Academic Medicine最新文献

{"title":"Incorporating Resident Perspectives to Improve Clinician Educator Tracks.","authors":"Anhthu Trinh, Faris Dar Hamed, Jameson Kuang","doi":"10.1097/ACM.0000000000006124","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006124","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267765","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":"Preparing Medical Students and Physicians to Cope With Their Medical Errors: A Scoping Review.","authors":"Julia Harrison, Chee Yan Ting, Michelle Leech, Elizabeth Molloy, Margaret Bearman","doi":"10.1097/ACM.0000000000006120","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006120","url":null,"abstract":"<p><strong>Purpose: </strong>Many clinicians will experience feeling responsible for inadvertently harming a patient through medical error. These situations can be distressing, difficult to navigate, and career altering. In addition to aftermath support, there is a recognized need for preemptive education to better prepare clinicians to cope after such events. Little published guidance exists about how best to do this. This scoping review explores the current knowledge about educational programs and strategies to prepare medical students and physicians to cope effectively with their own medical errors.</p><p><strong>Method: </strong>Three online databases, MEDLINE, PsycINFO, and Scopus, were searched on January 3, 2025, for articles published from database inception to the search date that described programs designed to prepare medical students and/or physicians to cope better with personal involvement in patient harm from medical error. Eligibility screening and data recording were independently performed by 2 reviewers. Simple data were summarized and common pedagogical strategies were identified by inductive thematic analysis.</p><p><strong>Results: </strong>The search yielded 5,359 unique articles for screening, of which 97 full-text articles were retrieved. Twelve articles met the eligibility criteria. The study interventions vary in structure and delivery methods but share similar rationale, key messages, and pedagogical strategies. Dominant pedagogical strategies were divided into 2 groups: (1) what students need to learn about coping after medical error (attend to emotions, universality of fallibility, helpful and unhelpful paths for coping, workplace culture, care for colleagues, transferal of learning to the workplace) and (2) ways to support students in this learning (actual cases, psychological safety and honest conversation, role-modeling, reflection and learning from others' experience).</p><p><strong>Conclusions: </strong>A constellation of pedagogical strategies synthesized from the literature provides program design ideas for education that targets the development of learners' capacity to cope with involvement in patient harm from medical error.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250692","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":"Does Knowledge of Clinical Case Outcome Influence Supervisor Evaluation of Resident Clinical Reasoning?","authors":"Charlotte van Sassen, Silvia Mamede, Walter van den Broek, Patrick Bindels, Laura Zwaan","doi":"10.1097/ACM.0000000000006122","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006122","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines whether outcome bias affects the assessment of general practice (GP) residents and explores supervisor feedback characteristics.</p><p><strong>Method: </strong>In a within-subjects experiment conducted in June 2023, Erasmus Medical Center GP supervisors reviewed 6 clinical vignettes with ambiguous diagnoses assessing residents' diagnostic decisions. Each vignette had 2 versions, differing only in the final sentence indicating favorable or adverse clinical outcome. Supervisors were randomly assigned to review half the vignettes with favorable clinical outcomes and half with adverse clinical outcomes. Supervisors provided scores (range of 1-10, with 10 indicating exceptional achievement and 1-5 indicating insufficient performance) and feedback, analyzed for valence, content specificity, process versus outcome focus, and politeness strategies.</p><p><strong>Results: </strong>Sixty-two supervisors participated in the study. Vignettes ending in adverse clinical outcomes received lower scores versus those ending in favorable clinical outcomes (mean [SE] scores, 5.25 [0.12] vs 6.26 [0.16]; P < .001) and prompted more negative feedback (mean [SE] negative idea units, 2.35 [0.11] vs 1.80 [0.09]; P < .001). Negative feedback exhibited greater specificity than positive feedback (mean [SE] proportion of specific idea units, 0.88 [0.02] vs 0.44 [0.03]; P < .001), regardless of clinical outcome. Most feedback addressed process-related aspects (grand mean proportion of process-related idea units, 0.97; 95% CI, 0.95-0.98). Polite language was more prevalent in negative vs positive feedback (mean [SE] proportion of feedback with politeness strategies, 0.50 [0.04] vs 0.15 [0.02]; P < .001), regardless of clinical outcome.</p><p><strong>Conclusions: </strong>The study identified outcome bias in the evaluation of GP residents, with adverse clinical outcomes leading to lower scores and more negative, specific, process-focused feedback. Although such feedback can enhance learning, it may also hinder learning by triggering negative emotions. The findings emphasize the educational value of diagnostic errors but stress the need for objective assessment strategies to optimize learning opportunities.