Academic Medicine最新文献

{"title":"Are Generative Artificial Intelligence-Aided Letters of Recommendation in the Recommender's Voice?","authors":"Shigeki Matsubara","doi":"10.1097/ACM.0000000000006106","DOIUrl":"10.1097/ACM.0000000000006106","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1110-1111"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163585","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":"2025 Dr. Hope Babette Tang Humanism in Healthcare Essay Contest: Third-Place Nursing Student Essay: Listening Beyond the Monitors: A Lesson From Joe.","authors":"Vonnie Cesar","doi":"10.1097/ACM.0000000000006166","DOIUrl":"10.1097/ACM.0000000000006166","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 10","pages":"1154-1155"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139263","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":"Defining a Supportive Teaching Climate for Clinical Supervisors in Residency Training.","authors":"Anne W van Graafeiland, Joost W Van den Berg, Pam A van Schie, Suzanne E Geerlings, Kiki M J M H Lombarts","doi":"10.1097/ACM.0000000000006097","DOIUrl":"10.1097/ACM.0000000000006097","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop a broad and contextualized understanding of what clinical supervisors require to optimally fulfill their teaching roles by operationalizing the newly formed theoretical construct of the teaching climate.</p><p><strong>Method: </strong>From September 2022 to March 2024, the authors conducted individual interviews and focus group discussions with program directors and clinical supervisors in postgraduate medical education from various specialties in multiple teaching hospitals in the Netherlands. The authors followed a constructivist interpretative phenomenological approach, studying the phenomenon of the teaching climate through iterative and axial data coding.</p><p><strong>Results: </strong>Twelve individual interviews, 8 with (deputy) program directors and 4 with clinical supervisors, were conducted. Sixteen additional participants attended the subsequent 2 focus groups, with 8 participants in each group. In total, 16 program directors and 12 nondirectors participated, of whom 17 were women. The authors identified 6 themes encompassing the needs of clinical supervisors: (1) social cohesion, (2) resources for individual clinical supervisors, (3) a dialogue with residents, (4) a strong teaching team, (5) administrative support and facilities in residency training, and (6) support in balancing residency training and patient care. A seventh theme described the specific resources for program directors. Social cohesion not only represented a separate need but also served as an intermediary among themes 2, 3, 4, and 7, characterizing clinical supervisors' needs in predominantly social interactions, and themes 5 and 6, representing context requirements influencing the work of clinical supervisors in an organizational sense.</p><p><strong>Conclusions: </strong>This study describes the needs of clinical supervisors in their work environment. A collective effort of all stakeholders involved in residency training is deemed crucial to providing high-quality guidance to residents, requiring organizational acknowledgment of educational efforts and social cohesion. Use of the teaching climate construct might help in the design of more actionable approaches to support clinical supervisors.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1210-1217"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163590","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":"Clerkship Assessment Reliability Based on Assessor Type and Assessor-Student Contact Frequency: A Generalizability Theory Analysis.","authors":"Christopher D Mattson, Celia L O'Brien, Yoon Soo Park, Sandra M Sanguino, Mary E McBride, Brigid M Dolan","doi":"10.1097/ACM.0000000000006143","DOIUrl":"10.1097/ACM.0000000000006143","url":null,"abstract":"<p><strong>Purpose: </strong>Workplace-based assessments (WBAs), such as clinical performance assessments (CPAs), often comprise a significant portion of clerkship assessment systems. This study explores the reliability of CPAs in clerkships based on assessor characteristics, including assessor type and assessor-student contact frequency.</p><p><strong>Method: </strong>The CPAs of third-year medical students at Northwestern University Feinberg School of Medicine completed during 5 clerkships in academic year 2021 to 2022 were compiled. Analyses compared clerkship assessments per student and breakdown of assessor characteristics by clerkship. Generalizability analysis divided assessments by clerkship, assessor type (resident vs attending), and assessor-student contact frequency (daily vs not daily). Decision studies examined the number of assessments needed per student to achieve reliability of 0.7 (D 0.7 ).