Academic Medicine最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-04","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}

{"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":"https://doi.org/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 (F2,27 = 7.73, P = .002) and screenings (F2,27 = 9.60, P < .001) but not lab testing (F2,27 = 2.88, P = .07) or disease control (F2,27 = 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":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-03","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":"Glow in the Dark: Promotion Pathways for the Academic Nocturnist.","authors":"Jessica Y Chambers, Kathleen Atlas, Alexander Rittenberg, John N George, Meggan Forbes, Nila Radhakrishnan","doi":"10.1097/ACM.0000000000006057","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006057","url":null,"abstract":"<p><strong>Abstract: </strong>Nocturnists are clinicians from multiple specialties who work predominantly at night. Although the nocturnist role has expanded, little to no literature addresses their career trajectories. Given their temporal isolation from diurnal colleagues, nocturnists have noted concerns of career stagnation and lack of mentorship, highlighting an inability to harness career development and promotion opportunities without leaving night work. This article outlines strategies for nocturnists to leverage their unique clinical and educational experiences to develop scholarly niches, enhance job satisfaction, and build promotion-worthy portfolios. Drawing on real-world examples from academic nocturnists, the authors explore opportunities in 3 key domains-educational service, clinical care, and health systems leadership-and how each can be leveraged to enhance scholarly productivity. Strategies to address barriers, such as the physical hardships of night shift work, the need to sleep during daytime professional development activities, frequent turnover, and generally negative attitudes from trainees regarding night shift work, include flexible scheduling, structured mentorship programs, and institutional recognition of nocturnist contributions. By leveraging these approaches and receiving institutional support, nocturnists can achieve academic success, contribute to the medical literature, and advance toward promotion.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765798","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 Importance of Sexual History-Taking Within Surgery.","authors":"Justine O Chinn, Mary T Hawn","doi":"10.1097/ACM.0000000000005965","DOIUrl":"10.1097/ACM.0000000000005965","url":null,"abstract":"<p><strong>Abstract: </strong>Sexual and reproductive health is an essential part of comprehensive medical care. As the field of medicine becomes more specialized and siloed and the diagnostic workup in surgery more advanced, the risk of anchoring diagnoses and partitioning of care increases. Thus, the fundamentals of a complete patient history and review of each body system remain critical in ensuring that surgeons establish a broad differential diagnosis; provide comprehensive, well-rounded care to patients; and create opportunities for patient counseling and interventions. The article by Coleman and colleagues reports on an intervention that did not result in trainees being more likely to take a sexual history; however, the intervention group did ask significantly more questions regarding sexual health than the comparison group when they did take a sexual history. They highlight that there is a persistent gap in sexual history-taking, and that this results in potential misdiagnoses as well as missed opportunities to counsel patients about sexual and reproductive health. Clinicians have a responsibility to recognize factors that increase risk for their patients and provide appropriate counseling, which they cannot do if they are not asking all the necessary questions, even the difficult ones.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"410-412"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928353","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":"Meaningful Patient Participation in Health Care Education: A Theoretically Informed Study Exploring Boundaries and Identities.","authors":"Amber Bennett-Weston, Simon Gay, Elizabeth S Anderson","doi":"10.1097/ACM.0000000000005919","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005919","url":null,"abstract":"<p><strong>Purpose: </strong>After recent policy and practice changes, health care schools are expected to involve patients as partners in the management, design, and delivery of professional curricula. However, what these partnerships mean for academic communities and the processes needed to support them are not yet understood. This study examines what involving patients as partners within an academic community means for key stakeholders.</p><p><strong>Method: </strong>A qualitative case study design with a social constructivist philosophical stance was used. Communities of practice served as the theoretical framework. Semistructured interviews were conducted with patients and educators from the University of Leicester between November 2021 and May 2022. Focus groups were held with penultimate-year students. Data were analyzed using reflexive thematic analysis informed by communities of practice.</p><p><strong>Results: </strong>The sample comprised 40 participants. Ten patients and 10 educators participated in 40- to 60-minute interviews. Twenty students participated in 1 of 5 focus group discussions lasting 30 to 50 minutes. Two overarching themes were reported: \"boundaries as (permeable) barriers to participation\" and \"identity as an interpretive lens.