Academic Medicine最新文献

{"title":"Not meeting expectations: A qualitative study of feedback from program directors about residents who did not meet performance expectations.","authors":"John W Ragsdale, Amy Pineda, Lynn Shaull, Douglas Grbic, Lisa Doyle Howley","doi":"10.1093/acamed/wvag292","DOIUrl":"https://doi.org/10.1093/acamed/wvag292","url":null,"abstract":"<p><strong>Purpose: </strong>The AAMC's Resident Readiness Survey (RRS) is administered to program directors (PDs) nationally about their postgraduate year-1 (PGY-1) residents and provides feedback to medical schools about their effectiveness in preparing graduates for residency. The authors sought to characterize the factors contributing to a PD's assessment that a resident had not met expectations.</p><p><strong>Method: </strong>Using 2023-2024 RRS data, the authors performed a qualitative analysis of free text responses from PDs regarding residents who were evaluated as \"did not meet overall performance expectations.\" The authors independently coded those comments using conventional content analysis to describe the categories of comments present. Using a recursive approach, they iteratively discussed and refined their codes until achieving consensus.</p><p><strong>Results: </strong>On the RRS, 431 PGY-1 residents were evaluated by PDs as not meeting expectations (2.9% of 14,641 completed surveys). Of these 431 residents, 309 residents (71.7%) had comments available for analysis. Categories for PDs' comments corresponded to challenges in five competencies with identified subcategories for each. In addition, professionalism and practice-based learning and improvement were identified as mitigators of challenges in other domains. PDs also provided comments about potential reasons a resident was not meeting performance expectations, including limited clinical exposure in medical school, inadequate identification by the medical school of performance issues, or a lack of communication to residency programs about those issues.</p><p><strong>Conclusions: </strong>PDs' comments described challenges of PGY-1 residents in five particular competencies, highlighting alignment between national competency frameworks for undergraduate medical education and how PDs view resident performance. The findings also highlight opportunities to improve the transition ecosystem, including enhanced student assessment in undergraduate medical education and improved communication to residency programs about medical school graduates' strengths and areas for continued growth and development.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026762","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":"Academic Medicine: Where have we been? Where are we going?","authors":"Kenneth M Ludmerer","doi":"10.1093/acamed/wvag286","DOIUrl":"https://doi.org/10.1093/acamed/wvag286","url":null,"abstract":"<p><p>The occasion of Academic Medicine's centennial anniversary (2026) provides the opportunity to look back to its history and forward to its future. The journal was founded in the aftermath of the revolution in American medical education of the late 19th and early 20th centuries. The events of that era are reviewed to correct the common misperception that little had happened in American medical education before the Flexner report of 1910. The work of Academic Medicine over 100 years is described, with an emphasis on how its focus expanded from the internal mechanics of medical education to include the complex, powerful external forces that affect medical education, research, and practice. In this effort, Academic Medicine has served as the profession's conscience, helping identify core values that must be defended to allow success in any future scenario.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002837","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":"Bridging algorithm and narrative: natural language processing, narratology, and radical empathy as core competencies in medical education.","authors":"Omar Dabash, Michael J Daly","doi":"10.1093/acamed/wvag289","DOIUrl":"https://doi.org/10.1093/acamed/wvag289","url":null,"abstract":"<p><p>As artificial intelligence (AI) increasingly shapes clinical practice, medical education faces a critical moment: integrating computational literacy with narrative understanding and radical empathy. This commentary argues that future physicians must master not only how machines extract meaning from clinical text but also how to preserve narrative complexity, honor patient agency, and maintain relational care in technologically mediated environments. The authors propose a framework for integrating natural language processing (NLP), narratology, and radical empathy into medical curricula. Drawing on evidence from narrative medicine interventions, emerging applications of clinical NLP, and literature on clinician well-being, the commentary demonstrates that narrative literacy-coupled with computational awareness-enhances diagnostic reasoning, reduces bias, and cultivates the empathy essential for patient-centered care. The authors examine barriers to curricular integration, propose pedagogical strategies, and outline implications for medical education reform.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978351","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":"Academic medical centers implementing new Medical Aid in Dying (MAiD) laws: challenges and solutions.","authors":"Robert Klitzman","doi":"10.1093/acamed/wvag288","DOIUrl":"https://doi.org/10.1093/acamed/wvag288","url":null,"abstract":"<p><p>New York and additional jurisdictions are now joining others in legalizing Medical Aid in Dying (MAiD), but academic medical centers and clinicians are, consequently, confronting dilemmas regarding whether to provide it, and if so, how. Institutions must decide what processes to establish if patients inquire about MAiD, which specific clinicians within an institution should evaluate patients for eligibility and capacity, and prescribe MAiD medications, how to communicate about the new law with patients and local communities, how to educate medical and other students and staff appropriately, and how to make these decisions. The contexts of state laws, hospital, clinicians, patients and local communities all vary in ways that can