Academic Medicine最新文献

{"title":"Disability in Undergraduate Medical Education in the United States: A Scoping Review.","authors":"Lauren A Maggio, Kirsten R Brown, Joseph A Costello, Aaron Konopasky, Dionna Bidny, Abigail Konopasky","doi":"10.1097/ACM.0000000000006154","DOIUrl":"10.1097/ACM.0000000000006154","url":null,"abstract":"<p><strong>Purpose: </strong>Students with disabilities remain disproportionately underrepresented in undergraduate medical education (UME). This scoping review synthesizes the literature on undergraduate medical students with disabilities in the United States to identify the purpose of the literature and map how disability is portrayed.</p><p><strong>Method: </strong>The authors searched 8 databases for relevant publications published between January 2008 through August 2024. Publication inclusion was determined using a 2-phase title/abstract screening process and full-text review conducted by 2 independent authors. Data extraction focused on characterizing the publication, followed by an analysis of the publications' goals and how disability was portrayed.</p><p><strong>Results: </strong>The authors identified 10,491 publications; 81 were included, most of which were journal articles ( n = 78). In 23 publications, at least one author disclosed their identity as disabled. Five main goals were identified in the publication purpose statements, including describing ( n = 50), calling for action ( n = 25), evaluating ( n = 24), arguing ( n = 14), and creating ( n = 14). Overall, disability was portrayed as (1) diversity, (2) deficiency, (3) inherently connected with accommodation and technical standards, and (4) a place of habitual omissions. Two studies discussed disability in relation to intersectional identities, and 2 used gender or race in multivariable models. No studies explicitly focused on UME and disabled students of color, disability and gender diversity, or disabled LGBQ+ students.</p><p><strong>Conclusions: </strong>This scoping review identified that disability is portrayed from an abled viewpoint as race- and gender-neutral, static, and as diversity, deficit, or a legal construct. Future researchers should consider how disability is conceptualized and the use of intersectional frameworks.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S64-S73"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512694","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":"Inclusion in Surgery: Case Study of a Deaf Surgical Resident in Otolaryngology.","authors":"Kris Merrill, Duncan A Meiklejohn","doi":"10.1097/ACM.0000000000006139","DOIUrl":"10.1097/ACM.0000000000006139","url":null,"abstract":"<p><strong>Abstract: </strong>Deaf and hard-of-hearing (DHH) trainees may be underrepresented in graduate medical education (GME) programs, including surgical specialties, and there is a paucity of data on the transition to GME after medical school for such learners. This case study describes the collaboration between the trainee, program leadership, and disability services to optimize the training environment for a deaf surgical trainee with bilateral cochlear implants at a major academic medical center. The authors review the implementation of communication strategies and adaptive technologies for a period spanning from July 2024 to December 2024 during the first half of the trainee's intern year in Otolaryngology-Head and Neck Surgery. Interventions included trainee-initiated proactive education of clinical team members, trainee-specific communication strategies, and personalized accommodations. Key operating room accommodations included the use of wireless Phonak Roger Microphones, which stream audio directly to hearing devices, and background noise reduction in the operating room environment.Interventions demonstrated improved communication and team dynamics as well as increased trainee confidence. Self-advocacy, individualized accommodations, and collaboration between DDH surgical trainees and colleagues foster an inclusive culture in surgery. The study highlights the potential for accommodations and adaptive technologies to support DHH learners in surgical training, contributing to increased diversity in the field. The authors plan to conduct a longitudinal study of accommodation efficacy and investigation of further adaptive technologies.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S179-S183"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477693","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":"Advancing Disability Equity and Inclusion in Undergraduate Medical Education: Proceedings From the Access in Medicine Summit.","authors":"Maggie Salinger, Mytien Nguyen, Allison Kessler, Sarah E Triano, Rylee Betchkal, Emily C Cleveland Manchanda, Pilar Ortega, Zoie C Sheets, Nalinda Charnsangavej, Christine Low, Gabe Abrams, Preetha Basaviah, Liz Bowen, Zainub Dhanani, James M Cooke, Ifeoma Ikedionwu, Aggie McGrane, Suchita Rastogi, Leslie L Rydberg, Samantha L Schroth, Erika Theiler, Amelia M Wallace, Peter Poullos, Raymond H Curry, Lisa M Meeks","doi":"10.1097/ACM.0000000000006157","DOIUrl":"10.1097/ACM.0000000000006157","url":null,"abstract":"<p><strong>Abstract: </strong>The Access in Medicine (AIM) Summit, held in April 2024, convened 60 delegates from across the United States to generate practicable solutions for dismantling accessibility barriers in medical education. These proceedings outline the Summit's objectives and present the resulting insights and actionable recommendations. The Summit featured an innovative design that engaged diverse delegates in collaborative, idea-generating activities that elevated the lived experiences of learners with disabilities. Inspired by guiding principles of social justice and accessibility, delegates recommended a bundle of action-oriented strategies for addressing social and structural barriers to disability equity and inclusion. The proposed action steps identified critical intervention points that span the continuum of undergraduate medical education, from improving support of disabled learners in recruitment and admissions processes through to their residency application and postgraduation transition stages. Though medical education was the AIM Summit focus, delegates emphasized the generalizability of themes to broad training contexts (e.g., residency and other health professions education training), both in the sociostructural challenges they confronted and in the solutions they proposed. These proceedings highlight the vital steps necessary to build more equitable and inclusive learning environments for learners with disabilities.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S54-S63"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512693","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":"Large Language Model Clinical Vignettes and Multiple-Choice Questions for Postgraduate Medical Education.","authors":"Frank I Jackson, Nathan A Keller, Insaf Kouba, Wassil Kouba, Luis A Bracero, Matthew J Blitz","doi":"10.1097/ACM.0000000000006137","DOIUrl":"10.1097/ACM.0000000000006137","url":null,"abstract":"<p><strong>Problem: </strong>Clinical vignette-based multiple-choice questions (MCQs) have been used to assess postgraduate medical trainees but require substantial time and effort to develop. Large language models, a type of artificial intelligence (AI), can potentially expedite this task. This report describes prompt engineering techniques used with ChatGPT-4 to generate clinical vignettes and MCQs for obstetrics-gynecology residents and evaluates whether residents and attending physicians can differentiate between human- and AI-generated content.</p><p><strong>Approach: </strong>The authors generated MCQs using a structured prompt engineering approach, incorporating authoritative source documents and an iterative prompt chaining technique, to refine output quality. Fifty human-generated and 50 AI-generated MCQs were randomly arranged into 10 quizzes (10 questions each). The AI-generated MCQs were developed in August 2024 and surveys conducted in September 2024. Obstetrics-gynecology residents and attending physician faculty members at Northwell Health or Donald and Barbara Zucker School of Medicine at Hofstra/Northwell completed an online survey, answering each MCQ and indicating whether they believed it was human or AI written or if they were uncertain.</p><p><strong>Outcomes: </strong>Thirty-three participants (16 residents, 17 attendings) completed the survey (80.5% response rate). Respondents correctly identified MCQ authorship a median (interquartile range [IQR]) of 39.1% (30.0%-50.0%) of the time, indicating difficulty in distinguishing human- and AI-generated questions. The median (IQR) correct answer selection rate was 62.3% (50.0%-75.0%) for human-generated MCQs and 64.4% (50.0%-83.3%) for AI-generated MCQs ( P = .74). The difficulty (0.69 vs 0.66, P = .83) and discriminatory (0.42 vs 0.38, P = .90) indexes showed no significant differences, supporting the feasibility of large language model-generated MCQs in medical education.</p><p><strong>Next steps: </strong>Future studies should explore the optimal balance between AI-generated content and expert review, identifying strategies to maximize efficiency without compromising accuracy. The authors will develop practice exams and assess their predictive validity by comparing scores with standardized exam results.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1163-1166"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477695","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":"Aligning Competencies Without Abandoning Personal and Professional Development.","authors":"Timothy Kuchera, Jillian Zavodnick, Gretchen Diemer","doi":"10.1097/ACM.0000000000006082","DOIUrl":"10.1097/ACM.0000000000006082","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1110"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040198","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":"Thistle: Maria Morrell, PhD.","authors":"","doi":"10.1097/ACM.0000000000006035","DOIUrl":"10.1097/ACM.0000000000006035","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1152"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631035","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":"Mapping the Landscape of Technical