Academic Medicine最新文献

{"title":"Validity Evidence for Using Virtual, Interactive Patient Encounters to Teach and Assess Clinical Reasoning for First-Year Medical Students.","authors":"John K Roberts, Nancy Weigle, James W Fox, Sreeja Natesan, David Gordon, Saumil M Chudgar","doi":"10.1097/ACM.0000000000005952","DOIUrl":"10.1097/ACM.0000000000005952","url":null,"abstract":"<p><strong>Purpose: </strong>Despite universal agreement on the importance of clinical reasoning skills, inadequate curricular attention to these skills remains a problem. To facilitate integration of clinical reasoning instruction and assessment into the preclerkship phase, the authors created a clinical reasoning curriculum using technology-enhanced patient simulations.</p><p><strong>Method: </strong>In 2023, first-year medical students at Duke University School of Medicine were enrolled in a biomedical science course using diagnostic reasoning sessions and 16 virtual, interactive patient (VIP) encounters to teach and assess clinical reasoning. The encounters were enhanced with interactive pop-in windows that assessed multiple clinical reasoning domains. Student responses were independently evaluated by faculty. Cumulative VIP clinical reasoning composite (CRC) scores were calculated, and growth mixture modeling was used to define students by growth trajectory. Clinical reasoning was assessed in a summative objective structured clinical examination (OSCE).</p><p><strong>Results: </strong>Of the 118 students who participated in the curriculum, 1 was excluded from analysis for inadequate participation in the VIP encounters, leaving 117 students. The aggregate VIP encounter response rate was 95% (1,783 of 1,872 assessments completed). Clinical reasoning was assessed through cumulative performance across multiple domains. The mean (SD) scores were 58 (13) for information gathering, 46 (13) for illness script identification, 64 (14) for hypothesis generation, 59 (12) for differential diagnosis, and 77 (21) for management and plan. To identify latent classes of growth in cumulative VIP-CRC scores, growth mixture modeling was performed for 1-, 2-, and 3-class models. The 2-class model showed the best fit due to having the lowest bayesian information criterion (11,765.17) and Akaike information criteria (11,737.55).</p><p><strong>Conclusions: </strong>Integrated clinical reasoning instruction and deliberate, formative practice through authentic simulations were effective at teaching and assessing clinical reasoning in the preclerkship phase. VIP and OSCE can be used to identify students at risk of low performance in the clerkship year.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"445-452"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848378","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":"Sexual History-Taking in a Surgery Clerkship Assessment: A Stubborn Clinical Skills Gap With Reproductive Health Care Implications.","authors":"Taylen Coleman, Dylan T Adamson, Hannah Marshall, Jensen Smith, Tiffany Wright, Carrie A Bohnert, M Ann Shaw, Laura A Weingartner","doi":"10.1097/ACM.0000000000005939","DOIUrl":"10.1097/ACM.0000000000005939","url":null,"abstract":"<p><strong>Purpose: </strong>Patients present with sexual and reproductive health needs in various clinical settings, so knowing when and how to elicit a relevant sexual history is critical in any specialty. This work examined whether reinforcing the surgical relevance of sexual health with an integrated training improved third-year medical students' sexual history-taking.</p><p><strong>Method: </strong>Third-year surgery clerkship standardized patient assessments were video coded from a 2021-2022 comparison and 2022-2023 intervention cohort (University of Louisville School of Medicine). The case used for both cohorts involved a 38-year-old patient assigned female at birth presenting with acute right lower abdominal pain. Before the assessment, the intervention cohort received an additional clerkship didactic session focused on evaluation and assessment of the acute abdomen emphasizing the importance of sexual history-taking for surgical patients. The frequency of sexual histories attempted, number of questions, topics discussed, and differential diagnoses were compared.</p><p><strong>Results: </strong>There was not a significant difference between cohorts' sexual history-taking frequency: 61% (72/119) of students in the comparison cohort, compared to 65% (86/132) in the intervention cohort. On average, students in the intervention group asked 6 questions related to sexual health, compared to 3 questions by students in the comparison group ( P < .001). Across cohorts, 66% (104/158) of students who took a sexual history considered sexual diagnoses on their differential, compared to only 23% (21/93) of students who did not take a sexual history ( P < .001).</p><p><strong>Conclusions: </strong>Reinforcing the clinical relevance of sexual history-taking for surgical patients was associated with higher-quality histories and broader differentials but not higher rates of sexual history-taking. Because there is now variability in how reproductive health care can be delivered across the United States, medical educators must refocus on sexual history-taking skills in a variety of settings and work to address barriers preventing students from collecting this information.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"438-444"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774396","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 Magic of Companionship.","authors":"Maggie M K Chan, E Angela Chan","doi":"10.1097/ACM.0000000000005966","DOIUrl":"10.1097/ACM.0000000000005966","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"474"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958394","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":"Coaching Learners During Medical School Training: Faculty Reflections on the Coaching Experience.","authors":"Maria A Blanco, Lauren Boehm, Victoria Hayes","doi":"10.1097/ACM.0000000000006054","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006054","url":null,"abstract":"<p><strong>Purpose: </strong>Research has shown the impact that coaching medical trainees has on the coaches' professional development and relationships. However, this research has not specifically investigated the evolution of this impact. The authors conducted a longitudinal qualitative research study to follow faculty as they developed their role as coaches of medical students during a 4-year coaching experience.