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250690","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":"Training Toward Health Justice: A Review of Community-Engaged Training in Primary Care Residency Programs in the United States.","authors":"Heather A Klusaritz, Kara Johnson, Laura Igarabuza, Giang T Nguyen, Elizabeth Harmon, Michael Bozzi, Peter F Cronholm","doi":"10.1097/ACM.0000000000006123","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006123","url":null,"abstract":"<p><strong>Purpose: </strong>A community-engaged approach to medicine, particularly primary care, is effective for health promotion. There is, however, limited evidence and no consensus on best training practices to ensure that physicians are trained adequately to practice community-engaged medicine. To define and determine how to fill this gap, the authors conducted a systematic review of literature on community-engaged activities in primary care resident training programs. The study sought to evaluate the quality of studied interventions and assess future research needs.</p><p><strong>Method: </strong>For this systematic review, the study team searched PubMed, MEDLINE, and PsycINFO using key search terms related to graduate medical education, community engagement activities, and potential outcomes. The team selected and reviewed all English-language articles published through December 2024 that described interventions in which primary care residents participated in activities that occurred in community-based settings. The team analyzed studies with quantitative and qualitative results. They assessed study quality using the Medical Education Research Study Quality Instrument (MERSQI) and assessed the quality of the community-engaged educational activity using a novel instrument called the Medical Education Engagement Quality Index (MEEQI).</p><p><strong>Results: </strong>The study team identified and reviewed the full texts of 29 articles (10 quantitative, 10 qualitative, and 9 quantitative and qualitative articles). Interventions included community engagement activities with varied settings, study length, and learning objectives. Outcomes included a change in attitudes, knowledge, skills, and career choices. The mean MERSQI score was 9.0 (range, 5.5-11.5), and the mean MEEQI score was 6.2 (range, 4.0-10.0).</p><p><strong>Conclusions: </strong>The authors' findings revealed limited quality and substantial variability of the current literature. Future research should use more rigorous evaluation methods to determine which community-engaged curricular components can most effectively provide primary care resident physicians with the skills needed to provide high-quality primary care, particularly for vulnerable populations.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250693","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":"Macy Foundation Innovation Report Part II: From Hype to Reality: Innovators' Visions for Navigating AI Integration Challenges in Medical Education.","authors":"Brian C Gin, Kate LaForge, Jesse Burk-Rafel, Christy K Boscardin","doi":"10.1097/ACM.0000000000006117","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006117","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence (AI) promises to significantly impact medical education, yet its implementation raises important questions about educational effectiveness, ethical use, and equity. In the second part of a 2-part innovation report, which was commissioned by the Josiah Macy Jr. Foundation to inform discussions at a conference on AI in medical education, the authors explore the perspectives of innovators actively integrating AI into medical education, examining their perceptions regarding the impacts, opportunities, challenges, and strategies for successful AI adoption and risk mitigation.</p><p><strong>Method: </strong>Semi-structured interviews were conducted with 25 medical education AI innovators-including learners, educators, institutional leaders, and industry representatives-from June to August 2024. Interviews explored participants' perceptions of AI's influence on medical education, challenges to integration, and strategies for mitigating challenges. Transcripts were analyzed using thematic analysis to identify themes and synthesize participants' recommendations for AI integration.</p><p><strong>Results: </strong>Innovators' responses were synthesized into 2 main thematic areas: (1) AI's impact on teaching, learning, and assessment, and (2) perceived threats and strategies for mitigating them. Participants identified AI's potential to enact precision education through virtual tutors and standardized patients, support active learning formats, enable centralized teaching, and facilitate cognitive offloading. AI-enhanced assessments could automate grading, predict learner trajectories, and integrate performance data from clinical interactions. Yet, innovators expressed concerns over threats to transparency and validity, potential propagation of biases, risks of over-reliance and deskilling, and institutional disparities. Proposed mitigation strategies emphasized validating AI outputs, establishing foundational competencies, fostering collaboration and open-source sharing, enhancing AI literacy, and maintaining robust ethical standards.</p><p><strong>Conclusions: </strong>AI innovators in medical education envision transformative opportunities for individualized learning and precision education, balanced against critical threats. Realizing these benefits requires proactive, collaborative efforts to establish rigorous validation frameworks; uphold foundational medical competencies; and prioritize ethical, equitable AI integration.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250691","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":"An Asynchronous Online Course to Introduce Interprofessional Education to Incoming Health Professions Students.","authors":"Laurel Daniels Abbruzzese, Urmi A Desai, Ashley Kingon, Michelle N Skelton, Phyllis R Simon, Jean N Churchill, Jordana Vanderselt, Letty Moss-Salentijn","doi":"10.1097/ACM.0000000000006121","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006121","url":null,"abstract":"<p><strong>Problem: </strong>Interprofessional practice and education (IPE) (educators and learners from ≥2 health professions) can improve patient health outcomes and is required for most health professional program accreditation. Conflicting academic schedules and space limitations are obstacles to implementing interprofessional learning experiences that prepare future clinicians for team-based care.