Academic Medicine最新文献

{"title":"Glow in the Dark: Promotion Pathways for the Academic Nocturnist.","authors":"Jessica Y Chambers, Kathleen Atlas, Alexander Rittenberg, John N George, Meggan Forbes, Nila Radhakrishnan","doi":"10.1097/ACM.0000000000006057","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006057","url":null,"abstract":"<p><strong>Abstract: </strong>Nocturnists are clinicians from multiple specialties who work predominantly at night. Although the nocturnist role has expanded, little to no literature addresses their career trajectories. Given their temporal isolation from diurnal colleagues, nocturnists have noted concerns of career stagnation and lack of mentorship, highlighting an inability to harness career development and promotion opportunities without leaving night work. This article outlines strategies for nocturnists to leverage their unique clinical and educational experiences to develop scholarly niches, enhance job satisfaction, and build promotion-worthy portfolios. Drawing on real-world examples from academic nocturnists, the authors explore opportunities in 3 key domains-educational service, clinical care, and health systems leadership-and how each can be leveraged to enhance scholarly productivity. Strategies to address barriers, such as the physical hardships of night shift work, the need to sleep during daytime professional development activities, frequent turnover, and generally negative attitudes from trainees regarding night shift work, include flexible scheduling, structured mentorship programs, and institutional recognition of nocturnist contributions. By leveraging these approaches and receiving institutional support, nocturnists can achieve academic success, contribute to the medical literature, and advance toward promotion.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765798","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":"Meaningful Patient Participation in Health Care Education: A Theoretically Informed Study Exploring Boundaries and Identities.","authors":"Amber Bennett-Weston, Simon Gay, Elizabeth S Anderson","doi":"10.1097/ACM.0000000000005919","DOIUrl":"10.1097/ACM.0000000000005919","url":null,"abstract":"<p><strong>Purpose: </strong>After recent policy and practice changes, health care schools are expected to involve patients as partners in the management, design, and delivery of professional curricula. However, what these partnerships mean for academic communities and the processes needed to support them are not yet understood. This study examines what involving patients as partners within an academic community means for key stakeholders.</p><p><strong>Method: </strong>A qualitative case study design with a social constructivist philosophical stance was used. Communities of practice served as the theoretical framework. Semistructured interviews were conducted with patients and educators from the University of Leicester between November 2021 and May 2022. Focus groups were held with penultimate-year students. Data were analyzed using reflexive thematic analysis informed by communities of practice.</p><p><strong>Results: </strong>The sample comprised 40 participants. Ten patients and 10 educators participated in 40- to 60-minute interviews. Twenty students participated in 1 of 5 focus group discussions lasting 30 to 50 minutes. Two overarching themes were reported: \"boundaries as (permeable) barriers to participation\" and \"identity as an interpretive lens.\" Boundaries among patients, educators, and students can hinder patients' meaningful involvement in health care education. Boundaries are marked through differences in knowledge, a lack of shared vision, and a lack of trust in patients. Patients, educators, and students have separate distinct identities. They experience tensions of identity when they meet across boundaries. These tensions reveal insights into the construction of the typical patient identity in health care education.</p><p><strong>Conclusions: </strong>Applying communities of practice illuminated boundary and identity issues that patients, educators, and students experience when patients are involved in health care education. Health care schools should develop comprehensive training for patients, provide faculty development regarding patient involvement, support students to trust in patient teachers, and embed a distinctive strand of patient involvement across health care curricula.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"466-474"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711961","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 Importance of Sexual History-Taking Within Surgery.","authors":"Justine O Chinn, Mary T Hawn","doi":"10.1097/ACM.0000000000005965","DOIUrl":"10.1097/ACM.0000000000005965","url":null,"abstract":"<p><strong>Abstract: </strong>Sexual and reproductive health is an essential part of comprehensive medical care. As the field of medicine becomes more specialized and siloed and the diagnostic workup in surgery more advanced, the risk of anchoring diagnoses and partitioning of care increases. Thus, the fundamentals of a complete patient history and review of each body system remain critical in ensuring that surgeons establish a broad differential diagnosis; provide comprehensive, well-rounded care to patients; and create opportunities for patient counseling and interventions. The article by Coleman and colleagues reports on an intervention that did not result in trainees being more likely to take a sexual history; however, the intervention group did ask significantly more questions regarding sexual health than the comparison group when they did take a sexual history. They highlight that there is a persistent gap in sexual history-taking, and that this results in potential misdiagnoses as well as missed opportunities to counsel patients about sexual and reproductive health. Clinicians have a responsibility to recognize factors that increase risk for their patients and provide appropriate counseling, which they cannot do if they are not asking all the necessary questions, even the difficult ones.