Academic Medicine最新文献

{"title":"Foreword: Disability Inclusion in Medical Education.","authors":"Lisa M Meeks","doi":"10.1097/ACM.0000000000006151","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006151","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477691","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":"Artificial Intelligence to Support Qualitative Data Analysis: Promises, Approaches, Pitfalls.","authors":"David A Cook, Shiphra Ginsburg, Adam P Sawatsky, Ayelet Kuper, Jonathan D D'Angelo","doi":"10.1097/ACM.0000000000006134","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006134","url":null,"abstract":"<p><strong>Abstract: </strong>How can artificial intelligence (AI) be used to support qualitative data analysis (QDA)? To address this question, the authors conducted 3 scholarly activities. First, they used a readily available large language model, ChatGPT-4, to analyze 3 existing narrative datasets (February 2024). ChatGPT generated accurate brief summaries; for all other attempted tasks the initial prompt failed to produce desired results. After iterative prompt engineering, some tasks (e.g., keyword counting, summarization) were successful, whereas others (e.g., thematic analysis, keyword highlighting, word tree diagram, cross-theme insights) never generated satisfactory results. Second, the authors conducted a brief scoping review of AI-supported QDA (through May 2024). They identified 130 articles (104 original research, 26 nonresearch) of which 64 were published in 2023 or 2024. Seventy studies inductively analyzed data for themes, 39 used keyword detection, 30 applied a coding rubric, 28 used sentiment analysis, and 13 applied discourse analysis. Seventy-five used unsupervised learning (e.g., transformers, other neural networks). Third, building on these experiences and drawing from additional literature, the authors examined the potential capabilities, shortcomings, dangers, and ethical repercussions of AI-supported QDA. They note that AI has been used for QDA for more than 25 years. AI-supported QDA approaches include inductive and deductive coding, thematic analysis, computational grounded theory, discourse analysis, analysis of large datasets, preanalysis transcription and translation, and suggestions for study planning and interpretation. Concerns include the imperative of a \"human in the loop\" for data collection and analysis, the need for researchers to understand the technology, the risk of unsophisticated analyses, inevitable influences on workforce, and apprehensions regarding data privacy and security. Reflexivity should embrace both strengths and weaknesses of AI-supported QDA. The authors conclude that AI has a long history of supporting QDA through widely varied methods. Evolving technologies make AI-supported QDA more accessible and introduce both promises and pitfalls.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486856","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":"https://doi.org/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%, CI: [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":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","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":"Reframing Disability: The Role of Professional Organizations in Fostering Inclusion for Disabled Physicians.","authors":"Emily C Cleveland Manchanda, Amy N Addams, Courtney A Roberts, Anne Messman, Pilar Ortega","doi":"10.1097/ACM.0000000000006153","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006153","url":null,"abstract":"<p><strong>Abstract: </strong>To create and sustain a thriving physician workforce capable of providing the highest quality medical care to the United States population, educational and healthcare institutions must transform narratives about disability and eliminate structural ableism from their policies and practices. By creating inclusive educational and healthcare environments that welcome and support people with disabilities in medicine, these institutions can improve learning and workplace experiences for all students and physicians, ultimately improving patient care. To do so will require reframing the concept of disability, shifting toward a socio-ecological understanding of what enables or limits an individual's ability to practice medicine, and recognizing that every student and physician benefits when medical education is designed to support a diverse range of learners. Eliminating structural ableism as it manifests in national and organizational policies and practices similarly holds promise for improving the diversity, vitality, and sustainability of the healthcare workforce. This commentary, authored by leaders from the American Medical Association, Accreditation Council for Graduate Medical Education, and Association of American Medical Colleges, along with students and physicians who support these organizations' efforts to combat ableism in medicine, offers both conceptual and practical recommendations for transforming the narratives and structural factors that currently hinder progress toward creating and sustaining a thriving physician workforce.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477706","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 Critical Nature of Belonging in Academic Medicine for Medical Students with Disabilities.","authors":"Zainub Dhanani, Samantha L Schroth, Sabrina Tran-Jolicoeur, Quinten K Clarke","doi":"10.1097/ACM.0000000000006152","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006152","url":null,"abstract":"<p><strong>Abstract: </strong>Medical students with disabilities (MSWD) report higher rates of distress and burnout when compared to their non-disabled peers as they navigate the challenges of medical education. However, cultivating a sense of belonging and creating safe spaces in which there is acceptance of the authentic self has been associated with improvements in these outcomes. This commentary explores the role of student-led disability organizations in promoting belonging through the development of community, offering mentorship, creating opportunities for leadership, sharing resources, and advancing anti-ableism. While these organizations are a powerful tool to advance inclusion, institutional accountability also remains critical. The authors offer strategies in which institutions can partner with MSWDs to further promote inclusion. These include: 1) collecting accurate and comprehensive data on the experiences of MSWDs, 2) reviewing and reforming policies that exclude or disadvantage MSWDs, and 3) supporting student-led disability organizations.