Academic Medicine最新文献

{"title":"Take Charge of Your Professional Network of Colleagues to Succeed in Academic Medicine.","authors":"Attila Nemeth, Neha Deshpande, Yilin Zhang, Mamta Singh","doi":"10.1097/ACM.0000000000005971","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005971","url":null,"abstract":"<p><strong>Abstract: </strong>Instead of relying on a single, dyadic mentor for career advice, we suggest creating and intentionally cultivating a professional network of colleagues (PNC) to guide your academic career. There are four archetypes to help clinician educators succeed in academic medicine: a traditional mentor, a sponsor, a coach, and a connector.1 However, these roles are not discrete, and overlap occurs. For example, some mentors are great sponsors. In fact, a clinician educator's PNC is akin to a board of directors in the business world. A board of directors determines the direction and strategic plan of a company,2 while a PNC helps a clinician educator strategically navigate academia and provides career guidance.It can be challenging to create a PNC. To choose membership for your PNC, we propose taking an active and self-reflective role. Ask where you see yourself in the future and perform a personal value assessment.3 Then, brainstorm with your PNC on how to achieve your goals. Use the Accreditation Council of Graduate Medical Education's Clinician Educator Milestones to develop valuable skills in academia,4 build your professional identity, and target areas for professional development. We present our strategy for using and maintaining a PNC below.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958391","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 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":"https://doi.org/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 sub-phenomena 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":""},"PeriodicalIF":5.3,"publicationDate":"2025-01-06","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":"Perceptions of Key Responsibilities and Professional Development Interests of Senior Educational Leaders: A Needs Assessment.","authors":"Duane R Bidwell, Anita Samuel, Ronald M Cervero, Steven J Durning, Sherri L Stephan, Erin L Patel, Marjorie A Bowman, Holly S Meyer","doi":"10.1097/ACM.0000000000005841","DOIUrl":"10.1097/ACM.0000000000005841","url":null,"abstract":"<p><strong>Purpose: </strong>High-ranking educational leaders in academic medicine oversee multiple clinical programs. This requires them to prioritize dozens of emergent tasks and responsibilities daily, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Identifying their key responsibilities and frequently used skills and competencies may clarify the educational needs of senior educational leaders and facilitate targeted professional development to promote effective and efficient performance.</p><p><strong>Method: </strong>In August 2022, researchers interviewed 12 designated education officers (DEOs) from U.S. Department of Veterans Affairs (VA) Veterans Health Administration medical centers about their daily work and most challenging responsibilities. Content analysis of interview transcripts identified key responsibilities and activities identified by participants and prioritization of the perceived skills needed to complete them.</p><p><strong>Results: </strong>Participants emphasized 4 key areas of responsibility: fiscal, administrative, affiliate partnership, and educational duties. They identified 12 skills as baseline requirements for effective performance for which additional professional development would be useful and suggested that both new and more established educational leaders receive targeted professional development and mentoring to foster these capacities.</p><p><strong>Conclusions: </strong>The key skills participants identified by area of perceived responsibility are relevant to VA DEOs, designated institutional officers, and senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. Structured orientation programs and ongoing professional development for senior educational leaders could emphasize these areas of responsibility, potentially enriching DEOs' performance and reducing burnout.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"50-56"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977182","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 Comparison of Psychometric Properties of the American Board of Anesthesiology's In-Person and Virtual Standardized Oral Examinations.","authors":"Mark T Keegan, Ann E Harman, Stacie G Deiner, Huaping Sun","doi":"10.1097/ACM.0000000000005782","DOIUrl":"10.1097/ACM.0000000000005782","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic prompted training institutions and national credentialing organizations to administer examinations virtually. This study compared task difficulty, examiner grading, candidate performance, and other psychometric properties between in-person and virtual standardized oral examinations (SOEs) administered by the American Board of Anesthesiology.