</p><p><strong>Method: </strong>The authors conducted 60-minute semistructured interviews with a selected group of faculty coaches at Tufts University School of Medicine, Boston, Massachusetts, from September 2019 to June 2023. Interviews were conducted at the beginning of the coaching experience and revisited at the end of the coaching experience with the first cohort of students. The authors performed a reflexive thematic analysis of all the transcripts using inductive open coding to construct themes.</p><p><strong>Results: </strong>Nine faculty coaches participated in the study. The coaches' reflections on their experiences coaching the same group of medical students for 4 years focused on the centrality of relationships in coaching, the evolving nature of the coaching relationship with medical students, and the impact of coaching on the coaches' professional and personal relationships, including their relationship with the field of medicine. The coaches found building the relationship as the most meaningful, as well as the most challenging, aspect of their coaching.</p><p><strong>Conclusions: </strong>The authors propose continuing to define skills for faculty to strengthen and expand relationships with trainees in these coaching relationships, which are at the core of the coaching endeavor and which our participants found as the most rewarding and yet challenging aspect of their role.</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":"143765792","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":"Premedical Course Requirements in U.S. Medical Schools.","authors":"Ahmed Ahmed, Yoseph Boku, Emma Korolik, Blake Shultz","doi":"10.1097/ACM.0000000000005951","DOIUrl":"10.1097/ACM.0000000000005951","url":null,"abstract":"<p><strong>Purpose: </strong>This study characterizes required or recommended premedical coursework, coursework fulfillment, and congruence among U.S. medical schools.</p><p><strong>Method: </strong>This cross-sectional study examined course requirements and recommendations of U.S. allopathic medical schools, using data from the 2023 to 2024 Association of American Medical Colleges Medical School Admission Requirements database. Courses required and recommended, credit hours, medical schools accepting pass/fail credits, advanced placement credits, online courses, and community college credits were evaluated.</p><p><strong>Results: </strong>Of 157 medical schools, 154 had at least 1 premedical course requirement or recommendation. No schools had the same requirements or recommendations; 113 (72.0%) required or recommended 10 or more courses. The most commonly required courses were biology (107 [68.2%]), physics (106 [67.5%]), organic chemistry (105 [66.9%]), and inorganic chemistry (90 [57.3%]). The most commonly recommended courses were social sciences (96 [61.1%]), genetics (96 [61.1%]), and psychology (86 [54.8%]). Humanities had the highest range of credit hours expected (median, 6; range, 3-24) and cell and molecular biology, computer science, physiology, microbiology, and ethics the smallest (median, 3; range, 3-3). College mathematics had the highest proportion of schools accepting pass/fail (n = 15/26 [57.7%]) and AP (n = 51/65 [78.5%]) credits and biochemistry the lowest (n = 18/54 [33.3%] and n = 57/116 [49.1%], respectively). Statistics had the highest proportion of schools accepting online courses (n = 41/54 75.9%]) and inorganic chemistry the lowest (n = 60/127 [47.2%]). College English had the highest proportion of schools accepting community college credits (n = 102/109 [93.6%]) and cell and molecular biology the lowest (n = 11/15 [73.3%]).</p><p><strong>Conclusions: </strong>These results show substantial variability in premedical course requirements or recommendations among U.S. medical schools, which could be challenging for premedical students planning their undergraduate studies. Additional research is needed on the effect of this variability on students interested in attending medical school.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"475-479"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848376","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":"Enhancing Medical Education to Improve Patient Safety.","authors":"Laura J Fochtmann","doi":"10.1097/ACM.0000000000005945","DOIUrl":"10.1097/ACM.0000000000005945","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"408"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787738","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":"Commentary on \"Listen Through\" by Stephen Clare.","authors":"Stephen Clare","doi":"10.1097/01.ACM.0001110312.33100.dd","DOIUrl":"https://doi.org/10.1097/01.ACM.0001110312.33100.dd","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"427"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712018","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":"\"Mission-Aligned Funds Flow\": Effect on Clinical Departments.","authors":"Satyan Lakshminrusimha, Susan Murin, Joseph M Galante, Zishan Mustafa, Noel Sousa, Stanley Chen, Debbie A Aizenberg, Elizabeth Morris, David A Lubarsky","doi":"10.1097/ACM.0000000000005909","DOIUrl":"10.1097/ACM.0000000000005909","url":null,"abstract":"<p><strong>Problem: </strong>Academic medical centers struggle with the high cost of care, reduced reimbursement, intense competition, and low profit margins. Many factors, including a high proportion of publicly insured patients, a model rewarding procedural specialties, and research and educational support burden, led to faculty salary inequities, physician disengagement, and difficulty recruiting.</p><p><strong>Approach: </strong>UC Davis Health implemented an aligned funds flow model in July 2021 to create a mission-aligned model in which all departments had financial margins to optimize recruitment, retention, research, and teaching.