Academic Medicine最新文献

{"title":"Application in Parallel to U.S. Residency Training Programs in Multiple Specialties: Trends and Differences by Applicant Educational Background, 2009-2021.","authors":"Samuel R Bunting, James N Woodruff, Nitin Vidyasagar, Neeral K Sheth, Deborah Spitz, Christine Babcock, Vineet Arora","doi":"10.1097/ACM.0000000000005825","DOIUrl":"10.1097/ACM.0000000000005825","url":null,"abstract":"<p><strong>Purpose: </strong>The medical education community is pursuing reforms addressing unsustainable growth in the number of residency applications per applicant and application costs. Little research has examined the prevalence or contributions of parallel applications (application to residency in multiple specialties) to this growth.</p><p><strong>Method: </strong>A retrospective analysis of Electronic Residency Application Service data provided by the Association of American Medical Colleges was conducted. The percentage of applicants applying to ≥ 1 specialty, mean number of specialties applied, number of submitted applications, and percentage of applicants to each specialty who were parallel applying were determined. MD, DO, and international (U.S. international medical graduate [IMG] and IMG) applicants were included.</p><p><strong>Results: </strong>The sample contained 586,246 applicant records from 459,704 unique applicants. The percentage of applicants who parallel applied decreased from 41.3% to 35.4% between 2009 and 2021. DO applicants were the only group for whom the percentage parallel applying increased (30.6% vs 32.1%). IMG (60.4% vs 49.1%) or USIMG applicants (69.6% vs 63.1%) were groups with the greatest percentage of applicants parallel applying each year (2009-2021). The mean number of specialties applied to when parallel applying also decreased from 2.96 in 2009 to 2.79 in 2021, overall. Between 2009 and 2021, mean number of applications increased for all applicant types among both single-specialty applicant and parallel-applying applicants. Among applicants who were single-specialty applying, mean number of applications grew from 38.6 in 2009 to 74.6 in 2021 and from 95.2 to 149.8 for parallel-applying applicants.</p><p><strong>Conclusions: </strong>All applicant groups experienced decreases in percentages parallel applying except for DO applicants. Parallel application appears to be common and slowly declining, and does not appear to significantly contribute to increasing numbers of applications per candidate. Efforts to control the growth of applications per applicant should continue to focus on applicants' numbers of applications submitted to each specialty.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"170-178"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749603","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":"Resident Unions: Why Now and Will They Change Medical Education and Health Care?","authors":"David Sklar, Britani Javed","doi":"10.1097/ACM.0000000000005902","DOIUrl":"10.1097/ACM.0000000000005902","url":null,"abstract":"<p><strong>Abstract: </strong>During the COVID-19 pandemic, resident unions proliferated. While unionization resulted in increased compensation and benefits, the process of union negotiations may have created adversarial relationships between residents and their institutions' leadership, whom residents depend on for supervision and the development of clinical expertise. Such adversarial relationships could affect the learning environment, which is critical to the delivery of high-quality care. In this commentary, the authors suggest that academic medical centers should offer residents an authentic seat at the institutional care delivery leadership table, ensuring residents' full participation in key organizational decisions. Doing so represents an alternative to unionization, with its potentially adversarial relationships, while still achieving a key goal of residents-to be included in the decisions that affect them and the care they provide. In this way, residents can use their unique understanding of the institutions' strengths and weaknesses to improve the quality of patient care and the learning environment. Such engagement can also help residents achieve competence in systems-based practice and provide a vital link between institutions and the patients and community they serve through health policy and advocacy activities.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"123-126"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479925","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":"Transition From Graduate Medical Education to Independent Practice: A Scoping Review.","authors":"Jillian Zavodnick, Abby Adamczyk, Gretchen Diemer, Timothy Kuchera, Nia Leonard, Rebecca Jaffe","doi":"10.1097/ACM.0000000000005888","DOIUrl":"10.1097/ACM.0000000000005888","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines the gaps in early career physician readiness for independent practice after graduating from their final graduate medical education (GME) program.