</p><p><strong>Results: </strong>A total of 4,062 CPAs completed by 734 assessors on 179 students were analyzed. The number of attending versus resident assessors and daily versus not daily assessors varied by clerkship. Assessments completed by residents were more reliable than assessments completed by attendings (resident φ coefficient = 0.62; student variance, 8.5%; D 0.7 = 19; attending φ coefficient = 0.48; student variance, 5.6%; D 0.7 = 34). Assessments completed by assessors with daily contact were more reliable than assessments completed by assessors with not daily contact (daily contact φ coefficient of = 0.63; student variance, 7.6%; D 0.7 = 22; not daily contact φ coefficient = 0.31; student variance, 5.7%; D 0.7 = 34). Residents with daily contact were most reliable (φ coefficient = 0.38, D 0.7 = 16).</p><p><strong>Conclusions: </strong>Differences in assessor type and assessor-student contact frequency may explain between-clerkship differences in assessment reliability. These findings provide an opportunity to consider assessor characteristics in the design of assessment systems, thus improving assessment reliability and working toward systems that can be trusted by all stakeholders.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1187-1193"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477674","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":"Demographic Factors and Burnout Outcomes Associated With Disability Status Uncertainty in U.S. Medical Students.","authors":"Karina Pereira-Lima, Lisa M Meeks, Mytien Nguyen, Zoie C Sheets, Neera R Jain, Erene Stergiopoulos, Amy N Addams, Christopher J Moreland, Dowin Boatright","doi":"10.1097/ACM.0000000000006128","DOIUrl":"10.1097/ACM.0000000000006128","url":null,"abstract":"<p><strong>Purpose: </strong>Studies suggest that medical trainees often experience uncertainty regarding their alignment with institutional and legal definitions of disability, which is exacerbated by barriers to documentation, stigma-related concerns, and ableist societal perceptions. This study examines demographic characteristics and burnout outcomes among medical students uncertain about their disability status compared to those identifying as a person with a disability.</p><p><strong>Method: </strong>The authors analyzed data from second-year medical students identifying as having a disability (N = 2438) or reporting not knowing if they had a disability (N = 496) among the 27,009 participants in the 2019 and 2020 Association of American Medical Colleges Year-Two Questionnaire cohorts. Burnout was measured using the Oldenburg Burnout Inventory for Medical Students. Demographic associations with disability status uncertainty and its relationship with burnout were examined through multivariable logistic regression.</p><p><strong>Results: </strong>Compared to White students, those identifying as Asian (odds ratio [OR], 3.36; 95% confidence interval [CI], 2.56-4.39), Black/African American (OR, 2.49; 95% CI, 1.71-3.59), Hispanic/Latino/Spanish origin (OR, 1.65; 95% CI, 1.14-2.36), and multiracial (OR, 1.66; 95% CI, 1.22-2.24) had significantly higher odds of reporting disability status uncertainty. Asian students also had significantly higher odds than Hispanic/Latino/Spanish origin (OR, 2.03; 95% CI, 1.37-3.05), multiracial (OR, 2.02; 95% CI, 1.44-2.86), or other (OR, 2.64; 95% CI, 1.31-5.92) students. Male students had significantly higher uncertainty odds than females (OR, 1.31, 95% CI, 1.06-1.61). Disability status uncertainty associated with significantly greater odds of high burnout (OR, 1.28; 95% CI, 1.03-1.59).</p><p><strong>Conclusions: </strong>Medical students uncertain about their disability status showed increased risk of burnout with differences by race, ethnicity, and gender underscoring the need for institutions to address structural and cultural barriers to seeking disability resources. Further research should investigate strategies for mitigating differences for medical students navigating disability and promoting well-being for all learners.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S131-S137"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477687","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":"Double Knowing: The Value of Bridging Dual Research Paradigms for Social Change.","authors":"Neera R Jain, Erene Stergiopoulos","doi":"10.1097/ACM.0000000000006155","DOIUrl":"10.1097/ACM.0000000000006155","url":null,"abstract":"<p><strong>Abstract: </strong>Methodological choices carry political consequences and real-world effects in research that seeks to advance justice. The epistemic and ontological grounding of a study shapes what researchers can know, and what they can change. Scholars who produce research with an aim to improve the world for disabled people and other equity-denied groups have debated the utility of certain paradigms and approaches, often arguing that one is superior to another in order to realize these aims. In this research methods paper, the authors set out to offer another view. They discuss their recent approach to analyzing a single dataset of survey responses from a national sample of medical students with disabilities, using 2 different orientations to reflexive thematic analysis: critical realist/contextualist and relativist/constructionist. They illustrate how each orientation, operating from a different paradigmatic position, generates distinct interpretations and implications. Engaging with debates from disability studies, feminist research, and health professions education, the authors argue that our field of disability inclusion in health professions education research and social justice research more broadly needs pragmatic solutions and exploration of underpinning discourses to achieve a grand project of social change-only possible through the exercise of multiple paradigmatic positions.