Academic Medicine最新文献

{"title":"A State-of-the-Art Review of the Historical Evolution of the Graduate Medical Educator Role.","authors":"Morgan Congdon, Katherine Schultz, Jerusalem Merkebu, Lara Varpio","doi":"10.1097/ACM.0000000000006171","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006171","url":null,"abstract":"<p><strong>Purpose: </strong>The role of the medical educator has evolved from being simply an educator of a learner apprentice to many different roles, such as mentor, assessor, and role model. This study examines how the conceptualization of the role of medical educators in graduate medical education (GME) has evolved over time.</p><p><strong>Method: </strong>The authors conducted a state-of-the-art literature review to explore (1) the current conceptualization of the roles of medical educators in GME, (2) how this conceptualization came to be, and (3) how we might revise this conceptualization to advance future work. The authors searched Scopus in May 2023 and selected sentinel articles broadly adopted in the medical education literature (24 journals) and then cross-checked the search strategy in Web of Science. The search was updated in both databases in March 2025. No time limits were imposed on the searches. The authors screened 4,468 articles from Scopus, 2,571 from Web of Science, and 82 from hand search.</p><p><strong>Results: </strong>From 1972 to March 2025, 30 roles appeared across the 55-article corpus. The germinal years showed educators as learner-centered role models. Transition points included (1) 1990s (broadening of educator roles relevant to professional development), (2) early 2000s (roles focused on society at large), and (3) 2010s (multiple tensions for the expanding roles of today's educator).</p><p><strong>Conclusions: </strong>The conceptualization of GME educators has expanded greatly over time. Reconciling, supporting, and anticipating roles will be important as GME educators continue to adapt to society's evolving needs, with implications for essential faculty development initiatives.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683556","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 Really Matters: A Qualitative Study of Student Perspectives on Exceptional Teaching.","authors":"A J Haas, George F Blackall, Wendy Osei-Bonsu, Emma Y Wu, Heather Costigan, Heather L Stuckey","doi":"10.1097/ACM.0000000000006172","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006172","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify characteristics that define exceptional teachers and provide recommendations for teaching in medical education.</p><p><strong>Method: </strong>A total of 3,409 student narratives that described characteristics of exceptional teachers were curated from August 2017 to January 2022 at Penn State College of Medicine. Narratives were submitted voluntarily in response to a single, open-ended question: \"Please tell us about what those teachers did that resulted in an exceptional educational experience and how it changed you?\" Narrative lengths varied, with a mean (SD) of 78.4 (58.0) words (range, 2-776). A systematically selected subset (n = 872) was analyzed using an inductive approach. After codebook development, 3 independent coders analyzed data (pooled Cohen κ = 0.77), organizing codes into themes and subthemes.</p><p><strong>Results: </strong>Three key themes (8 subthemes) were identified: (1) challenging and practical learning opportunities were embraced by students as a source of growth (being challenged with progressive complexity while simultaneously feeling supported, making the most of natural learning opportunities, and growing from judicious, actionable, and frequent feedback); (2) being included and valued as part of the team encouraged learners to contribute, to exercise autonomy, and to work alongside others as a colleague (being accepted and integrated as part of the team, receiving guided autonomy in interactions and responsibilities with patient care, and feeling respected as a teammate and future colleague); and (3) demonstrating enthusiasm for teaching and patient care, combined with a humanistic approach to role modeling, was inspirational to students (witnessing passion for teaching and caring for students and drawing inspiration from authentic role-modeling).</p><p><strong>Conclusions: </strong>The study findings support 5 recommendations: (1) challenge students while maintaining psychological safety, (2) provide feedback that is frequent and specific, (3) give autonomy for growth, (4) make them part of the team, and (5) cultivate the trainee-to-teacher relationship.