</p><p><strong>Outcomes: </strong>The 3-year experience (academic years 2021-2024) with this model at UC Davis Health was characterized by physician compensation, physician recruitment, and profit increases. Total collections for departments increased by 4% in the first year, 0.2% in the second year, and 11.3% in the third year of funds flow. Total productivity increased by 4.9% during the first year, 3.6% during the second year, and 8.4% during the third year. Salaries increased in all departmental categories in year 3. Productivity and collections per faculty member increased during the first year and were stable during the second and third years. Parity among procedural, primary care, and hospital-based service lines was improved because departmental revenue was agnostic to payer mix and hospital agreements were more formulaic. The hospital contribution to funds flow increased from $67 million in 2022 to $101 million in 2024.</p><p><strong>Next steps: </strong>Regular communication and transparency are critical to ongoing trust and success with implementation of sustaining funds flow. The new model resulted in improved physician compensation and increased hiring. However, the implementation of funds flow had a negative fiscal effect on the academic medical center, and sustainability may require fine-tuning to balance affordability. The authors plan to convert outpatient primary care to productivity-based models and decrease time-limited support for new faculty from 2 years to 1 year.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"433-437"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559323","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":"The Shadow Economy of Effort: Unintended Consequences of Pass/Fail Grading on Medical Students' Clinical Education and Patient Care Skills.","authors":"Eric Warm, David A Hirsh, Benjamin Kinnear, Henrike C Besche","doi":"10.1097/ACM.0000000000005973","DOIUrl":"10.1097/ACM.0000000000005973","url":null,"abstract":"<p><strong>Abstract: </strong>The shift to pass/fail grading in undergraduate medical education was designed to reduce medical students' stress. However, this change has given rise to a \"shadow economy of effort,\" as students move away from traditional didactic and clinical learning to engage in increasing numbers of research, volunteer, and work experiences to enhance their residency applications. These extracurricular efforts to secure a residency position are subphenomena of the hidden curriculum. Medical schools do not officially require all the activities students need to be most competitive for residency selection; therefore, students, as rational actors, participate in the activities they think will most help them succeed.Here, the authors frame residency application and selection as a complex adaptive system (CAS), which self-organizes without centralized control or hierarchical intent. Individuals in a CAS operate in environments marked by volatility, randomness, and uncertainty-all of which are abundant in the residency selection process. Outcomes in such systems, like the development of a shadow economy, are novel, emergent, and cannot always be anticipated. To address these challenges, the authors suggest the need for deep understanding of the system's elements, interrelationships, and dynamics, including feedback loops and emergent properties. Optimizing the results of a CAS requires incentivizing outcomes over activities, ensuring open information flow, and engaging in continuous monitoring and evaluation.The current pass/fail era and resultant shadow economy of effort risk creating a triple harm by devaluing clinical excellence, burning out medical students, and potentially producing superficial or, worse, inauthentic academic and community work. Medical educators must optimize residency application and selection for cooperative outcomes and design incentives to ensure the outputs of medical education align student, institutional, patient, and societal goals. Without a set of predictive \"answers,\" the authors suggest a process of determining actions to advance this ultimate aim and reduce harm.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"419-424"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958400","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":"How Does the Novice Become the Expert? An Instrumental Case Study of Procedural Educators.","authors":"Ilana Roberts Krumm, Adrienne Strait, Lekshmi Santhosh","doi":"10.1097/ACM.0000000000005917","DOIUrl":"10.1097/ACM.0000000000005917","url":null,"abstract":"<p><strong>Purpose: </strong>The classic paradigm of procedural education in medical training has involved trainees learning and performing invasive bedside procedures and subsequently teaching these procedures to more junior trainees. Many existing resident-as-teacher curricula focus on cognitive domains; there has been a lack of literature examining the transition from learner to teacher in procedural education. This hypothesis-generating instrumental case study explored how expert procedural educators transitioned from novice procedural educators to experts.</p><p><strong>Method: </strong>A constructivist approach with semistructured interviews was used to explore the individual narratives and experiences of faculty of the Hospitalist Procedure Service at the University of California San Francisco as they reflected on their journey from learners to teachers, focusing on the faculty of the hospitalist procedure team at the University of California San Francisco. All 12 Hospitalist Procedure Service faculty members received invitations to be interviewed, and 9 agreed to participate. Interviews were conducted between July and October 2023.</p><p><strong>Results: </strong>The 9 interviews created a rich and complex picture of the individual experiences and perceptions of procedural teaching. The faculty members varied in experience, ranging from 2 years on the procedure service faculty to more than 15 years of experience. Four main themes emerged from the interviews: methods for building teaching skills, tools that facilitate further educator growth, essential behaviors of effective educators, and common challenges. Inductive thematic analysis revealed trial and error as a major means of building procedural pedagogy and the use of precise communication as a crucial skill to manage learner cognitive load and the emotional challenges associated with learning and teaching procedures.</p><p><strong>Conclusions: </strong>The use of precise communication as a tool for both educator and learner to navigate the complexities of procedural teaching highlights the essential role of clear instruction and feedback in the learning process.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"453-458"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712019","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}