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S166-S172"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477689","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":"Strengthening Disability Inclusion in Medical Education: The Role of Disability Resource Professionals Through Bronfenbrenner's Ecological Systems Framework.","authors":"Sarah E Triano, Lisa M Meeks","doi":"10.1097/ACM.0000000000006149","DOIUrl":"10.1097/ACM.0000000000006149","url":null,"abstract":"<p><strong>Abstract: </strong>In this article, the authors examine the important yet often overlooked role of specialized disability resource professionals (DRPs) in medical education. Although disability inclusion has gained momentum, disparities in accommodations, learning environments, and residency selection persist for medical students with disabilities (MSWDs). Despite national calls for institutional commitment to accessibility, only 9% of U.S. medical schools employ a dedicated DRP, leaving many MSWDs without specialized support to navigate the complexities of medical training. The authors argue that DRPs are essential not only for individual accommodation implementation but also for institutional change, including faculty development, policy reform, and the dismantling of systemic ableism in medical education.Drawing on Bronfenbrenner's Ecological Systems Theory, the authors propose a framework for understanding the multilevel impact of DRPs from direct student support to shaping national policies. Data from the 2024 Association of American Medical Colleges Graduation Questionnaire (GQ) highlight significant barriers in disability support services: 15.4% of students found the accommodation process overly difficult, 27.2% refrained from seeking accommodations due to stigma, and 5.1% reported unclear institutional processes for requesting accommodations. These findings underscore the necessity of specialized DRPs to enhance transparency, streamline accommodation processes, and improve faculty preparedness to support disabled learners.The authors advocate for standardized DRP competencies in medical education to ensure consistent, high-quality disability support across institutions. Without investment in specialized DRPs, inequities in medical education may persist, undermining broader efforts toward inclusion. To create a truly accessible and equitable learning environment, medical schools should move beyond compliance and recognize DRPs as indispensable to the success of all learners.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S98-S104"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477707","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":"Timing of Disability Diagnosis and Accommodations During Medical School by First-Generation Status, Race, Ethnicity, and Gender.","authors":"Mytien Nguyen, Charlene K Green, Hyacinth R C Mason, Karina Pereira-Lima, Zoie C Sheets, Samantha L Schroth, Lydia Smeltz, Christopher J Moreland, Rylee Betchkal, Christina Grabowski, Dowin Boatright, Michael H Kim, Lisa M Meeks","doi":"10.1097/ACM.0000000000006147","DOIUrl":"10.1097/ACM.0000000000006147","url":null,"abstract":"<p><strong>Purpose: </strong>Timely diagnosis of disability is essential to student success. This study assesses the association between disability type; first-generation college graduate status; and race, ethnicity, and gender and the timing of disability diagnosis among medical students, and whether the timing of diagnosis is associated with likelihood of receiving accommodations in the preclinical and clinical phases of medical training.</p><p><strong>Method: </strong>The authors conducted a retrospective cohort study between April 2023-April 2024 across 9 U.S. MD-granting programs. Data were obtained from individual student records in collaboration with administrators and designated staff who support students with disability-related concerns and accommodation requests. Modified Poisson regression was utilized to estimate the relative risk of diagnosis timing after matriculation and preclinical and clinical accommodations to account for potential variability across schools.