Academic Medicine最新文献

{"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}

{"title":"Sexual History-Taking in a Surgery Clerkship Assessment: A Stubborn Clinical Skills Gap With Reproductive Health Care Implications.","authors":"Taylen Coleman, Dylan T Adamson, Hannah Marshall, Jensen Smith, Tiffany Wright, Carrie A Bohnert, M Ann Shaw, Laura A Weingartner","doi":"10.1097/ACM.0000000000005939","DOIUrl":"10.1097/ACM.0000000000005939","url":null,"abstract":"<p><strong>Purpose: </strong>Patients present with sexual and reproductive health needs in various clinical settings, so knowing when and how to elicit a relevant sexual history is critical in any specialty. This work examined whether reinforcing the surgical relevance of sexual health with an integrated training improved third-year medical students' sexual history-taking.</p><p><strong>Method: </strong>Third-year surgery clerkship standardized patient assessments were video coded from a 2021-2022 comparison and 2022-2023 intervention cohort (University of Louisville School of Medicine). The case used for both cohorts involved a 38-year-old patient assigned female at birth presenting with acute right lower abdominal pain. Before the assessment, the intervention cohort received an additional clerkship didactic session focused on evaluation and assessment of the acute abdomen emphasizing the importance of sexual history-taking for surgical patients. The frequency of sexual histories attempted, number of questions, topics discussed, and differential diagnoses were compared.</p><p><strong>Results: </strong>There was not a significant difference between cohorts' sexual history-taking frequency: 61% (72/119) of students in the comparison cohort, compared to 65% (86/132) in the intervention cohort. On average, students in the intervention group asked 6 questions related to sexual health, compared to 3 questions by students in the comparison group ( P < .001). Across cohorts, 66% (104/158) of students who took a sexual history considered sexual diagnoses on their differential, compared to only 23% (21/93) of students who did not take a sexual history ( P < .001).</p><p><strong>Conclusions: </strong>Reinforcing the clinical relevance of sexual history-taking for surgical patients was associated with higher-quality histories and broader differentials but not higher rates of sexual history-taking. Because there is now variability in how reproductive health care can be delivered across the United States, medical educators must refocus on sexual history-taking skills in a variety of settings and work to address barriers preventing students from collecting this information.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"438-444"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774396","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":"Validity Evidence for Using Virtual, Interactive Patient Encounters to Teach and Assess Clinical Reasoning for First-Year Medical Students.","authors":"John K Roberts, Nancy Weigle, James W Fox, Sreeja Natesan, David Gordon, Saumil M Chudgar","doi":"10.1097/ACM.0000000000005952","DOIUrl":"10.1097/ACM.0000000000005952","url":null,"abstract":"<p><strong>Purpose: </strong>Despite universal agreement on the importance of clinical reasoning skills, inadequate curricular attention to these skills remains a problem. To facilitate integration of clinical reasoning instruction and assessment into the preclerkship phase, the authors created a clinical reasoning curriculum using technology-enhanced patient simulations.</p><p><strong>Method: </strong>In 2023, first-year medical students at Duke University School of Medicine were enrolled in a biomedical science course using diagnostic reasoning sessions and 16 virtual, interactive patient (VIP) encounters to teach and assess clinical reasoning. The encounters were enhanced with interactive pop-in windows that assessed multiple clinical reasoning domains. Student responses were independently evaluated by faculty. Cumulative VIP clinical reasoning composite (CRC) scores were calculated, and growth mixture modeling was used to define students by growth trajectory. Clinical reasoning was assessed in a summative objective structured clinical examination (OSCE).</p><p><strong>Results: </strong>Of the 118 students who participated in the curriculum, 1 was excluded from analysis for inadequate participation in the VIP encounters, leaving 117 students. The aggregate VIP encounter response rate was 95% (1,783 of 1,872 assessments completed). Clinical reasoning was assessed through cumulative performance across multiple domains. The mean (SD) scores were 58 (13) for information gathering, 46 (13) for illness script identification, 64 (14) for hypothesis generation, 59 (12) for differential diagnosis, and 77 (21) for management and plan. To identify latent classes of growth in cumulative VIP-CRC scores, growth mixture modeling was performed for 1-, 2-, and 3-class models. The 2-class model showed the best fit due to having the lowest bayesian information criterion (11,765.17) and Akaike information criteria (11,737.55).</p><p><strong>Conclusions: </strong>Integrated clinical reasoning instruction and deliberate, formative practice through authentic simulations were effective at teaching and assessing clinical reasoning in the preclerkship phase. VIP and OSCE can be used to identify students at risk of low performance in the clerkship year.