Standards: A Nationwide Review of Medical Schools.","authors":"Tracey Singer, Lance Madanguit, King T Fok, Catherine E Stauffer, Lisa M Meeks, Christopher J Moreland, Lynn Huang, Benjamin Case, Tara Lagu, Allison Kannam, Carol Haywood","doi":"10.1097/ACM.0000000000006135","DOIUrl":"10.1097/ACM.0000000000006135","url":null,"abstract":"<p><strong>Purpose: </strong>As a requirement for accreditation, medical schools must have technical standards to outline essential abilities for admission, progression, and graduation. In the absence of national guidance, the AMA published recommendations in 2021 for schools to use \"functional\" technical standards language (focused on achieving outcomes), as opposed to \"organic\" (focused on body functions). This study benchmarks the extent to which U.S. MD- and DO-granting programs have adopted functional language and assesses public availability of technical standards.</p><p><strong>Method: </strong>In 2023, the authors conducted a national cross-sectional content analysis of technical standards from all fully accredited U.S. MD- and DO-granting medical schools (N = 192) using AMA-endorsed criteria. Three technical standard domains-observation, communication, and motor-were coded as \"functional,\" \"organic,\" or \"mixed,\" generating a composite score for each school. Descriptive analysis was used to identify patterns and associations.</p><p><strong>Results: </strong>Of 192 eligible schools, 99.4% of MD and 100.0% of DO programs provided their technical standards online; one school did not have technical standards. The mean composite score was 1.24 (95% confidence interval, 1.02-1.46; SD = 1.55) out of a possible 6 for fully functional standards. MD programs were more likely to use functional language than DO programs, reflected in the higher overall mean score of 1.43 (SD = 1.59) for MD programs compared to 0.37 (SD = 1.00; P < .001) for DO programs. Schools established in 2010 or after were less likely to have functional technical standards than older schools ( P = .01), and schools reporting updates to their technical standards in 2022 or later had slightly higher functional scores than schools with less recent updates.</p><p><strong>Conclusions: </strong>Adoption of functional technical standards is varied. Most medical schools maintain restrictive organic language despite AMA recommendations. Greater alignment with functional standards could enhance inclusion of people with disabilities in medicine.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S144-S151"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486858","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":"From Policy to Practice: Building the Disability Inclusion Infrastructure in Graduate Medical Education.","authors":"Emily Green, Kelley A Volpe","doi":"10.1097/ACM.0000000000006127","DOIUrl":"10.1097/ACM.0000000000006127","url":null,"abstract":"<p><strong>Abstract: </strong>Disability inclusion in graduate medical education (GME) remains understudied despite its importance for equity and patient care. Recent data reveal a significant attrition of disabled trainees between medical school and practice, with disclosure barriers-such as stigma and unclear policies-compounding the issue. For learners with multiple marginalized identities, such as those underrepresented in medicine and disabled, compounded barriers may exist. While the Accreditation Council for Graduate Medical Education (ACGME) has strengthened diversity and accommodation requirements, many GME programs still lack formal disability policies and transparent processes. This case study follows an African American woman psychiatry fellow with ADHD and a reading disorder as she navigates disability accommodations in GME. After successful experiences in undergraduate medical education and residency, she encountered significant challenges in fellowship due to the absence of a clear accommodations process. Her program director and institutional resources were supportive but lacked coordinated protocols, leading to inconsistent, discretionary accommodations that undermined legal protections and caused significant distress. This experience highlights how administrative failures and ableism intersect with other systemic biases, creating barriers to success for disabled trainees. Drawing on this case, the authors recommend establishing formal accommodation protocols, faculty training, legally binding accommodations, peer mentorship networks, and regular policy review. Implementing these recommendations can help GME programs operationalize ACGME's diversity and inclusion standards, ultimately improving equity and retention for disabled trainees. This case illustrates the urgent need for standardized, inclusive policies to ensure disabled physicians-in-training receive the support they need to thrive.