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477709","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":"Double Knowing: The Value of Bridging Dual Research Paradigms for Social Change.","authors":"Neera R Jain, Erene Stergiopoulos","doi":"10.1097/ACM.0000000000006155","DOIUrl":"https://doi.org/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 two 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":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","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":"The Intersection of Disability, Race, Ethnicity, and Financial Background on Food Insecurity Among Medical Students.","authors":"Mytien Nguyen, Bassel M Shanab, Pavan Khosla, Dowin Boatright, Sarwat I Chaudhry, Eric J Brandt, Nour M Hammad, Karri L Grob, Morgan Brinker, Caden Cannon, Katherine Cermack, Maha Fathali, John W R Kincaid, Yuxing Emily Ma, Yuu Ohno, Aishwarya Pradeep, Anitza Quintero, Neelufar Raja, Brendan L Rooney, Sasha Stogniy, Kiara K Smith, George Sun, Jahnavi Sunkara, Belinda Tang, Gabriella VanAken Rubick, JiCi Wang, Sanaea Z Bhagwagar, Nathan Luzum, Frank Liu, John S Francis, Lisa M Meeks, Cindy W Leung","doi":"10.1097/ACM.0000000000006156","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006156","url":null,"abstract":"<p><strong>Purpose: </strong>Food insecurity is negatively associated with college students' well-being and academic performance. Little is known about the prevalence of food insecurity among medical students. This study examined variations in food insecurity among medical students at 15 schools, analyzing differences by disability status, race, ethnicity, and financial background.</p><p><strong>Method: </strong>Between March-October 2024, 1,659 students across 15 MD-granting medical schools completed an online survey. Over the past 12 months, food insecurity was assessed using the 10-item U.S. Household Food Security Survey Module. Additional survey measures included age, gender identity, race, ethnicity, Pell Grant recipient status, disability status, and graduation year. Poisson regression models were utilized to estimate the relative risk of food insecurity based on self-reported disability, race, ethnicity, and financial background and their intersections.</p><p><strong>Results: </strong>In the analytic sample, a higher proportion of students with disability (33.7% vs 21.8%, P < .001), from low-income backgrounds (34.9% vs 20.3%, P < .001), and those underrepresented in medicine (URiM) reported food insecurity (37.6% vs 19.7%, P < .001). Across intersectional groups, URiM low-income students with disability have the highest rate of food insecurity (62.5% vs 16.8% for nondisabled non-URiM non-low-income peers, P < .001). In the fully adjusted model, compared to nondisabled non-URiM non-low-income students, non-URiM and URiM low-income students with disability (non-URiM aRR: 2.44, 95% CI 1.72-3.48; URiM aRR: 3.52, 95% CI 2.79-4.45) had a higher relative risk of food insecurity.</p><p><strong>Conclusions: </strong>In this study, nearly 1 in 4 medical students were food insecure. URiM, low-income, and students with disabilities reported food insecurity at a significantly higher rate than their peers, with over half of URiM low-income students with disabilities reporting food insecurity. These findings suggest a promising yet underutilized avenue for approaches to enhancing well-being. Proactive efforts should prioritize supporting marginalized students by linking them to nutrition resources and advocating for policies that address their essential needs.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477710","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":"Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education.","authors":"Cheryl L Holmes, Laura Yvonne Bulk, Naomi Lear, Lynn Ashdown, Quinten K Clarke, Laura Farrell, Rachel Giddings, Lisa Graves, Julia Ersilia Hanes, George Kim, Michael Quon, Saleem Razack, Francesco A Rizzuti, Ginger Ruddy, Alex Scott, Erene Stergiopoulos, Lee Toner, Laura Nimmon","doi":"10.1097/ACM.0000000000006132","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006132","url":null,"abstract":"<p><strong>Abstract: </strong>A socially accountable physician workforce must include disabled learners and providers. However, current Canadian Technical Standards (TS) for medical school admissions create barriers to their inclusion. These standards overlook advances in assistive technology, universal design, evolving inclusion practices, and legal protections. Replacing the TS required consensus, but traditional methods of achieving consensus on disability inclusion risk reinforcing ableism in medical education. To address challenges with existing TS, the Association of Faculties of Medicine of Canada (AFMC) formed the \"Re-envisioning TS Working Group,\" using a novel consensus approach grounded in disability inclusion and critical disability discourse. Guided by transparency, accessibility, and respect for disability as diversity, the group prioritized engagement with disabled physicians, educators, scholars, and learners. The WG followed five stages: (1) identifying key concepts and reviewing literature on TS reform and ableism; (2) examining relevant legislation and case law; (3) drafting functional Core Competencies; (4) consulting partners across the medical education continuum; and (5) presenting outcomes to the AFMC Board, highlighting a commitment to disability inclusion in undergraduate medical education. The AFMC Board unanimously endorsed the \"Report on Re-Envisioning Technical Standards,\" including the \"Desired Outcomes\" and the \"Core Competencies for Entering Medical Students.