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"445-452"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848378","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":"Electronic Flashcards in Health Professions Education: A Scoping Review.","authors":"Philip D Barrison, Emily A Balczewski, Emily Capellari, Zach Landis-Lewis, Alexandra H Vinson","doi":"10.1097/ACM.0000000000005968","DOIUrl":"10.1097/ACM.0000000000005968","url":null,"abstract":"<p><strong>Purpose: </strong>Electronic flashcards (EFs) are a widely used learning resource in medical education. This scoping review provides a comprehensive overview of the existing empirical research on EFs and a direction for future research on EF interventions. The authors organized the reviewed articles into 4 nonmutually exclusive categories: development, delivery, utilization, and associated outcomes.</p><p><strong>Method: </strong>In this scoping review, search queries were composed for 6 databases (PubMed, Embase, Education Resource Information Center, Web of Science, PsychInfo, and the Cumulative Index to Nursing and Allied Health Literature). The database search was conducted on April 12, 2024, for articles published before this date using the following keywords (as well as other keywords): anki, quizlet, firecracker, osmosis, flashcard , spaced repetition , spaced interval training , spaced interval learning , spaced test , and parallel curriculum. Two reviewers screened the studies for eligibility and performed data extraction between August 12, 2024, and September 26, 2024.</p><p><strong>Results: </strong>Sixty-four studies were included in the review. Most articles were published in the last 6 years (2019-2024) (49 [77%]), in the United States (45 [7%]), and in the context of undergraduate medical education (42 [66%]). The studies predominantly focused on the utilization (51 [78%]) and associated outcomes (38 [59%]) of EFs. In contrast, EF development (12 [19%]) and delivery methods (16 [25%]) were less frequently examined.</p><p><strong>Conclusions: </strong>This review of the rapidly increasing body of research on EFs suggests broad use and satisfaction among health professions learners; however, much work remains to be done to systematically understand EF development and delivery. Future research directions may consider more systematic investigations of how decisions made during the development and delivery of EFs affect downstream use and learning outcomes. Addressing these gaps will deepen the understanding of how EFs affect medical education pedagogy and facilitate their informed integration and refinement within curricula.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"497-506"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958385","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":"Variability in Learner Performance Using the ACGME Harmonized Milestones During the First Year of Postgraduate Training.","authors":"Sally A Santen, Michael S Ryan, Tonya L Fancher, Tyler Carcamo, Sean O Hogan, Laurah Turner, Jeffery J H Cheung, Kate Berg, Moshe Feldman, Eric S Holmboe, Yoon Soo Park","doi":"10.1097/ACM.0000000000006053","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006053","url":null,"abstract":"<p><strong>Purpose: </strong>Postgraduate medical training in the United States requires formative assessments of learners using the Accreditation Council for Graduate Medical Education (ACGME) milestones system. With Milestones 2.0, Harmonized Milestones (HMs) for 4 competency domains (professionalism, communication and interpersonal skills, systems-based practice, and practice-based learning and improvement) across specialties were developed. Performance of postgraduate trainees across specialties and at the transition to residency can be explored with the HMs. This study examined the factors that contribute to the variability in the assessments of postgraduate year 1 (PGY-1) learners as measured using Milestones 2.0.</p><p><strong>Method: </strong>This retrospective study assessed national ACGME HM data from PGY-1 residents at U.S. medical schools in July 2021 and 2022 from the 6 largest specialties: emergency medicine, family medicine, internal medicine, general surgery, psychiatry, and pediatrics. Variance component analyses were conducted using cross-classified random-effects models, accounting for clustering; estimated variance components were used to generate inference on contribution of learner variability due to residency program, medical school, and specialty and make inferences on HM rating practices, including straight-lining.</p><p><strong>Results: </strong>The sample included 57,132 PGY-1 residents (2,430 programs). Specialty accounted for the largest variance (22%) across HM competency domains. Within specialty, variance components for trainees, residency programs, and medical schools accounted for 22%, 35%, and 2% of total variance, respectively. Straight-lining was found at 6 months for 6,827 of 56,804 PGY-1 residents (12%), with the greatest amount in surgery (2,105 of 5,559 [38%]).</p><p><strong>Conclusions: </strong>This study found variability in HM performance across 6 specialties due to medical schools, specialty, residency programs, and trainees with limited variability attributed to medical school and learner. Substantial differences across specialties call for the need for clinical educators, researchers, and accreditors to create a shared mental model to bolster the evaluative strength of milestones and prepare residents for the needs of health care.