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S184-S187"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318613","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 Is Taught Versus What Is Learned: Health Advocacy in Specialist Graduate Medical Education.","authors":"Yvonne Ying, Maria Athina Tina Martimianakis, Brett Schrewe","doi":"10.1097/ACM.0000000000006074","DOIUrl":"10.1097/ACM.0000000000006074","url":null,"abstract":"<p><strong>Purpose: </strong>Health advocacy (HA) is a key component of competency frameworks in many global jurisdictions, yet how HA is taught is not well defined, particularly in specialty graduate medical education. This study explored how residents in these programs came to understand what HA is, what activities it entails, and what importance it carries.</p><p><strong>Method: </strong>This qualitative study conducted semistructured interviews of 39 specialty residents from 2 universities (University of Toronto and University of Ottawa) from July 2019 to June 2023. A reflexive thematic analysis was used, with sensitizing concepts of the formal, informal, and hidden curricula and the CanMEDS health advocate role to construct themes from this data set.</p><p><strong>Results: </strong>Most trainees struggled to define what HA means, what good HA should look like, and which kinds of activities it signifies. The lack of definitional clarity meant that many non-HA activities became conflated with HA, particularly research and quality improvement. Few could recall clear formal curricular content, whereas exposure in clinical training environments was highly variable. Many perceived HA activities as threats to clinical efficiency, of little interest to residency program leadership, and of minimal currency in being competitive for eventual staff positions. Self-identified advocates frequently engaged in self-censoring behaviors because they thought their programs and leaders were often not supportive of this kind of work.</p><p><strong>Conclusions: </strong>Trainees struggled to understand what activities comprise HA because it was not prioritized in their programs or they encountered highly variable role modeling. Trainees who participated in HA activities experienced difficulties integrating HA into their overall clinical skill set due to a lack of institutional support. Health advocacy training requires consideration of structural and cultural reinforcements, including the adoption of curricula that integrate it with daily clinical care and address hidden curriculum effects.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1203-1209"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007505","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":"Perceptions of the Learning Environment Among Medical Students With Disabilities and the Impact of Program Access.","authors":"Christopher J Moreland, Melissa Plegue, Zoie C Sheets, Karina Pereira-Lima, Neera R Jain, Erene Stergiopoulos, Ben Case, Amy Addams, Lisa M Meeks","doi":"10.1097/ACM.0000000000006086","DOIUrl":"10.1097/ACM.0000000000006086","url":null,"abstract":"<p><strong>Purpose: </strong>Negative learning environment experiences may contribute to burnout for medical students with disabilities (MSWD). This study explores MSWD's perceptions of the learning environment and the effects of program access (having received or not needing accommodations).</p><p><strong>Method: </strong>The authors analyzed the Association of American Medical Colleges Year Two Questionnaire data from 2019 and 2020, comparing nondisabled students, MSWD with program access, and MSWD without program access (having not received or requested an accommodation, despite a need). Three learning environment measures were examined: how schools fostered students' personal and professional development; a shortened Medical School Learning Environment Scale (MSLES); and subscales on emotional climate, student-faculty interactions, and student-student interactions. Responses were compared across the 3 groups using chi-square and ANOVA tests with post-hoc pairwise comparisons.</p><p><strong>Results: </strong>Of the 23,898 respondents, 10.2% (2,438) self-reported a disability. Among those, 83.6% (2,039) reported program access, and 13.9% (340) reported lack of program access. Students without disabilities (21,008) reported higher agreement that their school fostered their development as a person (72.2%, 15,172) and physician (90.9%, 19,089) compared with MSWD with access (65.6%, 1,312 and 89.0%, 1,778, P < .001). MSWD without access reported lower agreement than both groups (43.7%, 149 and 80.1%, 273, P < .001). There were no differences regarding the MSLES statement about high-performance standards ( F (2, 23742) = 2.35, P = .095). For the 8 remaining MSLES statements and for all 3 subscales, nondisabled students reported significantly higher agreement than MSWD with and without access, and MSWD with access had higher agreement than those without.</p><p><strong>Conclusions: </strong>This nationally representative study demonstrates that MSWD perceive the learning environment less favorably than their nondisabled peers. Program access partially mitigates these differences, underscoring the critical role of accommodations and the need to address structural barriers to access.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1179-1186"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049625","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}