</p><p><strong>Approach: </strong>In February 2019, an asynchronous online course (eCUIMC) was created at Columbia University Irving Medical Center (CUIMC) to equip incoming health professions students to deliver team-based health care and engage in IPE without a shared space and time. eCUIMC oriented first-year students to the IPE core competencies: (1) values and ethics for interprofessional practice, (2) roles and responsibilities, (3) interprofessional communication, and (4) teams and teamwork. Participants were assigned to interprofessional teams of 8 students and 2 faculty. During a 5-day period in fall 2019 and 2020, participants completed interactive activities, performed a clinical case study, facilitated discussions, and completed a self-directed learning activity addressing structural determinants of health. Students completed a pre-post survey of beliefs and attitudes using the 21-item Interprofessional Socialization and Valuing Scale, which uses a 7-point scale to assess the change in interprofessional socialization after interprofessional education, with 1 indicating not at all and 7 indicating to a very great extent.</p><p><strong>Outcomes: </strong>A total of 1,345 participants, representing 10 different health professional programs, completed course evaluations and a pre-post survey of attitudes. Most students found the course engaging, relevant, and manageable, with 1,267 (94%) reporting increased understanding of other health professions. Mean Interprofessional Socialization and Valuing Scale scores increased from 4.5 to 5.8 (P < .001).</p><p><strong>Next steps: </strong>eCUIMC is a feasible and effective modality for uniting students from different health profession programs where time and space are barriers. eCUIMC is being integrated into the curriculum as an annual requirement for all 10 CUIMC health professions programs.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250689","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":"Proposing a Research Agenda for Situational Judgment Tests in U.S. Medical School Admissions.","authors":"Ioannis Koutroulis, Alexandra H Vinson","doi":"10.1097/ACM.0000000000006118","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006118","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217415","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 Moineau and León-Bórquez.","authors":"Abida Shaheen, Fahad Azam","doi":"10.1097/ACM.0000000000006116","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006116","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210121","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":"Vicarious Trauma and Medical Student Engagement.","authors":"Charles D Anderson","doi":"10.1097/ACM.0000000000006113","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006113","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210127","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":"Macy Foundation Innovation Report Part I: Current Landscape of Artificial Intelligence in Medical Education.","authors":"Christy K Boscardin, Raja-Elie E Abdulnour, Brian C Gin","doi":"10.1097/ACM.0000000000006107","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006107","url":null,"abstract":"<p><strong>Abstract: </strong>The rapid emergence of artificial intelligence (AI), including generative large language models, offers transformative opportunities in medical education. This proliferation has generated numerous speculative discussions about AI's promise but has been limited in delivering a comprehensive analysis to distinguish evidence-based utility from hype while identifying context-specific limitations.In this first part of a two-part innovation report, commissioned by the Josiah Macy Jr. Foundation to inform the discussions at a conference on AI in medical education, the authors synthesize the landscape of AI in medical education, underscoring both its potential advantages and inherent challenges. To map the AI landscape, they reviewed 455 articles that targeted five medical education domains: (1) Admissions, (2) Classroom-Based Learning and Teaching, (3) Workplace-Based Learning and Teaching, (4) Assessment, Feedback, and Certification, and (5) Program Evaluation and Research.In admissions, AI-driven strategies facilitated holistic applicant reviews through predictive modeling, natural language processing, and large language model-based chatbots. Preclinical learning benefited from AI-powered virtual patients and curriculum design tools that managed expanding medical knowledge and supported robust student practice. Within clinical learning, AI aided diagnostic and interpretive processes, prompting medical education curricula to demand relevant AI competency and literacy frameworks. A few studies reported that assessment and feedback processes became more efficient through automated grading and advanced analytics, which reduced faculty workload and offered timely, targeted feedback. Program evaluation and research gained additional insights using AI on careers, diversity, and performance metrics of faculty and learners, improving resource allocations and guiding evidence-based approaches.Despite these possibilities, bias in AI algorithms, concerns about transparency, inadequate ethical guidelines, and risks of over-reliance highlighted the need for cautious, informed AI implementation. By mapping AI tasks to medical education applications, the authors provide a framework for understanding and leveraging AI's potential while addressing technical, ethical, and human-factor complexities in this evolving field.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210123","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}