</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":"143765804","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":"Premedical Course Requirements in U.S. Medical Schools.","authors":"Ahmed Ahmed, Yoseph Boku, Emma Korolik, Blake Shultz","doi":"10.1097/ACM.0000000000005951","DOIUrl":"10.1097/ACM.0000000000005951","url":null,"abstract":"<p><strong>Purpose: </strong>This study characterizes required or recommended premedical coursework, coursework fulfillment, and congruence among U.S. medical schools.</p><p><strong>Method: </strong>This cross-sectional study examined course requirements and recommendations of U.S. allopathic medical schools, using data from the 2023 to 2024 Association of American Medical Colleges Medical School Admission Requirements database. Courses required and recommended, credit hours, medical schools accepting pass/fail credits, advanced placement credits, online courses, and community college credits were evaluated.</p><p><strong>Results: </strong>Of 157 medical schools, 154 had at least 1 premedical course requirement or recommendation. No schools had the same requirements or recommendations; 113 (72.0%) required or recommended 10 or more courses. The most commonly required courses were biology (107 [68.2%]), physics (106 [67.5%]), organic chemistry (105 [66.9%]), and inorganic chemistry (90 [57.3%]). The most commonly recommended courses were social sciences (96 [61.1%]), genetics (96 [61.1%]), and psychology (86 [54.8%]). Humanities had the highest range of credit hours expected (median, 6; range, 3-24) and cell and molecular biology, computer science, physiology, microbiology, and ethics the smallest (median, 3; range, 3-3). College mathematics had the highest proportion of schools accepting pass/fail (n = 15/26 [57.7%]) and AP (n = 51/65 [78.5%]) credits and biochemistry the lowest (n = 18/54 [33.3%] and n = 57/116 [49.1%], respectively). Statistics had the highest proportion of schools accepting online courses (n = 41/54 75.9%]) and inorganic chemistry the lowest (n = 60/127 [47.2%]). College English had the highest proportion of schools accepting community college credits (n = 102/109 [93.6%]) and cell and molecular biology the lowest (n = 11/15 [73.3%]).</p><p><strong>Conclusions: </strong>These results show substantial variability in premedical course requirements or recommendations among U.S. medical schools, which could be challenging for premedical students planning their undergraduate studies. Additional research is needed on the effect of this variability on students interested in attending medical school.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"475-479"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848376","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 Magic of Companionship.","authors":"Maggie M K Chan, E Angela Chan","doi":"10.1097/ACM.0000000000005966","DOIUrl":"10.1097/ACM.0000000000005966","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"474"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958394","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":"Coaching Learners During Medical School Training: Faculty Reflections on the Coaching Experience.","authors":"Maria A Blanco, Lauren Boehm, Victoria Hayes","doi":"10.1097/ACM.0000000000006054","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006054","url":null,"abstract":"<p><strong>Purpose: </strong>Research has shown the impact that coaching medical trainees has on the coaches' professional development and relationships. However, this research has not specifically investigated the evolution of this impact. The authors conducted a longitudinal qualitative research study to follow faculty as they developed their role as coaches of medical students during a 4-year coaching experience.</p><p><strong>Method: </strong>The authors conducted 60-minute semistructured interviews with a selected group of faculty coaches at Tufts University School of Medicine, Boston, Massachusetts, from September 2019 to June 2023. Interviews were conducted at the beginning of the coaching experience and revisited at the end of the coaching experience with the first cohort of students. The authors performed a reflexive thematic analysis of all the transcripts using inductive open coding to construct themes.</p><p><strong>Results: </strong>Nine faculty coaches participated in the study. The coaches' reflections on their experiences coaching the same group of medical students for 4 years focused on the centrality of relationships in coaching, the evolving nature of the coaching relationship with medical students, and the impact of coaching on the coaches' professional and personal relationships, including their relationship with the field of medicine. The coaches found building the relationship as the most meaningful, as well as the most challenging, aspect of their coaching.</p><p><strong>Conclusions: </strong>The authors propose continuing to define skills for faculty to strengthen and expand relationships with trainees in these coaching relationships, which are at the core of the coaching endeavor and which our participants found as the most rewarding and yet challenging aspect of their role.</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":"143765792","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 Medical Education to Improve Patient Safety.","authors":"Laura J Fochtmann","doi":"10.1097/ACM.0000000000005945","DOIUrl":"10.1097/ACM.0000000000005945","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"408"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787738","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}