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"410-412"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928353","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":"Association of Communication, Engagement, and Well-Being With Turnover Among Faculty at a Large Academic Health Care and Research System.","authors":"Fares Qeadan, Mindy J Vanderloo, Megan Call, Rose Thornquist, Benjamin Tingey, Ellen Morrow, Amy Locke","doi":"10.1097/ACM.0000000000006055","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006055","url":null,"abstract":"<p><strong>Purpose: </strong>Burnout among health care professionals is associated with turnover and significant costs. This study explored the association between self-reported communication, engagement, and employee well-being and department turnover among faculty at an academic medical institution.</p><p><strong>Method: </strong>This study used engagement survey data from an annual survey administered to all faculty at the University of Utah School of Medicine. Data sources included individual self-reported survey data collected in February 2022 and subsequent department-wide turnover counts captured across academic year 2023 (July 1, 2022, to June 30, 2023). Domain scores for communication, engagement, and well-being were constructed for participants, averaged across each department, and compared against matching department turnover in the following academic year. A principal component analysis was conducted to derive a weighted index score of wellness domains and fit in a negative binomial regression to assess its association with the ensuing turnover rate. Model R2 values determined predictive ability.</p><p><strong>Results: </strong>Nineteen departments with 2,084 faculty members met the inclusion criteria of the study. There was a decreasing trend between all 3 wellness domain scores and turnover, such that departmental turnover rates were lower at higher reported departmental wellness domain scores. A stronger decreasing trend was observed between turnover and the weighted index wellness score, with a 1-unit (approximately 20%) increase in this score being associated with a significant decrease of 32% in the rate of turnover across departments (incidence rate ratio, 0.68; 95% CI, 0.58-0.80; P < .001). The weighted index wellness score explained 53% of variation in departmental turnover (R2 = 0.53).</p><p><strong>Conclusions: </strong>Strong communication, engagement, and well-being were significantly associated with decreased turnover among faculty within this organization. The strong association between turnover and the weighted index score indicates that a multipronged approach to improving workplace culture could be most effective at reducing turnover.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765790","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":"\"Having Support at Work 'Is Different' and Important\": A Qualitative Study of Virtual Peer Discussion Groups With Medical School Faculty.","authors":"Chantal M L R Brazeau, Manasa S Ayyala, Ping-Hsin Chen, Margaret Swarbrick","doi":"10.1097/ACM.0000000000005916","DOIUrl":"10.1097/ACM.0000000000005916","url":null,"abstract":"<p><strong>Purpose: </strong>In response to the need to support health care professionals during the COVID-19 pandemic, an innovative, peer-led discussion group program for medical school faculty, called CIRCLE (Colleague Involved in Reaching Colleagues through Listening and Empathy), was developed at Rutgers Health. This article describes results of a qualitative analysis of the participants' experiences, explores virtual communication platform use during this peer support program, and identifies the program's beneficial elements.</p><p><strong>Method: </strong>CIRCLE was inaugurated in October 2020 at Rutgers New Jersey Medical School and Rutgers Robert Wood Johnson Medical School using evidence-informed topics. The inaugural CIRCLE peer-led discussion groups included 50 physicians who met twice monthly in groups of 5 to 8 between October 2020 and April 2021. Deidentified transcript data were iteratively reviewed using conventional content analysis, including familiarization, thematic framework creation, indexing, charting, mapping, and interpretation. Themes were grouped into 4 conceptual framework categories based on social support theory in context of work-related stress: emotional, appraisal, informational, and instrumental support.</p><p><strong>Results: </strong>Themes emerged based on the framework: emotional support (connecting on a deeper level, importance of support at work, COVID-19 made virtual connections needed and relevant), appraisal support (feeling \"not alone,\" safe space to connect and share), informational support (sharing self-care strategies), and instrumental support (incentives to join are helpful but connection leads to engagement, some structure but \"not too much\" is important, virtual modalities are convenient and conducive to connection).