</p><p><strong>Method: </strong>The authors conducted a literature search of 4 online databases (PubMed, Scopus, Health Business Elite, and Education Resources Information Center) using the following terms: population terms ( GME, fellow, resident , and others), early career terms ( onboarding, hiring, early career, ready , and others), readiness terms ( readiness, preparedness, knowledge, skills, competence ), and independence terms ( attending, physician, independent practice ). The databases were searched on March 12, 2024, for articles that explored GME graduate gaps in readiness for independent practice; assessment tools, curricula, or curricular need aimed at gaps in early career physician readiness; or an area where GME graduates need more knowledge and skills. They extracted specific gaps in preparedness and categorized them using existing competency frameworks.</p><p><strong>Results: </strong>The search returned 116 articles addressing gaps in preparedness for independent practice among recent GME graduates. Surgery yielded more articles than any other specialty (43 [37%]). Overall, 192 individual gaps were extracted; the greatest number of gaps came from patient care (75 [39%]) followed by personal and professional development (44 [23%]). The most frequently identified gaps were procedural independence (10 occurrences), practice management (9 occurrences), and billing (7 occurrences).</p><p><strong>Conclusions: </strong>Despite advances in GME, learners still struggle when transitioning to independent practice. Personal and professional development is a useful categorization for many gaps and should be considered for inclusion as a GME competency. Systematic assessment of new-to-practice attendings could help stakeholders better understand the true outcomes of GME programs. Concerted investment by specialty societies may drive greater understanding and innovative solutions. Additional study could help address the challenges in the GME-to-practice transition.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"239-247"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331865","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 Use of Virtual Patients to Provide Feedback on Clinical Reasoning: A Systematic Review.","authors":"Robert Jay, John Sandars, Rakesh Patel, Jo Leonardi-Bee, Yasmin Ackbarally, Soham Bandyopadhyay, Dabean Faraj, Mary O'Hanlon, Jeremy Brown, Emma Wilson","doi":"10.1097/ACM.0000000000005908","DOIUrl":"10.1097/ACM.0000000000005908","url":null,"abstract":"<p><strong>Purpose: </strong>Virtual patients (VPs) are increasingly used in health care professions education to support clinical reasoning (CR) development. However, the extent to which feedback is given across CR components is unknown, and guidance is lacking on how VPs can optimize CR development. This systematic review sought to identify how VPs provide feedback on CR.</p><p><strong>Method: </strong>Seven databases (MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, and ProQuest Dissertations) were searched in March 2023 using terms (e.g., medical education , virtual patient , case-based learning , computer simulation ) adapted from a previous systematic review. All studies describing VP use for developing CR in medical professionals and provided feedback on at least 1 CR component were retrieved. Screening, data extraction, and quality assessment were performed. Narrative synthesis was performed to describe the approaches used to measure and provide feedback on CR.</p><p><strong>Results: </strong>A total of 6,526 results were identified from searches, of which 72 met the criteria, but only 35 full-text articles were analyzed because the reporting of interventions in abstracts (n = 37) was insufficient. The most common CR components developed by VPs were leading diagnosis (23 [65.7%]), management or treatment plan (23 [65.7%]), and information gathering (21 [60%]). The CR components were explored by various approaches, from predefined questions to free text and concept maps.</p><p><strong>Conclusions: </strong>Studies describing VP use for giving CR feedback have mainly focused on easy-to-assess CR components, whereas few studies have described VPs designed for assessing CR components, such as problem representation, hypothesis generation, and diagnostic justification. Despite feedback being essential for learning, few VPs provided information on the learner's use of self-regulated learning processes. Educators designing or selecting VPs for CR use must consider the needs of learner groups and how different CR components can be explored and should make the instructional design of VPs explicit in published work.