affect these new institutional practices and policies. Though a few jurisdictions have addressed MAiD in the past, use has been increasing and attitudes changing, and the contexts of different states and their relevant laws vary considerably. For example, though some states require that patients alone, not clinicians, raise the topic of MAiD, others allow clinicians to broach the topic as well, posing challenges. These issues have critical implications for governmental and institutional policies, practice, research and education. This paper provides suggestions for how institutions should address these challenges-by establishing as early as possible a multidisciplinary working group, including providers (e.g., from palliative care, psychiatry, nursing and social work), compliance, other administrative, legal, and ethics stakeholders. Hospitals should establish and disseminate clear step-by-step policies and procedures, including standardized electronic health record templates, and develop research protocols to assess the effects of implementation. Institutions should also provide and organize structured \"debriefs\" after initial cases (to examine what went well or not) and/or periodic case conferences among clinicians performing MAiD, and mentorship in providing and prescribing MAiD, offering support, in part due to moral distress and other concerns that can emerge.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978343","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":"When the scribe does the reasoning: ambient artificial intelligence, inference impersonation, and the development of trainees' clinical judgment.","authors":"Steven McGaughey, Jane Abernethy, Jordan Wackett, John Organick-Lee, R Logan Jones, Robert L Cloutier","doi":"10.1093/acamed/wvag287","DOIUrl":"https://doi.org/10.1093/acamed/wvag287","url":null,"abstract":"<p><p>Ambient artificial intelligence (AI) scribes are entering clinical practice on aligned incentives, with physicians gaining relief from documentation burden and health systems gaining revenue through more complete coding. Yet adoption has outpaced evaluation. This paper identifies a specific phenomenon, which it calls inference impersonation. In the Assessment and Plan, ambient AI scribes do not transcribe clinical reasoning but rather generate it. The resulting text mimics physician judgment without the iterative hypothesis testing, contextual weighing, and management reasoning that define clinical thought. Generated and transcribed content are effectively indistinguishable in the final note, so neither the signing physician nor the reviewing trainee can identify where transcription ends and generation begins. The risk falls hardest on trainees. An experienced attending may recognize a narrow differential or a generic plan, but a trainee cannot evaluate what they cannot yet produce independently, and automation bias is powerful. In one randomized trial, physicians shown deliberately erroneous AI suggestions after a 20-hour artificial intelligence literacy program scored 73% on diagnostic reasoning versus 85% among those receiving error-free suggestions. When trainees learn to reason by editing AI drafts rather than producing their own, they risk never developing the judgment that training exists to build. The authors propose a response that is both technical and educational. Vendors should offer centrally managed, learner-specific configurations and section-level transparency distinguishing transcribed from generated content, and training programs should make these an explicit condition of deployment. Because no major commercial scribe today constrains inference for trainees, programs can protect an existing norm now by requiring trainees to present their reasoning before the note is generated, gating scribe access to demonstrated competency, and assessing reasoning through the oral case presentation as well as the written note, mapped to an entrustable activity and its milestones.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978427","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":"Emotional exhaustion and poor psychological well-being among osteopathic medical school matriculants and graduates.","authors":"Zachary M Himmelberger, Erik Guercio, Jay R Barrow, Matthew Best, Yoi Tibbetts, Kenneth E Barron, Mark R Speicher, Chris S Hulleman","doi":"10.1093/acamed/wvag284","DOIUrl":"https://doi.org/10.1093/acamed/wvag284","url":null,"abstract":"<p><strong>Purpose: </strong>Burnout is prevalent among medical students and is linked to depression, impaired academic performance, and medical errors. Although osteopathic medical students comprise 25% of U.S. medical students and often serve in high-need settings, their burnout and psychological well-being have been less frequently studied. The present study seeks to describe the prevalence of emotional exhaustion and psychological symptoms at matriculation and graduation in U.S. osteopathic medical students, and to examine differences across gender and race/ethnicity.</p><p><strong>Method: </strong>In Fall 2022 (matriculating class of 2026; N=7,414; 80.9% of the class) and Spring 2023 (graduating class of 2023; N=4,048; 50.7% of the class), the American Association of Colleges of Osteopathic Medicine administered surveys to assess medical student well-being, including measures of emotional exhaustion (originally derived from the Maslach Burnout Inventory) and psychological symptoms (as measured by the Brief Symptom Rating Scale).</p><p><strong>Results: </strong>Among matriculants (N = 7414), 28.6% of students reported at least mild emotional exhaustion and 70.6% reported at least mild psychological symptoms. Among graduates (N = 4048), 63.7% of students reported at least mild emotional exhaustion and 85.7% reported at least mild psychological symptoms. At matriculation, female students reported greater emotional exhaustion [31.8 v. 30.1; P=.003, d=0.07] and psychological symptoms [matriculating: 7.9 v. 6.8; P<.001, d=0.30] than male students. The same pattern emerged at graduation, where female students reported greater emotional exhaustion [52.9 v. 48.3; P<.001, d=0.17] and psychological symptoms [10.3 v. 9.1; P<.001, d=0.31]. Graduating students reported greater emotional exhaustion [51.0 v. 31.4; P<.001, d=0.80] and psychological symptoms [9.8 v. 7.5; P<.001, d=0.60] than matriculants.