Academic Medicine最新文献

{"title":"Trainees as Agents of Change: A Theory-Informed Model for Trainee-Driven Curricular Advocacy in Medical Education.","authors":"Lauren Clarke","doi":"10.1097/ACM.0000000000005754","DOIUrl":"10.1097/ACM.0000000000005754","url":null,"abstract":"<p><strong>Abstract: </strong>Trainees (medical students, residents, and fellows) are beginning to make strides in pushing for changes to their education. While there are many examples of successful trainee-led curriculum reform efforts, the path to success remains unclear. To better understand the process of trainee-driven curricular advocacy, the author analyzes this process through the lens of ecological systems theory (EST) not only to provide readers with context for the barriers and facilitators to trainee-driven curricular advocacy but also to further medical education's understanding of the sociopolitical forces influencing the process of trainee-driven curricular advocacy and reform through the lens of the trainee. EST explains how individuals are influenced by a complex web of social and environmental forces. The theory outlines 5 ecological systems of influence: the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Using EST to explore the process of trainee-driven curricular advocacy therefore clarifies the many layers of influence that trainees must navigate while advocating for curriculum change. The author then draws on this theory and their own experience as a medical student advocating for local and national curriculum reform to develop a model to facilitate trainee-driven curricular advocacy in medical education. The proposed model outlines concrete steps trainees can take while going through the process of curricular advocacy both within their own institutions and on a national level. Through developing this model, the author hopes not only to empower trainees to become agents of change in medical education but also to encourage faculty members and administrators within health professional training programs to support trainees in these efforts.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899976","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":"It Is Time to Recognize Health Professions Educator Competencies.","authors":"Julie Browne, Alison Bullock, Derek Gallen, John Jenkins","doi":"10.1097/ACM.0000000000005789","DOIUrl":"10.1097/ACM.0000000000005789","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312217","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":"Learning Plan Use in Undergraduate Medical Education: A Scoping Review.","authors":"Anna Romanova, Claire Touchie, Sydney Ruller, Shaima Kaka, Alexa Moschella, Marc Zucker, Victoria Cole, Susan Humphrey-Murto","doi":"10.1097/ACM.0000000000005781","DOIUrl":"10.1097/ACM.0000000000005781","url":null,"abstract":"<p><strong>Purpose: </strong>How to best support self-regulated learning (SRL) skills development and track trainees' progress along their competency-based medical education learning trajectory is unclear. Learning plans (LPs) may be the answer; however, information on their use in undergraduate medical education (UME) is limited. This study summarizes the literature regarding LP use in UME, explores the student's role in LP development and implementation, and identifies additional research areas.</p><p><strong>Method: </strong>MEDLINE, Embase, PsycInfo, Education Source, and Web of Science databases were searched for articles published from database inception to March 6, 2024, and relevant reference lists were manually searched. The review included studies of undergraduate medical students, studies of LP use, and studies of the UME stage in any geographic setting. Data were analyzed using quantitative and qualitative content analyses.</p><p><strong>Results: </strong>The database search found 7,871 titles and abstracts with an additional 25 found from the manual search for a total of 7,896 articles, of which 39 met inclusion criteria. Many LPs lacked a guiding framework. LPs were associated with self-reported improved SRL skill development, learning structure, and learning outcomes. Barriers to their use for students and faculty were time to create and implement LPs, lack of training on LP development and implementation, and lack of engagement. Facilitators included SRL skill development, LP cocreation, and guidance by a trained mentor. Identified research gaps include objective outcome measures, longitudinal impact beyond UME, standardized framework for LP development and quality assessment, and training on SRL skills and LPs.</p><p><strong>Conclusions: </strong>This review demonstrates variability of LP use in UME. LPs appear to have potential to support medical student education and facilitate translation of SRL skills into residency training. Successful use requires training and an experienced mentor. However, more research is required to determine whether benefits of LPs outweigh the resources required for their use.