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664073","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":"Rethinking Workplace-Based Assessment: The Costly Illusion of Authenticity.","authors":"Chris B T Rietmeijer, Christopher J Watling, Pim W Teunissen","doi":"10.1097/ACM.0000000000006173","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006173","url":null,"abstract":"<p><strong>Abstract: </strong>The current practice of workplace-based assessment (WBA) in many health professions education contexts does not live up to the expectations regarding WBA's both formative (for learning) and summative (for decision-making) potential. In this Scholarly Perspective, the authors argue that the ambition to observe and assess so-called authentic behavior of trainees plays a role in this. According to the literature, for assessments in the workplace to be valid, direct observation of authentic behavior of trainees performing authentic clinical work is key. Guidelines, therefore, advise supervisors to observe their trainees silently from a distance, while avoiding direct eye contact with the patient. If these guidelines are followed, trainee-patient-supervisor situations that could be used for teaching in dialogue, with bidirectional observations, must be transformed into distanced, silent, unidirectional assessments. Research outcomes, however, suggest that direct observation and assessment of true authentic behavior of trainees in true authentic clinical work is an illusion; the presence of an observing supervisor, however distanced, changes the situation and, with that, the conduct of the trainee. Additionally, this illusion is costly because distancing the supervisor from the trainee comes at the expense of teaching and learning in dialogue. Although assessments in the workplace may serve summative purposes, they do not fit well with formative goals of health professions education. Therefore, WBA's current central position in health professions education, which is based on both its summative and formative promises, should be questioned. More specifically, the prominent role of assessment when supervisors are present while their trainee works with a patient should be reconsidered. The authors propose to use these trainee-patient-supervisor situations predominantly for teaching and learning, with bidirectional direct observation and dialogue, and then determine the needs for and purposes of assessment.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664072","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":"Trust the Process.","authors":"Benjamin W Frush","doi":"10.1097/ACM.0000000000006170","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006170","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644096","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":"Well-Being, Work Environment, and Control Over Workload Accounting for Burnout Among Medical School Staff.","authors":"Mohammed A A Abulela, Bethany Schowengerdt, Heather Dorr, Amanda Termuhlen, Claudio Violato","doi":"10.1097/ACM.0000000000006169","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006169","url":null,"abstract":"<p><strong>Purpose: </strong>Research on well-being and burnout of administrative medical school staff has received little attention compared with faculty and learners. This study investigates the extent to which well-being domains, work environment, and control over workload account for administrative staff burnout.</p><p><strong>Method: </strong>The authors developed and administered a comprehensive well-being survey to University of Minnesota Medical School administrative staff (N = 2,367) from April 17 to June 7, 2022, with 1,027 providing complete responses (43% response rate). Ordinal logistic regression was used with 7 independent variables (basics, safety, respect, appreciation, contribution, work environment, and control over workload) and 1 dependent variable (burnout). To identify the amount of variance explained in the outcome variable by each well-being domain, work environment, and control over workload, the authors added each of the 7 independent variables hierarchically.</p><p><strong>Results: </strong>Well-being domains were positively correlated with one another but negatively associated with burnout. Well-being domains, work environment, and control over workload explained approximately 45% of the variance in medical school administrative staff burnout. A one-unit increase in the basics well-being domain and work environment was each associated with 18% reductions in medical staff's burnout. Descriptively, 47 (4.57%), 191 (18.57%), 347 (33.81%), 354 (34.48%), and 88 (8.57%) of the staff reported poor, marginal, satisfactory, good, and optimal control over their workload, respectively. Compared with staff reporting poor control over workload, those who reported satisfactory, good, and optimal control experienced 63%, 70%, and 80% lower levels of burnout, respectively.</p><p><strong>Conclusions: </strong>Although this study affirmed the hierarchical nature of the 5 well-being domains, staff who reported lacking basics, perceived their work environment to be less supportive, or had less control over workload reported higher burnout. Accordingly, ability to control workload, supportive work environment, and focus on foundational basics have the potential to reduce burnout and improve well-being.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644097","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":"Commentary on \"Not Giving Up\".","authors":"Zhaohui Su","doi":"10.1097/ACM.0000000000006168","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006168","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644095","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 Power of First-Generation Medical Students: Mapping the Contours of Belonging in Medical School.","authors":"David A Ansari, Nikki Waltrich, Izziah Thabath, Vivian Nguyen, Vennela Challagondla, Emily R Via, Joanna Michel","doi":"10.1097/ACM.0000000000006163","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006163","url":null,"abstract":"<p><strong>Purpose: </strong>Research frequently portrays the experiences of first-generation medical students in terms of a series of challenges, such as inadequate levels of institutional and, at times, familial support, lack of financial resources, and more stress than their non-first-generation peers. These challenges affect first-generation medical students' sense of belonging in medical school. Studies that address the unique perspectives of this student population tend to focus on students' resilience. This study examines first-generation medical students' reflections on their multiple identities and experiences of marginalization that have shaped their experiences of belonging in medical school.