Academic Medicine最新文献

{"title":"Perceptions of the Learning Environment Among Medical Students with Disabilities and the Impact of Program Access.","authors":"Christopher J Moreland, Melissa Plegue, Zoie C Sheets, Karina Pereira-Lima, Neera R Jain, Erene Stergiopoulos, Ben Case, Amy Addams, Lisa M Meeks","doi":"10.1097/ACM.0000000000006086","DOIUrl":"10.1097/ACM.0000000000006086","url":null,"abstract":"<p><strong>Purpose: </strong>Negative learning environment experiences may contribute to burnout for medical students with disabilities (MSWD). This study explores MSWD's perceptions of the learning environment and the effects of program access (having received or not needing accommodations).</p><p><strong>Method: </strong>The authors analyzed Association of American Medical Colleges Year Two Questionnaire data from 2019 and 2020, comparing non-disabled students, MSWD with program access, and MSWD without program access (having not received or requested an accommodation, despite a need). Three learning environment measures were examined: how schools fostered students' personal and professional development; a shortened Medical School Learning Environment Scale (MSLES); and subscales on emotional climate, student-faculty interactions, and student-student interactions. Responses were compared across the 3 groups using chi-square and ANOVA tests with post-hoc pairwise comparisons.</p><p><strong>Results: </strong>Of the 23,898 respondents, 10.2% (2,438) self-reported a disability. Among those, 83.6% (2,039) reported program access, 13.9% (340) lack of program access. Students without disabilities (21,008) reported higher agreement that their school fostered their development as a person (72.2%, 15,172) and physician (90.9%, 19,089) compared with MSWD with access (65.6%, 1,312 and 89.0%, 1,778, P < .001). MSWD without access reported lower agreement than both groups (43.7%, 149 and 80.1%, 273, P < .001). There were no differences regarding the MSLES statement about high-performance standards (F(2, 23742) = 2.35, P = .095). For the 8 remaining MSLES statements and for all 3 subscales, non-disabled students reported significantly higher agreement than MSWD with and without access and MSWD with access had higher agreement than those without.</p><p><strong>Conclusion: </strong>This nationally representative study demonstrates that MSWD perceive the learning environment less favorably than their non-disabled peers. Program access partially mitigates these differences, underscoring the critical role of accommodations and the need to address structural barriers to access.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049625","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":"Standardized Language for Clinical Accommodations in U.S. Undergraduate Medical Training: Results From a National Modified Delphi Consensus Study.","authors":"Zainub Dhanani, Suchita Rastogi, Matthew Sullivan, Rylee Betchkal, Peter Poullos, Lisa M Meeks","doi":"10.1097/ACM.0000000000006150","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006150","url":null,"abstract":"<p><strong>Purpose: </strong>Limited guidance on and access to clinical accommodations pose significant barriers to disabled learners' full participation in medical education. The lack of standardized accommodation language and institutional expertise leads to inconsistent implementation, creating barriers for medical students. This study aimed to establish a consensus-based, standardized language for clinical accommodations to improve clarity, consistency, and accessibility for learners with disabilities in U.S. medical schools.</p><p><strong>Method: </strong>A modified Delphi approach was employed to achieve consensus on clinical accommodation language. A committee of nine disability resource professionals (DRPs) compiled a list of 271 accommodations, which were refined to 89 unique accommodations after eliminating redundancies. These were categorized into six domains: adaptive equipment, assistive technology, communication access, location, individualized adjustment/need, and scheduling. Two groups (disability inclusion experts and clinical-phase medical students with lived disability experience) engaged in four Delphi rounds between October 2024 and February 2025. Consensus was defined a priori as 80% agreement on accommodation language.</p><p><strong>Results: </strong>In Round 1, none of the accommodations met the 80% consensus threshold. Revisions were made, reducing the list to 75 accommodations for Round 2, where 65 accommodations met the threshold. In Round 3, nine additional accommodations achieved consensus, leaving one accommodation for final revision in Round 4, after which complete consensus was reached. The outcome was a list of 75 vetted clinical accommodations with standardized accommodation language.</p><p><strong>Conclusions: </strong>The study produced a consensus-based list of clinical accommodations to educate and empower students, faculty, and DRPs. By standardizing the language used in accommodations, this work seeks to promote accessibility and advance equity within medical education. Future research should explore the effectiveness and feasibility of implementing these accommodations in clinical settings. Additional efforts should include expanding the guidance to DO-granting institutions, incorporating faculty perspectives, and evaluating the long-term impact of standardized accommodation language on clinical training outcomes.