\" Boundaries among patients, educators, and students can hinder patients' meaningful involvement in health care education. Boundaries are marked through differences in knowledge, a lack of shared vision, and a lack of trust in patients. Patients, educators, and students have separate distinct identities. They experience tensions of identity when they meet across boundaries. These tensions reveal insights into the construction of the typical patient identity in health care education.</p><p><strong>Conclusions: </strong>Applying communities of practice illuminated boundary and identity issues that patients, educators, and students experience when patients are involved in health care education. Health care schools should develop comprehensive training for patients, provide faculty development regarding patient involvement, support students to trust in patient teachers, and embed a distinctive strand of patient involvement across health care curricula.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"466-474"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711961","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 of Communication, Engagement, and Well-Being With Turnover Among Faculty at a Large Academic Health Care and Research System.","authors":"Fares Qeadan, Mindy J Vanderloo, Megan Call, Rose Thornquist, Benjamin Tingey, Ellen Morrow, Amy Locke","doi":"10.1097/ACM.0000000000006055","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006055","url":null,"abstract":"<p><strong>Purpose: </strong>Burnout among health care professionals is associated with turnover and significant costs. This study explored the association between self-reported communication, engagement, and employee well-being and department turnover among faculty at an academic medical institution.</p><p><strong>Method: </strong>This study used engagement survey data from an annual survey administered to all faculty at the University of Utah School of Medicine. Data sources included individual self-reported survey data collected in February 2022 and subsequent department-wide turnover counts captured across academic year 2023 (July 1, 2022, to June 30, 2023). Domain scores for communication, engagement, and well-being were constructed for participants, averaged across each department, and compared against matching department turnover in the following academic year. A principal component analysis was conducted to derive a weighted index score of wellness domains and fit in a negative binomial regression to assess its association with the ensuing turnover rate. Model R2 values determined predictive ability.</p><p><strong>Results: </strong>Nineteen departments with 2,084 faculty members met the inclusion criteria of the study. There was a decreasing trend between all 3 wellness domain scores and turnover, such that departmental turnover rates were lower at higher reported departmental wellness domain scores. A stronger decreasing trend was observed between turnover and the weighted index wellness score, with a 1-unit (approximately 20%) increase in this score being associated with a significant decrease of 32% in the rate of turnover across departments (incidence rate ratio, 0.68; 95% CI, 0.58-0.80; P < .001). The weighted index wellness score explained 53% of variation in departmental turnover (R2 = 0.53).</p><p><strong>Conclusions: </strong>Strong communication, engagement, and well-being were significantly associated with decreased turnover among faculty within this organization. The strong association between turnover and the weighted index score indicates that a multipronged approach to improving workplace culture could be most effective at reducing turnover.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765790","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":"\"Having Support at Work 'Is Different' and Important\": A Qualitative Study of Virtual Peer Discussion Groups With Medical School Faculty.","authors":"Chantal M L R Brazeau, Manasa S Ayyala, Ping-Hsin Chen, Margaret Swarbrick","doi":"10.1097/ACM.0000000000005916","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005916","url":null,"abstract":"<p><strong>Purpose: </strong>In response to the need to support health care professionals during the COVID-19 pandemic, an innovative, peer-led discussion group program for medical school faculty, called CIRCLE (Colleague Involved in Reaching Colleagues through Listening and Empathy), was developed at Rutgers Health. This article describes results of a qualitative analysis of the participants' experiences, explores virtual communication platform use during this peer support program, and identifies the program's beneficial elements.</p><p><strong>Method: </strong>CIRCLE was inaugurated in October 2020 at Rutgers New Jersey Medical School and Rutgers Robert Wood Johnson Medical School using evidence-informed topics. The inaugural CIRCLE peer-led discussion groups included 50 physicians who met twice monthly in groups of 5 to 8 between October 2020 and April 2021. Deidentified transcript data were iteratively reviewed using conventional content analysis, including familiarization, thematic framework creation, indexing, charting, mapping, and interpretation. Themes were grouped into 4 conceptual framework categories based on social support theory in context of work-related stress: emotional, appraisal, informational, and instrumental support.</p><p><strong>Results: </strong>Themes emerged based on the framework: emotional support (connecting on a deeper level, importance of support at work, COVID-19 made virtual connections needed and relevant), appraisal support (feeling \"not alone,\" safe space to connect and share), informational support (sharing self-care strategies), and instrumental support (incentives to join are helpful but connection leads to engagement, some structure but \"not too much\" is important, virtual modalities are convenient and conducive to connection).