Medicine Trainees How to Manage Microaggressions.","authors":"David Fernandez, Sophia Gorgens, Molly McCann-Pineo, Michael Sperandeo, Michael Cassara, Tiffany Moadel","doi":"10.1097/ACM.0000000000005869","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005869","url":null,"abstract":"<p><strong>Purpose: </strong>Microaggressions are discriminatory actions or words targeted at people for their perceived or expressed identities. The study aimed to address the critical need for training emergency medicine (EM) resident-physicians to manage microaggressions. The authors compared the effectiveness of the Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP) curriculum from Inova Children's Hospital and a simulation (SIM) curriculum created by a research team specifically for this study. The new SIM curriculum was guided by the original RISE UP curriculum but incorporates simulation as a learning tool. These 2 educational modalities were selected based upon previous literature showing their efficacy as tools in medical education.</p><p><strong>Method: </strong>Through a collaboration with residency leadership, EM residents were recruited to participate in a comparison study in which they received either the RISE UP or newly created SIM curriculum as part of their regular simulation training. Pre- and post-intervention surveys assessed perceived knowledge on handling microaggressions. A follow-up survey was sent one month post-intervention to evaluate retention of self-reported knowledge.</p><p><strong>Results: </strong>Out of 81 eligible residents, 69 residents participated: 37 in the new SIM curriculum group, 32 in the RISE UP curriculum group. Participants in both groups self-reported significant improvements in perceived knowledge immediately post-intervention. At the 1-month follow up, both intervention groups retained higher levels of perceived knowledge. Additionally, while both curricula were effective, the RISE UP group showed slightly higher retention rates of self-reported knowledge compared to the SIM group, although this difference was not statistically significant.</p><p><strong>Conclusions: </strong>Both the SIM and RISE UP curricula were effective in improving resident knowledge about handling workplace microaggressions, with participants in the RISE UP curriculum showing marginally better retention of skills. Implementing such educational programs may enhance workplace awareness and response to microaggressions among EM residents.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143473","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 McBride and Walsh.","authors":"William Copeland, Leigh Ann Holterman, Lee Rosen","doi":"10.1097/ACM.0000000000005844","DOIUrl":"10.1097/ACM.0000000000005844","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977180","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":"Championing Civility in the Clinical Learning Environment: Evaluation of a Novel Training Program.","authors":"Sharon L Shofer, Jane P Gagliardi, Stephanie Bryant, Apurva M Khedagi, Dinushika Mohottige, Ada Gregory, Aimee K Zaas, Tracy Truong, Betty B Staples","doi":"10.1097/ACM.0000000000005866","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005866","url":null,"abstract":"<p><strong>Problem: </strong>Incivility in the health care workplace is increasing and negatively impacts everyone in the environment, including health care team members and the patients and families they serve. This study examined the efficacy and impact of Civility Champions (CCs), a novel training program for a multidisciplinary cohort of faculty and graduate medical education (GME) trainees based in principles of trauma-informed care, nonviolent communication, and restorative practices.</p><p><strong>Approach: </strong>Participants were 39 faculty and GME trainees representing 6 departments in a major academic medical center. The concurrent, mixed-methods study employed the Kirkpatrick New World Model as a framework for the creation of the evaluation tools as well as to analyze and report the results of the study. Quantitative and qualitative data analysis examined participants' reactions, perceived learning, workplace use of the skills following training, and initial indicators of whether the program is on track to meet its goals.</p><p><strong>Outcomes: </strong>Participants found CCs training to be valuable (84.6% agree or strongly agree that training was relevant and would recommend it to others). Post-training, CCs felt an increased sense of confidence and commitment using the skills and knowledge learned as indicated by a positive average change score (P < .05) on all measures. At the 6-month survey, 70% of CCs had employed the skills. Results on the implementation of the CCs program found that key success factors include improving program visibility, providing opportunities for skill refreshment, and fostering a supportive community.</p><p><strong>Next steps: </strong>This study expanded a novel training program to multidisciplinary departments and provided early evaluation of the efficacy of the training in the health care workplace. CCs training showed significant measurable benefit using both quantitative and qualitative measures. Future iterations will include training interdisciplinary cohorts and will attempt to assess the program's impact on institutional culture.