</p><p><strong>Results: </strong>Among the 362 medical students in the study, 167 (46.1%) were diagnosed after medical school matriculation. Compared to continuing-generation students, first-generation college graduates were significantly more likely to have a disability diagnosis after medical school matriculation (59.0% vs 43.2%; aIRR, 1.33; 95% CI, 1.01-1.77). Across all racial and ethnic groups, Black students were significantly more likely to be diagnosed after matriculation compared to their White peers (66.6% vs 41.5%; aIRR, 1.58; 95% CI, 1.21-2.06). Female students were less likely to be diagnosed with a disability after matriculation (aIRR, 0.85; 95% CI, 0.73-0.98). Overall, 232 (64.1%) and 284 (78.4%) participants received preclinical and clinical accommodations, respectively. Students who received a disability diagnosis before medical school matriculation were significantly more likely to receive preclinical accommodations (79.4%) compared to those diagnosed after matriculation (46.1%; aIRR, 0.60; 95% CI, 0.50-0.72). No significant association was found between timing of diagnosis and clinical accommodations.</p><p><strong>Conclusions: </strong>This study highlights the challenges medical students with disabilities face in requesting accommodation, particularly for those who are diagnosed after medical school matriculation.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S124-S130"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477763","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":"Centering a Justice-Based Approach to Disability Inclusion in Medical Education.","authors":"Mytien Nguyen, Justin L Bullock, Shruthi Venkataraman, Dowin Boatright","doi":"10.1097/ACM.0000000000006146","DOIUrl":"10.1097/ACM.0000000000006146","url":null,"abstract":"<p><strong>Abstract: </strong>Despite institutional efforts to promote diversity and inclusion, medical education continues to marginalize students with disabilities through persistent structural, cultural, and procedural barriers. Inaccessible learning environments, inadequate accommodations, and entrenched ableist attitudes contribute to inequitable educational experiences and outcomes for disabled students. These barriers are further compounded for individuals who hold intersecting marginalized identities, particularly those who are racially and ethnically underrepresented in medicine. This commentary applies the disability justice framework-a praxis developed by disabled queer and trans activists of color-to critically examine the limitations of current inclusion efforts within academic medicine. By analyzing the framework's 10 guiding principles, the authors identify systemic gaps and propose concrete, equity-driven strategies for transforming medical education. Recommendations include integrating intersectionality into curricula, adopting universal design, revising technical standards, elevating the leadership of disabled individuals, and embedding structural accountability. Operationalizing disability justice enables medical institutions to move beyond performative inclusion, dismantle ableist norms, and foster educational environments in which all trainees-particularly those at the margins-can thrive.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S119-S123"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477673","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":"Sustaining the Biomedical Research Workforce: Medical School Leadership in Supporting Research Learners.","authors":"Bruce H Mandt, Nicquet M J Blake, Talia H Swartz","doi":"10.1097/ACM.0000000000006114","DOIUrl":"10.1097/ACM.0000000000006114","url":null,"abstract":"<p><strong>Abstract: </strong>Biomedical graduate students and postdoctoral researchers contribute to scientific innovation, driving discovery and advancing health solutions. However, their success depends on more than research skills; they require strong mentorship, mental health support, and inclusive training environments. Despite the critical importance of research learners, the current structures at many medical schools prioritize clinical learners, often leaving research learners without adequate institutional support. Unique challenges, including prolonged training, reliance on a single mentor, and dual roles as learners and researchers, are compounded by high stress, ineffective mentorship, and underaddressed mistreatment, particularly for underrepresented groups. This commentary highlights the urgent need for medical schools to address these issues through targeted interventions. Institutions must implement proactive mental health strategies, strengthen culturally aware and effective mentorship, and foster inclusive research environments that promote equity and psychological safety. By prioritizing these efforts, medical schools can support research learners' success, reduce attrition, and cultivate a diverse and innovative biomedical research workforce. This approach is an investment in the future of biomedical research and its long-term sustainability.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1113-1119"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217416","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}