</p><p><strong>Conclusions: </strong>Benefits of peer discussion groups include deeper connections at work, reduced isolation, safe sharing, and exchange of information on self-care. Connection and balancing structure and autonomy were important to engagement. Virtual modalities were viewed as feasible, convenient, and conducive to connection. This article highlights the benefits and convenience of virtual peer-led discussion groups for medical school clinical faculty and provides evidence for content development of these programs.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"459-465"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712011","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":"Integrating Generative Artificial Intelligence Into Medical Education: Curriculum, Policy, and Governance Strategies.","authors":"Marc M Triola, Adam Rodman","doi":"10.1097/ACM.0000000000005963","DOIUrl":"10.1097/ACM.0000000000005963","url":null,"abstract":"<p><strong>Abstract: </strong>The rapid advancement of generative artificial intelligence (GAI) is poised to revolutionize medical education, clinical decision-making, and health care workflow. Despite considerable interest and a surfeit of newly available tools, medical educators largely lack both competencies and guidance on how to incorporate the new and rapidly evolving world of GAI into the core medical school curriculum and experiences of undergraduate medical education. This Scholarly Perspective highlights the need for medical schools to adapt to this new paradigm by implementing policies, governance, and curricula that address the ethical, technical, and pedagogical implications of GAI. The authors recommend creating policies for appropriate GAI use, designed to protect institutional and patient data, and provide students with clarity on the appropriate use of AI for education. The authors suggest that implementing GAI governance at institutions is crucial to create guiding principles on ethical and equitable GAI use and involving students as coinventors of local innovation. The authors argue that providing faculty and learners with tools and training for safe experimentation with GAI and defining competencies for students and faculty are essential. Curricula for GAI should focus on implications of clinical uses. The authors propose a set of new competencies for GAI that build on those already established for AI in general. Given how dynamic the world of GAI is and how quickly new innovations are changing longstanding practices of clinical medicine, it is imperative that the medical education community acts together to share best practices, gather data to assess the impact of GAI education, continuously update the expected competencies of medical students, and help students prepare for a career that will be continually changed by GAI.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"413-418"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869747","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":"Creating More Reliable Large Language Models in Medical Education.","authors":"Nicholas J Cione, Malford T Pillow","doi":"10.1097/ACM.0000000000006058","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006058","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765796","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":"Unveiling Potential: Achieving Mission by Integrating Enrollment Management With Identity-Masked Holistic Admissions Practices.","authors":"Crystal I Bryce, Gisele Armond Abron, Amanda M Lynn, Brigham C Willis, Sunny Nakae","doi":"10.1097/ACM.0000000000005918","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005918","url":null,"abstract":"<p><strong>Purpose: </strong>Holistic review for admissions is designed to mitigate the common systemic barriers applicants may face in their medical school application journey and the common mistakes committed by admissions committees, but limited literature outlines how this can be modeled. This study examined a blinded holistic admissions approach that emphasized mission and value alignment and the resulting characteristics of applicants by admission status.</p><p><strong>Method: </strong>Application data from 2,027 applicants to The University of Texas at Tyler School of Medicine with complete secondary applications for the 2022 to 2023 cycle were analyzed. Applicants were categorized by the most advanced stage they reached in the admissions process: not selected for interview (n = 1,742), interviewed (n = 239), or accepted (n = 46). Data included information on students' geographic ties to East Texas, institutional mission alignment, academic preparation information, and Computer-Based Assessment for Sampling Personal Characteristics (CASPer) test results.</p><p><strong>Results: </strong>In the not selected for interview and interviewed groups, mission commitment was significantly negatively associated with geographic ties ( r = -0.189 and -0.209., respectively) and academic preparation ( r = -0.195 and -0.241, respectively). In the not selected for interview group, higher mission commitment scores were significantly associated with lower CASPer scores ( r = -0.110). In the interviewed group, higher geographic ties were significantly associated with lower academic preparation ( r = -0.143) and lower CASPer scores ( r = -0.280). Demographically, the accepted group had higher than expected counts of individuals who reported free or reduced lunch eligibility (14 vs 8), Pell Grant eligibility (22 vs 12), and family incomes of less than $50,000 per year (14 vs 6).</p><p><strong>Conclusions: </strong>This study demonstrates successful and effective implementation of a mission-aligned holistic admissions process, with accepted students exemplifying the mission of the institution and representing traditionally underrepresented groups.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"480-489"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711979","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}