</p><p><strong>Conclusions: </strong>Benefits of peer discussion groups include deeper connections at work, reduced isolation, safe sharing, and exchange of information on self-care. Connection and balancing structure and autonomy were important to engagement. Virtual modalities were viewed as feasible, convenient, and conducive to connection. This article highlights the benefits and convenience of virtual peer-led discussion groups for medical school clinical faculty and provides evidence for content development of these programs.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"459-465"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712011","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":"Integrating Generative Artificial Intelligence Into Medical Education: Curriculum, Policy, and Governance Strategies.","authors":"Marc M Triola, Adam Rodman","doi":"10.1097/ACM.0000000000005963","DOIUrl":"10.1097/ACM.0000000000005963","url":null,"abstract":"<p><strong>Abstract: </strong>The rapid advancement of generative artificial intelligence (GAI) is poised to revolutionize medical education, clinical decision-making, and health care workflow. Despite considerable interest and a surfeit of newly available tools, medical educators largely lack both competencies and guidance on how to incorporate the new and rapidly evolving world of GAI into the core medical school curriculum and experiences of undergraduate medical education. This Scholarly Perspective highlights the need for medical schools to adapt to this new paradigm by implementing policies, governance, and curricula that address the ethical, technical, and pedagogical implications of GAI. The authors recommend creating policies for appropriate GAI use, designed to protect institutional and patient data, and provide students with clarity on the appropriate use of AI for education. The authors suggest that implementing GAI governance at institutions is crucial to create guiding principles on ethical and equitable GAI use and involving students as coinventors of local innovation. The authors argue that providing faculty and learners with tools and training for safe experimentation with GAI and defining competencies for students and faculty are essential. Curricula for GAI should focus on implications of clinical uses. The authors propose a set of new competencies for GAI that build on those already established for AI in general. Given how dynamic the world of GAI is and how quickly new innovations are changing longstanding practices of clinical medicine, it is imperative that the medical education community acts together to share best practices, gather data to assess the impact of GAI education, continuously update the expected competencies of medical students, and help students prepare for a career that will be continually changed by GAI.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"413-418"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869747","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":"Creating More Reliable Large Language Models in Medical Education.","authors":"Nicholas J Cione, Malford T Pillow","doi":"10.1097/ACM.0000000000006058","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006058","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling Potential: Achieving Mission by Integrating Enrollment Management With Identity-Masked Holistic Admissions Practices.","authors":"Crystal I Bryce, Gisele Armond Abron, Amanda M Lynn, Brigham C Willis, Sunny Nakae","doi":"10.1097/ACM.0000000000005918","DOIUrl":"10.1097/ACM.0000000000005918","url":null,"abstract":"<p><strong>Purpose: </strong>Holistic review for admissions is designed to mitigate the common systemic barriers applicants may face in their medical school application journey and the common mistakes committed by admissions committees, but limited literature outlines how this can be modeled. This study examined a blinded holistic admissions approach that emphasized mission and value alignment and the resulting characteristics of applicants by admission status.</p><p><strong>Method: </strong>Application data from 2,027 applicants to The University of Texas at Tyler School of Medicine with complete secondary applications for the 2022 to 2023 cycle were analyzed. Applicants were categorized by the most advanced stage they reached in the admissions process: not selected for interview (n = 1,742), interviewed (n = 239), or accepted (n = 46). Data included information on students' geographic ties to East Texas, institutional mission alignment, academic preparation information, and Computer-Based Assessment for Sampling Personal Characteristics (CASPer) test results.</p><p><strong>Results: </strong>In the not selected for interview and interviewed groups, mission commitment was significantly negatively associated with geographic ties ( r = -0.189 and -0.209., respectively) and academic preparation ( r = -0.195 and -0.241, respectively). In the not selected for interview group, higher mission commitment scores were significantly associated with lower CASPer scores ( r = -0.110). In the interviewed group, higher geographic ties were significantly associated with lower academic preparation ( r = -0.143) and lower CASPer scores ( r = -0.280). Demographically, the accepted group had higher than expected counts of individuals who reported free or reduced lunch eligibility (14 vs 8), Pell Grant eligibility (22 vs 12), and family incomes of less than $50,000 per year (14 vs 6).</p><p><strong>Conclusions: </strong>This study demonstrates successful and effective implementation of a mission-aligned holistic admissions process, with accepted students exemplifying the mission of the institution and representing traditionally underrepresented groups.