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"229-238"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559326","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":"Using Generative Artificial Intelligence in Medical Education.","authors":"Adam Rodman, Nicholas M Mark, Anthony R Artino, Juan N Lessing","doi":"10.1097/ACM.0000000000005937","DOIUrl":"10.1097/ACM.0000000000005937","url":null,"abstract":"<p><p>Large Language Models (LLMs) are a type of generative artificial intelligence (AI) that produce realistic-sounding language in response to text prompts, giving AI the capability to simulate human discourse in various domains, including medical education.1 The pace of technological advancement is staggering, which comes with promise and peril. This Last Page summarizes some potential LLM uses in medical education.2 However, AI is rapidly advancing, and these uses will likely evolve as well.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"250"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774404","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 Association of Psychotherapy With Burnout, Depression, and Measures of Well-Being in Residents and Fellows: A Pilot Study.","authors":"Sidney Zisook, Neal Doran, Nancy Downs, Desiree Shapiro, Angela Haddad, Daniel Lee, Isabel Newton, Julie Kawasaki, Anastasiya Nestsiarovich, Judy Davidson","doi":"10.1097/ACM.0000000000005750","DOIUrl":"10.1097/ACM.0000000000005750","url":null,"abstract":"<p><strong>Purpose: </strong>Resident physicians experience high rates of burnout and depression but rarely prioritize their well-being or seek mental health care. The Accreditation Council for Graduate Medical Education mandated that training programs prioritize resident wellness and emotional and mental health to ensure readily available and accessible mental health care. To help meet that requirement and circumvent barriers to accessing care, the University of California San Diego Healer Education Assessment & Referral (HEAR) Program offers residents and fellows short-term therapy for coping with challenges that threaten their well-being. This report describes the results of a pilot study designed to evaluate the feasibility and effectiveness of the HEAR Program's resident therapy program.</p><p><strong>Method: </strong>The cohort included residents and fellows who completed at least 1 postbaseline assessment from January to May 2022. Measures of fulfillment, burnout, self-compassion, quality of life, depression, and suicidal ideation were assessed and compared before and up to 12 weeks after enrollment.</p><p><strong>Results: </strong>Of the 39 residents who consented to participation, 30 completed at least 1 postbaseline assessment. Most outcomes improved after therapy, with significant increases in fulfillment (mean [SE] coefficient, 0.24 [0.08]; z score, 2.86; P = .004), self-compassion (mean [SE] coefficient, 0.37 [0.07]; z score, 5.72; P < .001), and quality of life ( P < .001) and significant reductions in burnout (Stanford burnout scale: mean [SE] coefficient, -0.27 [0.07]; z score, -4.01; P < .001; single-item burnout scale: mean [SE] coefficient, -0.34 [0.08]; z score, -4.37; P < .001) and depression severity (mean [SE] coefficient, -1.08 [0.25]; z score, -4.36; P < .001).</p><p><strong>Conclusions: </strong>This pilot study noted improvements in fulfillment, compassion, quality of life, and function, as well as reductions in burnout and depression severity, among resident physicians. Future studies in larger cohorts are needed to validate these findings and inform further optimization of this program.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"203-209"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871193","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":"Stepping Back: How Should Pass/Fail Scoring Influence Step 1 Timing?","authors":"Rebecca L Toonkel, Arnyce R Pock, Karen E Hauer, Jennifer R Kogan, Christine S Seibert, Aubrie Swan Sein, Seetha U Monrad, David Gordon, Michelle Daniel, Michael S Ryan, Nadia Ismail, Sara B Fazio, Sally A Santen","doi":"10.1097/ACM.0000000000005887","DOIUrl":"10.1097/ACM.0000000000005887","url":null,"abstract":"<p><strong>Abstract: </strong>Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency match success. Step 1 completion before clerkships promotes learning outcomes (e.g., integration and mastery of foundational material), may encourage students to focus on the curriculum, and may better prepare students for clinical science exams (CSEs). However, delaying the exam ensures that students maintain foundational knowledge and may encourage clinical educators to demonstrate basic science illustrations. An early Step 1 may affect learner behavior by allowing clerkship students to focus