</p><p><strong>Method: </strong>This exploratory, qualitative study assessed 50 medical students between March and July 2024 at a tricampus medical school in a larger Midwestern city who identified as the first in their families to attend medical school. The research team, which included first-generation medical students, developed an interview guide that examined the meanings of first generation and the impact of first-generation status on patient care, self-care, social support, and ideas around flourishing. The data analysis was inductive and data driven.</p><p><strong>Results: </strong>Students situated being first generation with other identities and marginalized positions in medicine. Although students reflected on experiencing insecurity and having to work harder than their peers, they also enumerated the unique perspectives that they bring to medical school and the ways in which their lived experiences will help them relate to patients and other health professionals.</p><p><strong>Conclusions: </strong>Strengths and asset-based approaches are needed to understand the experiences of first-generation medical students. Medical school faculty and administrators seeking to create an inclusive community for all students should take into consideration the multiple layers of identity of first-generation students and the beneficial contributions that their lived experiences can bring to classroom learning and patient care.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610182","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":"Commentary on \"The Loudest Silence\".","authors":"Jacqueline Pflaum-Carlson","doi":"10.1097/ACM.0000000000006164","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006164","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610262","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":"Commentary on The Penitent Magdalen.","authors":"J Brewer Eberly","doi":"10.1097/ACM.0000000000006161","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006161","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610263","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":"Development and Validation of a Model to Predict Milestone Levels Based on Entrustable Professional Activity Entrustment-Supervision Levels.","authors":"Daniel J Schumacher, Benjamin Kinnear, Catherine Michelson, David A Stewart, Bruce E Herman, Adam D Wolfe, Ariel Winn, Jaclyn Boulais, David A Turner, Heather B Howell, Alan Schwartz","doi":"10.1097/ACM.0000000000006165","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006165","url":null,"abstract":"<p><strong>Purpose: </strong>Residency programs are increasingly interested in or required to assess residents using Accreditation Council for Graduate Medical Education (ACGME) milestones and specialty-defined entrustable professional activities (EPAs). The authors aimed to develop a model to predict individual residents' milestone levels based on their assigned EPA entrustment-supervision levels.</p><p><strong>Method: </strong>During 3 academic years from 2021 to 2024, the authors conducted a multisite prospective cohort study at 48 U.S. pediatric residency programs. Programs collected entrustment-supervision levels for the 17 general pediatrics EPAs and milestone levels for the 22 ACGME pediatric milestones for every resident biannually. EPA and milestone ratings were assigned by clinical competency committees. The first 4 of 6 biannual data reporting cycles were used to fit multilevel structural equation models and produce equations to generate, for each resident, predicted milestone levels based on EPA entrustment-supervision levels. They developed 2 models: one using 17 EPAs and one using 12 EPAs.</p><p><strong>Results: </strong>Data used for modeling represented 4,328 residents, with 164,886 total entrustment-supervision levels across the general pediatrics EPAs and 243,949 total milestone levels across the pediatric milestones. The fit of the round 1 to 4 model to the round 1 to 4 data (internal prediction) was excellent for both models, with comparative fit indexes of 0.982 (17 EPAs) and 0.981 (12 EPAs). The ability of the round 1 to 4 model to predict milestones for reporting cycles 5 and 6 (external prediction) was similar to the internal predictions, with correlation coefficients of 0.68 (17 EPAs) and 0.69 (12 EPAs) for round 5 and 0.72 (17 EPAs) and 0.68 (12 EPAs) for round 6.</p><p><strong>Conclusions: </strong>This study demonstrates a strong ability to predict milestone levels based on EPA entrustment-supervision levels in a manner that enables meaningful use of EPAs and milestones in assessment efforts at residency programs.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610180","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}