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143468","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":"What Are We Made For? Mobilizing Medical Education Research for Impact.","authors":"Javeed Sukhera, Cha-Chi Fung, Arianne Teherani, Tasha R Wyatt, Daniel J Schumacher, Andrea N Leep Hunderfund","doi":"10.1097/ACM.0000000000005850","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005850","url":null,"abstract":"<p><strong>Abstract: </strong>During the past several decades, medical education research has advanced in many ways. However, the field has struggled somewhat with translating knowledge into practice. The field has tremendous potential to generate insights that may improve educational outcomes, enhance teaching experiences, reduce costs, promote equity, and inform policy. However, the gap between research and practice requires attention and reflection. In this commentary, the authors reflect on ways that medical education researchers can balance relevance and rigor, while discussing a potential path forward. First, medical education research can learn from implementation science, which focuses on adopting and sustaining best practices in real-world settings. Second, gaining a deeper understanding of the complex and dynamic ways that medical education contexts may influence the uptake of research findings into practice would facilitate the translation and mobilization of knowledge into practical settings. Third, moving from unilateral knowledge translation to participatory knowledge mobilization and engaging diverse stakeholders as active participants in the research process can also enhance impact and influence research findings. Overall, for medical education research to effect meaningful change, it must transition from producing generalizable findings to generating context-specific insights and embracing participatory knowledge mobilization. This shift will involve rethinking traditional research approaches and fostering collaboration with knowledge users to cocreate and implement innovative solutions tailored to their unique settings.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143475","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":"Reports of Burnout Among Historically Marginalized and Female Graduating Medical Students During the COVID-19 Pandemic.","authors":"Liselotte N Dyrbye, Danielle E Brushaber, Colin P West","doi":"10.1097/ACM.0000000000005854","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005854","url":null,"abstract":"<p><strong>Purpose: </strong>To examine graduating medical student reports of burnout by sex, race and ethnicity, and sexual orientation and explore trends within intersectional demographic groups from 2019-2021 in a national sample.</p><p><strong>Method: </strong>The authors obtained medical student responses to the 2019-2021 Association of American Medical Colleges (AAMC) Graduation Questionnaires (GQs) linked to data from other AAMC sources. The dataset included year of GQ completion, responses to a modified Oldenburg Burnout Inventory (exhaustion subscale range: 0-24; disengagement subscale range: 0-15), and demographics previously shown to relate to the risk of burnout in medical students, residents, or physicians. Multivariable linear regression analysis was performed to evaluate independent associations between demographics and burnout.</p><p><strong>Results: </strong>Overall response rate was 80.7%. After controlling for other factors, mean exhaustion scores were higher among Asian (parameter estimate [PE] 0.38, 95% confidence interval [CI] 0.21, 0.54), bisexual (PE 0.97, 95% CI 0.76, 1.17), and gay or lesbian (PE 0.55, 95% CI 0.35, 0.75) students than those who did not identify with each of those respective groups. Mean disengagement scores were lower among female (PE -0.47, 95% CI -0.52, -0.42), Hispanic (PE -0.11, 95% CI -0.22, -0.01), and White (PE -0.10, 95% CI -0.19, 0.00) students and higher among Asian (PE 0.17, 95% CI 0.07, 0.27), Black or African American (PE 0.31, 95% CI 0.18, 0.44), bisexual (PE 0.54, 95% CI 0.41, 0.66), and gay or lesbian (PE 0.23, 95% CI 0.11, 0.35) students than those who did not identify with each of those respective groups. From 2019-2021, mean exhaustion and disengagement scores were relatively stable or improved across nearly all intersectional groups.</p><p><strong>Conclusions: </strong>Male, Asian, Black or African American, and sexual minority students had a higher risk of burnout, while female, Hispanic, White, and heterosexual or straight students had a lower risk of burnout.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143471","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":"Simulation Training to Interrupt Microaggressions.","authors":"Sushant Srinivasan, Claudia E Evaristo, Haroon Ali, Gina E Tranel, Shannon M DiMarco, Naomi Takahashi, Shiva Bidar-Sielaff, Emily Ruedinger","doi":"10.1097/ACM.0000000000005868","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005868","url":null,"abstract":"<p><strong>Abstract: </strong>Microaggressions in health care occur frequently and negatively impact the well-being of trainees. High-realism simulation can effectively train health care providers to communicate in emotionally difficult situations. In 2023, we developed and piloted 4 simulation scenarios for pediatric residents centered on addressing microaggressions in the clinical environment that built on an existing didactic curriculum. These scenarios included single and intersecting forms of oppression including racism, sexism, ableism, ethnocentrism, and weight bias. We also trained faculty, who had no prior simulation debriefing experience, to facilitate and debrief the simulation sessions. Thirty-three residents participated and reported an increase in confidence immediately following the simulation training; this increase was sustained at 3 months. Faculty participants reported increased empathy for residents, recognition of microaggressions, and confidence facilitating conversation after microaggressions that occur both in the simulated setting and in real life. High-realism simulation holds promise as a way to bridge the gap between classroom and real-life interruption of microaggressions, a necessary skill to improve the health care environment for learners and patients.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143472","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":"Correction: The Associations Between United States Medical Licensing Examination Performance and Outcomes of Patient Care.","authors":"","doi":"10.1097/ACM.0000000000005859","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005859","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143469","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}