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437811","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":"Enhancing Clinical Learning Environments: Strategies to Foster Belonging in Graduate Medical Education.","authors":"Holly J Humphrey, David Blumenthal, Patricia Poitevien","doi":"10.1097/ACM.0000000000005860","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005860","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114503","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 Optimal Clinical Learning Environments Through Interprofessional Bedside Rounding Models: Lessons From the iPACE Story.","authors":"Sarah Hallen, Melissa I Zelaya, Patti White, Kalli Varaklis","doi":"10.1097/ACM.0000000000005863","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005863","url":null,"abstract":"<p><strong>Abstract: </strong>The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and implemented at Maine Medical Center in 2016 as part of the Accreditation Council for Graduate Medical Education's Pursuing Excellence in Clinical Learning Environments (CLE) demonstration project. The model is based on the belief that, in optimal CLEs, residents are trained in team-based, interprofessional collaborative care and use clinical care experiences to innovate in the areas of patient safety and quality of care. The model's inclusion of systems engineering principles, such as design thinking, allows teams to design, customize, and iteratively improve their own iPACE model.The iPACE model was further developed and disseminated with support from an American Medical Association Reimagining Residency grant and from the MaineHealth health system's medical education and clinical leadership. iPACE started as a small pilot project on a single inpatient unit and has evolved to become the standard for inpatient team rounds at the bedside. iPACE has received positive feedback from patients, demonstrated benefits to care team members and resident education, and proven its value to the health system through sustained reductions in length of stay and cost of care metrics. The iPACE project has fulfilled MMC's original goal of intentionally redesigning its CLEs to expose residents to high-functioning interprofessional teams with the goal of improving patient care and safety. The model has shown direct learner benefits through increased faculty observation and improved quality of feedback. Interprofessional bedside rounding models like iPACE have the potential to imprint learners with the skills and behaviors essential to provide collaborative patient-centered care. Strategies exist that improve resident and faculty engagement in bedside rounding models like iPACE and should be employed to encourage teaching and learning at the bedside.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114502","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":"Enhancing the Graduate Medical Education Clinical Learning Environment Through Community of Practice Forums.","authors":"James N Woodruff, Monica B Vela, Wei Wei Lee, John F McConville","doi":"10.1097/ACM.0000000000005862","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005862","url":null,"abstract":"<p><strong>Abstract: </strong>An optimal clinical learning environment (CLE) is associated with improved learning and patient care outcomes. Significant concerns exist about the state of the CLE in graduate medical education (GME). Research suggests GME programming falls short in interpersonal aspects of training that promote trainee engagement and psychological safety. Furthermore, published educational interventions in the CLE lack adequate theoretical backing to inform a rational approach to interventions in the CLE that could address these important problems.The authors apply the 2002 work of Etienne Wenger on communities of practice (COP) to address these GME CLE concerns. To distinguish this COP intervention from earlier theoretical work on COPs, the authors refer to this management concept as \"COP forums.\" COP forums favorably influence the GME CLE through effects that complement experiential learning in patient care. COP forums support trainee psychological safety, mentorship from near peers, and opportunities to innovate-effects that can serve as a counterbalance to the time pressures, hierarchy, and compliance culture often experienced in the clinical environment. Deliverables of COP forums, including practice innovation and trainee self-efficacy, can favorably impact organization-wide performance and engagement.This article describes the historical position of COP forums in the evolution of COP theory and outlines the basic structure and function of COP forums. It contrasts COP forums to other COP-related concepts to explain their relevance to the GME CLE. Examples of innovative GME COP forums illustrate the structure and function of these interventions. Finally, the authors call for more research on the impact of COP forums on the GME CLE. To avoid confusion, such scholarship must account for the ongoing evolution of the larger COP framework and target specific dimensions of the theory most pertinent to the medical education research question at hand.