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512695","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":"A 10-Year Review of U.S. Medical School Revenue, Fiscal Years 2012 to 2021.","authors":"Alexander G Geboy, Diana Tung, Valerie M Dandar","doi":"10.1097/ACM.0000000000006138","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006138","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines how U.S. medical school revenue diversification has changed over time, particularly growth of practice plan, hospital, and research revenue sources, and explores how these revenue changes have occurred alongside changes to the number of full-time faculty, student enrollment, and tuition and fees revenues.</p><p><strong>Method: </strong>Aggregate census data for fiscal years (FYs) 2012 to 2021 are from fully accredited U.S. medical schools and affiliated organizations. Most revenue source data are from December 2022. Tuition and student fees analysis was conducted in June 2023. The numbers of full-time faculty for FY 2012 to FY 2018 are from the Association of American Medical Colleges (AAMC) Faculty Roster and for full-time faculty for FY 2019 onward from the Liaison Committee on Medical Education Annual Medical School Questionnaire Part II. Student enrollment data are from the AAMC Student Records System. Faculty and student enrollment data are from June 2023.</p><p><strong>Results: </strong>Between FY 2012 and FY 2021, total U.S. medical school revenue increased by 48%, from $95.8 billion to $142.0 billion (in constant 2012 dollars). Most (78%) of this growth came from practice plans and hospitals, whereas revenues from federal research grants and contracts saw attenuated growth (12%). The number of full-time clinical faculty increased by 35% compared with a 9% increase in basic science faculty. Total undergraduate medical education student enrollment increased 17%, with average enrollment per school increasing 2%, from 602.6 to 616.3 students.</p><p><strong>Conclusions: </strong>Practice plan and hospital revenue accounted for the largest portion of total U.S. medical school revenue. The number of total full-time clinical faculty increased, potentially reflecting robust clinical service-related medical education activity. Although U.S. medical school revenue has continued to increase despite environmental fluctuations, concern remains that current trends in the diversification of U.S. medical school revenue could hinder education, research, and clinical missions.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530954","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":"Disability in Undergraduate Medical Education in the United States: A Scoping Review.","authors":"Lauren A Maggio, Kirsten R Brown, Joseph A Costello, Aaron Konopasky, Dionna Bidny, Abigail Konopasky","doi":"10.1097/ACM.0000000000006154","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006154","url":null,"abstract":"<p><strong>Purpose: </strong>Students with disabilities remain disproportionately underrepresented in undergraduate medical education (UME). This scoping review synthesizes the literature on undergraduate medical students with disabilities in the United States to identify the purpose of the literature and map how disability is portrayed.</p><p><strong>Method: </strong>The authors searched 8 databases for relevant publications published between January 2008 through August 2024. Publication inclusion was determined using a two-phase title/abstract screening process and full-text review conducted by two independent authors. Data extraction focused on characterizing the publication, followed by an analysis of the publications' goals and how disability was portrayed.</p><p><strong>Results: </strong>The authors identified 10,491 publications; 81 were included, most of which were journal articles (n = 78). In 23 publications, at least one author identified as disabled. Five main goals were identified in the publication purpose statements, including describing (n = 50), calling for action, evaluating, arguing, and creating. Overall, disability was portrayed as (1) diversity, (2) deficiency, (3) inherently connected with accommodation and technical standards, and (4) a place of habitual omissions. Two studies discussed disability in relation to intersectional identities, and two used gender or race in multivariable models. No studies explicitly focused on UME and disabled students of color, disability and gender diversity, or disabled LGBQ+ students.</p><p><strong>Conclusions: </strong>This scoping review identified that disability is portrayed from an abled viewpoint as race and gender-neutral, static, and as diversity, deficit, or a legal construct. Future researchers should consider how disability is conceptualized and the use of intersectional frameworks.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512694","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":"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}