\" The AFMC's adoption of functional Core Competencies is a significant step toward inclusion and support for learners with disabilities in Canadian medical education. Medical schools should adopt these competencies, combat ableism, and invest in universal design to promote access. Accommodation support should extend from admission through postgraduate training to independent practice. Finally, efforts to foster an inclusive culture and contribute to a healthy, diverse physician workforce must be evaluated as part of medical schools' social accountability mandate.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486857","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":"Evaluating Disability-Inclusive Content on U.S. Medical Schools' Websites: A National Study.","authors":"Ifeoma Ikedionwu, Kirsten Ludwig, Dominique Cook, Marjorie Fitzsimmons, Allison Liu, Benjamin Case, Eli Falk, Jeanne Farnan, Lisa M Meeks","doi":"10.1097/ACM.0000000000006133","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006133","url":null,"abstract":"<p><strong>Abstract: </strong>PurposeDespite national calls for disability inclusion in medical education, medical students with disabilities (MSWD) continue to face systemic barriers. One understudied but critical factor is how medical schools publicly communicate their commitment to inclusion, especially through their websites, which often serve as the initial point of reference for prospective applicants. In this research report, the authors evaluate the presence and quality of disability-inclusive content on the websites of U.S. MD-granting medical schools and assess alignment with best practices.MethodFrom May 2023 to July 2023 a cross-sectional content analysis was performed on the websites of all but one U.S. MD-granting medical schools listed in the annual Association of American Medical Colleges' (AAMC) Organizational Characteristics Database. Websites were independently reviewed by trained coders using a 5-item rubric based on AAMC and American Medical Association recommendations and scored on 5 themes: (1) disability in diversity statements, (2) accommodations request instructions, (3) affiliation with national MSWD organizations, (4) comprehensive technical standards, and (5) public technical standards. The \"total disability inclusion\" score ranged from 0 to 8.ResultsThe national average disability inclusion score was 5.9/8. Most school websites (96.1%) provided accommodation instructions, but only 38.3% included disability in public diversity statements. Technical standards were publicly available in 92.9% of cases but varied in clarity and accessibility. No significant associations were found between inclusion scores and institutional characteristics, though regional patterns were observed.ConclusionsDespite progress, public messaging on disability inclusion remains inconsistent. Clear, inclusive website content is essential to attract and support MSWD and should be guided by national standards and mechanisms for accountability.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477690","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":"Promoting Disability Inclusion Through an Expanded Conceptual Framework of the Learning Environment.","authors":"Alexandra C P Theall, Joanne E Crandall, Haley N Gamboa, Michael Chichioco, Sarah E Hughes, Larry Gruppen, Erick Hung","doi":"10.1097/ACM.0000000000006148","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006148","url":null,"abstract":"<p><strong>Abstract: </strong>The inclusion of people with disabilities in medicine is imperative to ensuring a diverse, culturally adept physician workforce. Despite increasing representation in U.S. medical schools, medical students with disabilities (MSWD) continue to face considerable challenges in pursuing medical education due to systemic discrimination, entrenched biases, and insufficient support and program accessibility. To systematically address the disparities and challenges faced by MSWD, there is a pressing need for a comprehensive framework to design, implement, and evaluate the breadth of initiatives employed across learning contexts needed to promote disability equity, inclusion, and belonging. Here, the authors expand on Gruppen and colleagues' existing conceptual framework of the Learning Environment (LE) in the health professions by considering the role of societal influence on students' educational experiences. The authors offer this updated conceptualization of the LE as an approach to perform detailed assessments of the broader educational climate, identify areas for improvement, implement interventions that advance equity and inclusion, and evaluate these important initiatives.The framework conceptualizes the LE as consisting of 2 dimensions-the material, which includes physical and virtual components, and the psychosocial, which adds personal, social, organizational, and societal components. These 6 components profoundly affect medical students' educational opportunities and learning outcomes. By thoughtfully considering these factors, medical schools can assess the LE in a dynamic, iterative manner. Furthermore, medical schools can foster disability equity and inclusion through the development of interventions that strategically address a spectrum of LE domains. This framework can be applied in real-world settings to support the design, implementation, and evaluation of accessibility and equity initiatives across diverse institutional contexts. By leveraging this systems-oriented framework to guide these efforts, medical schools can thoughtfully create inclusive environments that support the success of all learners.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477705","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}