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114504","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":"Shifting the Paradigm in Workforce Diversity: Prioritizing an Inclusive Environment in Graduate Medical Education.","authors":"Shaunte Y Anum-Addo, Jessica Hippolyte, Aisha Barber","doi":"10.1097/ACM.0000000000005864","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005864","url":null,"abstract":"<p><strong>Abstract: </strong>A diverse physician workforce is important to achieving the goal of health equity. Recruitment efforts are often the focus of graduate medical education (GME) workforce diversity efforts. However, to achieve the goal of workforce diversity, a foundation of inclusivity is essential to address the experiences of trainees whose race and ethnicity are underrepresented in medicine (UIM).Professional identity formation (PIF) describes the process through which trainees integrate their personal and professional identities as they learn to not only act but feel like they belong in their professional role. The concept of PIF provides a framework to consider how GME leaders can intentionally address inclusivity in training programs. The process of PIF is influenced by many factors including trainees' clinical and non-clinical experiences, their treatment by others, as well as the training program's structure, policy, and physical environment. The authors describe these factors influencing PIF, then through the lens of PIF, describe approaches that programs and institutions have taken to address inclusivity by investing in the workforce, disrupting the hidden curriculum, revisiting policies and procedures, and examining the physical environment.The authors encourage programs, institutions, and the greater GME community to leverage each learning environment's unique strengths and root out challenges to enhance inclusivity for UIM trainees.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114506","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":"Our House Won't Rebuild Itself: Peace, Love, and Hope as Tools to Transform Graduate Medical Education.","authors":"Justin L Bullock, Adelaide H McClintock, Ryan Abe, Markus D Boos, Jennifer A Best","doi":"10.1097/ACM.0000000000005861","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005861","url":null,"abstract":"<p><strong>Abstract: </strong>Graduate medical education (GME), the period of specialty and subspecialty training following attainment of a medical degree, is the final step in a continuum of medical education culminating in independent physician practice. This manuscript uses the metaphor \"our house\" to describe all aspects of the GME environment in which health care professionals and trainees learn and work. Our house's inhabitants have unequivocally stated that our house is in a state of disrepair. While physicians-in-training inevitably face challenges on their journey to independent practice, those from historically marginalized backgrounds face these challenges compounded by the disproportionate impact of identity-based harms. The authors use critical and liberatory theories to explore dominant power dynamics in GME, classifying identity-based harms as silence, pain, and despair. To strive for true transformation, the authors advocate for a new set of house rules, a different way of co-existing based on the principles of liberatory design. The authors call on readers to rebuild the house of GME by drawing parallels between the foundational human values of peace, love, and hope and the educational principles of psychological safety, identity safety, and belonging. To transform GME, our community must make space in our house for all individuals to join, and indeed, to rebuild together.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114505","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":"Toward a More Perfect Union.","authors":"Louis W Sullivan","doi":"10.1097/ACM.0000000000005865","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005865","url":null,"abstract":"<p><strong>Abstract: </strong>In this essay, the author, Dr. Louis Sullivan, describes his life experiences, having been born in the American South during the period of legal racial segregation. Despite many obstacles, Dr. Sullivan became a physician who founded the predominantly Black Morehouse School of Medicine and served as Secretary of the United States Department of Health and Human Services.In his efforts to improve the health of people from historically marginalized groups, including Black and Brown people as well as those experiencing poverty, Dr. Sullivan organized the Association of Minority Health Professions Schools. He chaired the Sullivan Commission to evaluate the strategies developed to increase the number of Black physicians in the nation. He supported development of the Office for Women's Health and led efforts to create the National Institute for Minority Health and Health Disparities, both at the National Institutes of Health. When reflecting on his achievements, Dr. Sullivan cites his many mentors and allies who supported him in his career.Despite significant, ongoing resistance to current efforts to advance diversity, equity, and inclusion in our society, Dr. Sullivan is optimistic that progress toward this goal will continue to be made. He imparts lessons about persistence and positivity and reflects on several initiatives to advance diversity, equity, and inclusion in the health professions and in our society more broadly.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114507","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":"Continuity of Care Explains Disparities Between Faculty and Trainee Practice in Residency Clinics.","authors":"Bryce A Ringwald, Jennifer L Middleton","doi":"10.1097/ACM.0000000000005852","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005852","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019424","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}