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"480-489"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in Learner Performance Using the ACGME Harmonized Milestones During the First Year of Postgraduate Training.","authors":"Sally A Santen, Michael S Ryan, Tonya L Fancher, Tyler Carcamo, Sean O Hogan, Laurah Turner, Jeffery J H Cheung, Kate Berg, Moshe Feldman, Eric S Holmboe, Yoon Soo Park","doi":"10.1097/ACM.0000000000006053","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006053","url":null,"abstract":"<p><strong>Purpose: </strong>Postgraduate medical training in the United States requires formative assessments of learners using the Accreditation Council for Graduate Medical Education (ACGME) milestones system. With Milestones 2.0, Harmonized Milestones (HMs) for 4 competency domains (professionalism, communication and interpersonal skills, systems-based practice, and practice-based learning and improvement) across specialties were developed. Performance of postgraduate trainees across specialties and at the transition to residency can be explored with the HMs. This study examined the factors that contribute to the variability in the assessments of postgraduate year 1 (PGY-1) learners as measured using Milestones 2.0.</p><p><strong>Method: </strong>This retrospective study assessed national ACGME HM data from PGY-1 residents at U.S. medical schools in July 2021 and 2022 from the 6 largest specialties: emergency medicine, family medicine, internal medicine, general surgery, psychiatry, and pediatrics. Variance component analyses were conducted using cross-classified random-effects models, accounting for clustering; estimated variance components were used to generate inference on contribution of learner variability due to residency program, medical school, and specialty and make inferences on HM rating practices, including straight-lining.</p><p><strong>Results: </strong>The sample included 57,132 PGY-1 residents (2,430 programs). Specialty accounted for the largest variance (22%) across HM competency domains. Within specialty, variance components for trainees, residency programs, and medical schools accounted for 22%, 35%, and 2% of total variance, respectively. Straight-lining was found at 6 months for 6,827 of 56,804 PGY-1 residents (12%), with the greatest amount in surgery (2,105 of 5,559 [38%]).</p><p><strong>Conclusions: </strong>This study found variability in HM performance across 6 specialties due to medical schools, specialty, residency programs, and trainees with limited variability attributed to medical school and learner. Substantial differences across specialties call for the need for clinical educators, researchers, and accreditors to create a shared mental model to bolster the evaluative strength of milestones and prepare residents for the needs of health care.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic Flashcards in Health Professions Education: A Scoping Review.","authors":"Philip D Barrison, Emily A Balczewski, Emily Capellari, Zach Landis-Lewis, Alexandra H Vinson","doi":"10.1097/ACM.0000000000005968","DOIUrl":"10.1097/ACM.0000000000005968","url":null,"abstract":"<p><strong>Purpose: </strong>Electronic flashcards (EFs) are a widely used learning resource in medical education. This scoping review provides a comprehensive overview of the existing empirical research on EFs and a direction for future research on EF interventions. The authors organized the reviewed articles into 4 nonmutually exclusive categories: development, delivery, utilization, and associated outcomes.</p><p><strong>Method: </strong>In this scoping review, search queries were composed for 6 databases (PubMed, Embase, Education Resource Information Center, Web of Science, PsychInfo, and the Cumulative Index to Nursing and Allied Health Literature). The database search was conducted on April 12, 2024, for articles published before this date using the following keywords (as well as other keywords): anki, quizlet, firecracker, osmosis, flashcard , spaced repetition , spaced interval training , spaced interval learning , spaced test , and parallel curriculum. Two reviewers screened the studies for eligibility and performed data extraction between August 12, 2024, and September 26, 2024.</p><p><strong>Results: </strong>Sixty-four studies were included in the review. Most articles were published in the last 6 years (2019-2024) (49 [77%]), in the United States (45 [7%]), and in the context of undergraduate medical education (42 [66%]). The studies predominantly focused on the utilization (51 [78%]) and associated outcomes (38 [59%]) of EFs. In contrast, EF development (12 [19%]) and delivery methods (16 [25%]) were less frequently examined.</p><p><strong>Conclusions: </strong>This review of the rapidly increasing body of research on EFs suggests broad use and satisfaction among health professions learners; however, much work remains to be done to systematically understand EF development and delivery. Future research directions may consider more systematic investigations of how decisions made during the development and delivery of EFs affect downstream use and learning outcomes. Addressing these gaps will deepen the understanding of how EFs affect medical education pedagogy and facilitate their informed integration and refinement within curricula.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"497-506"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}