on clinical learning. The associated National Board of Medical Examiners performance report may also be used for Step 2 and CSE preparation. However, delaying Step 1 allows greater scheduling flexibility based on developmental milestones. Administration of Step 1 before clerkships removes a significant stressor from the clinical year and decompresses the residency application period. However, a delayed Step 1 reduces the pressure on students to engage in numerous extracurricular and research activities to distinguish themselves due to the pass/fail change. An early Step 1 exam may also lead to improved CSE performance, which is often linked to clerkship honors criteria, an increasingly valuable distinction for residency match success after the change to pass/fail. In contrast, delaying Step 1 is associated with higher first-time pass rates, which may be especially important for students at risk for failure. Medical educators and students should collaboratively approach the question of Step 1 timing, considering these factors within the context of the medical school program, curricular constraints and priorities, and students' individual needs and goals.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"137-143"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331864","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":"Text \"HEALER\": Using Text Mentorship to Engage American Indians and Alaska Natives Interested in the Health Professions.","authors":"Cirila Estela Vasquez Guzman, Jasmine Fernandez, Christina Uh, Stephanie Craig Rushing, Caitlin Donald, Dove Spector, David Stephens, Roger Peterson, Cynthia Taylor, Cristi Pinela, Jeremiah Wistrom, Patricia A Carney, Erik Brodt","doi":"10.1097/ACM.0000000000005900","DOIUrl":"10.1097/ACM.0000000000005900","url":null,"abstract":"<p><strong>Problem: </strong>The persistent underrepresentation of American Indians and Alaska Natives (AIANs) in the health professions and the decline of AIAN matriculants into health-related programs suggest interventions are needed. The authors developed Healers, a text message mentoring service, to engage and support AIANs interested in the health professions.</p><p><strong>Approach: </strong>Healers, launched in 2018, seeks to reach urban and rural high school/college-aged AIANs and other AIANs. Individuals subscribe by texting \"HEALER\" to a numeric code using their mobile device. Two concurrent intervention strategies include (1) a 17-week schedule of scripted texts and (2) live weekly office hours with 2 health pathway coaches. During the pilot year (June 2018 to June 2019), participants were recruited via national conferences, health fairs, social media, and word of mouth. Intake and exit surveys were conducted. Content analysis of text messages received during office hours was conducted.</p><p><strong>Outcomes: </strong>During the pilot, 304 subscribers opted into Healers and generated 2,933 text messages. Intake survey respondents included high school students (n = 18/77, 23.4%), college students (n = 29/77, 37.7%), and others (n = 29/77, 37.7%). They represented 60 Tribes from 28 U.S. states. Among exit survey respondents, 26/28 (92.9%) reported Healers was useful, 25/27 (92.6%) reported it exposed them to new health professions, 26/27 (96.3%) expressed stories from AIAN health professionals were valuable, and 25/26 (96.2%) reported pursuing a health professions career seemed possible. Five themes emerged from the analysis of 346 texts received from participants during office hours: cultural support, mentorship, opportunities, wellness, and community building.</p><p><strong>Next steps: </strong>Based on the pilot data concerning reach and impact, the Healers service has continued to enroll subscribers, host office hours, and promote the program. Future research should examine which careers interest participants and factors leading to successful enrollment in health pathway programs and attainment of health professions degrees.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"146-152"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reforming Health Economics and Policy Curriculum to Form a Path for Changemaking in Medicine.","authors":"Annika N Hiredesai, Xindi Cece Chen","doi":"10.1097/ACM.0000000000005910","DOIUrl":"10.1097/ACM.0000000000005910","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"121"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559325","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":"My First Foley.","authors":"Oscar Li, Yeonsoo Sara Lee","doi":"10.1097/ACM.0000000000005921","DOIUrl":"10.1097/ACM.0000000000005921","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 2","pages":"152"},"PeriodicalIF":5.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061091","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}