</p><p><strong>Conclusions: </strong>Osteopathic medical students experience concerning rates of emotional exhaustion and psychological symptoms, evident both at matriculation and graduation. In both cohorts, female students were particularly affected. These findings highlight a challenge that medical schools must continue to address.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957083","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":"Those left behind: the impact of resident suicide on trainees, faculty, departments, and institutions.","authors":"Audrey Rosenblatt, Ruojia Debbie Li, Brian J Nasca, Elaine Cheung, Egide Abahuje, Daniela Amortegui, Heather Ballard, Karl Y Bilimoria, Gaurava Agarwal, Yue-Yung Hu, Julie K Johnson","doi":"10.1093/acamed/wvag283","DOIUrl":"https://doi.org/10.1093/acamed/wvag283","url":null,"abstract":"<p><strong>Purpose: </strong>Suicide is a leading cause of death for residents and can have a profound impact on those left behind, increasing their risk of suicide. Suicide survivorship has not previously been explored in residency programs. This study sought to understand and describe the impact of resident suicide on trainees, faculty, and programs via a hermeneutic phenomenological approach.</p><p><strong>Method: </strong>Semistructured interviews and focus groups were conducted during site visits to 15 U.S. Accreditation Council for Graduate Medical Education-accredited general surgery residency programs (March 2019-March 2020) with purposive sampling to identify key stakeholders in resident wellness. If suicide was disclosed, interviewees were asked to share perspectives on their relationship to the resident, perceived risk, responses, and subsequent changes. Transcripts were analyzed with both deductive and inductive coding by multidisciplinary dyads.</p><p><strong>Results: </strong>Of 393 transcripts, 34 had content focused on suicide, representing residents (postgraduate years 1-5), faculty, program directors or associate program directors, program coordinators, department chairs, and designated institutional officials or deans from 10 programs. Themes were aligned with the stages of processing suicide-sense-making, postvention, and transition to prevention. Across all phases, programs differed in their recovery trajectories. Respondents reported convergent and divergent reactions, perceptions, and pathways through sense-making and described both effective and ineffective postvention efforts. Some programs successfully transformed loss into prevention efforts, while others confronted the limits of understanding a suicide. Lack of faculty support after a suicide was noted to have far-reaching implications for resident education. Programs that successfully transitioned reduced barriers to accessing mental health resources: ensuring confidentiality, easing financial and scheduling challenges, decreasing stigma, and implemented risk mitigation strategies.</p><p><strong>Conclusions: </strong>Resident suicide is a profound loss, affecting everyone left behind. Providing support to those affected during the aftermath of suicide is critical to facilitate sense-making, provide effective postvention, and spur a meaningful transition to prevention.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921726","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":"Being there.","authors":"Aldis H Petriceks","doi":"10.1093/acamed/wvag282","DOIUrl":"https://doi.org/10.1093/acamed/wvag282","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907849","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":"Translation of alcohol research to the academic medicine community.","authors":"George F Koob","doi":"10.1093/acamed/wvag249","DOIUrl":"https://doi.org/10.1093/acamed/wvag249","url":null,"abstract":"<p><p>The goal of alcohol research is to improve overall health and well-being. Alcohol misuse causes an estimated 178,000 deaths annually in the United States, involves over 4 million emergency room visits annually, and contributes to or exacerbates 200 medical disorders and conditions. Reducing and preventing the pathology and other consequences of alcohol misuse can significantly reduce morbidity and mortality. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) was created in 1970 in response to national interest in fundamental research to address these challenges. The mission of NIAAA is to generate and disseminate fundamental knowledge about adverse effects of alcohol on health and well-being and apply that knowledge to improve the diagnosis, prevention, and treatment of alcohol-related problems, including alcohol use disorder, across the lifespan. Major advances have been made in the prevention and reduction of alcohol misuse, alcohol use disorder, and their consequences by (1) identifying patterns, trends, and public health impacts of alcohol misuse and designing effective interventions, (2) elucidating biological mechanisms of alcohol misuse and its consequences, including alcohol-related pathology, and (3) improving the diagnosis and treatment of alcohol use disorder and other alcohol-related conditions. Such efforts require an iterative process whereby the National Institutes of Health and NIAAA interact with medical schools and academic health systems of academic medicine to engage health professionals and health sciences students, clinical trainees, and faculty to meet these goals. Major challenges remain in translating fundamental research in diagnosis, prevention, and treatment into clinical practice in the academic medical community and into information for the public at large. The present commentary is a brief overview of recent alcohol research from a translational perspective for the academic medical community, described by: Quod Facimus, Quid Fecimus, et Quo Vadimus (Where Do We Come From? What are We? Where Are We Going?).</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889371","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":"More than a job.","authors":"Albert Bradford","doi":"10.1093/acamed/wvag281","DOIUrl":"https://doi.org/10.1093/acamed/wvag281","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876622","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}