</p><p><strong>Method: </strong>This retrospective study included SOEs administered in person from March 2018 to March 2020 and virtually from December 2020 to November 2021. The in-person and virtual SOEs share the same structure, including 4 tasks of preoperative evaluation, intraoperative management, postoperative care, and additional topics. The Many-Facet Rasch Model was used to estimate candidate performance, examiner grading severity, and task difficulty for the in-person and virtual SOEs separately; the virtual SOE was equated to the in-person SOE by common examiners and all tasks. The independent-samples and partially overlapping-samples t tests were used to compare candidate performance and examiner grading severity between these 2 formats, respectively.</p><p><strong>Results: </strong>In-person (n = 3,462) and virtual (n = 2,959) first-time candidates were comparable in age, sex, race and ethnicity, and whether they were U.S. medical school graduates. The mean (standard deviation [SD]) candidate performance was 2.96 (1.76) logits for the virtual SOE, which was statistically significantly better than that for the in-person SOE (mean [SD], 2.86 [1.75]; Welch independent-samples t test, P = .02); however, the effect size was negligible (Cohen d = 0.06). The difference in the grading severity of examiners who rated the in-person (n = 398; mean [SD], 0.00 [0.73]) versus virtual (n = 341; mean [SD], 0.07 [0.77]) SOE was not statistically significant (Welch partially overlapping-samples t test, P = .07).</p><p><strong>Conclusions: </strong>Candidate performance and examiner grading severity were comparable between the in-person and virtual SOEs, supporting the reliability and validity of the virtual oral exam in this large-volume, high-stakes setting.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"86-93"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301992","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":"In Reply to Perry et al.","authors":"Joseph M Gosnell, Caitlin M Raymond, Christopher Zahner","doi":"10.1097/ACM.0000000000005899","DOIUrl":"10.1097/ACM.0000000000005899","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 1","pages":"4"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883575","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 Johns Hopkins Physician-Scientist Training Program to Enhance Institutional Retention and Entry Into Academic Positions: An Evaluation of Program Effectiveness and Outcomes.","authors":"Jordina Rincon-Torroella, James Feghali, Albert Antar, Tej D Azad, Antony Rosen, Roy C Ziegelstein, Paul B Rothman, Kathleen H Burns, Jessica L Bienstock, Andrea L Cox, Chetan Bettegowda","doi":"10.1097/ACM.0000000000005748","DOIUrl":"10.1097/ACM.0000000000005748","url":null,"abstract":"<p><strong>Purpose: </strong>The Johns Hopkins Physician-Scientist Training Program (PSTP) was implemented to overcome well-documented challenges in training and retaining physician-scientists by providing physician-scientist pathway training for residents and clinical fellows. The program's core tenets include monthly seminars, individualized feedback on project proposals, access to mentors, and institutional funding opportunities. This study evaluated the effectiveness and outcomes of the PTSP and provides a framework for replication.</p><p><strong>Method: </strong>A query of institutional demographic data and bibliometric variables of the PSTP participants (2017-2020) at a single academic medical center was conducted in 2021. In addition, a voluntary survey collected personal and program evaluation information.</p><p><strong>Results: </strong>Of 145 PSTP scholars, 59 (41%) were women, and 41 (31%), 8 (6%), and 6 (5%) of scholars self-identified as Asian, Hispanic, and Black, respectively. Thirty-three (23%) scholars received PSTP research support or career development microgrants. Of 66 PSTP graduates, 29 (44%) remained at Johns Hopkins as clinical fellows or faculty. Of 48 PSTP graduates in a posttraining position, 42 (88%) were in academia, with the majority, 29 (76%), holding the rank of assistant professor. Fifty-nine of 140 available participants responded to the survey (42% response rate). The top-cited reason for joining the PSTP was exposure to mentors and administration (50/58 respondents, 86%), followed by seeking scholarly opportunities (37/58 respondents, 64%). Most scholars intended to continue a career as a physician-scientist.</p><p><strong>Conclusions: </strong>The PSTP provides internal research support and institutional oversight. Although establishing close mentor-mentee relationships requires individualized approaches, the PSTP provided structured academic pathways that enhanced participating scholars' ability to apply for grants and jobs. The vast majority continued their careers as physician-scientists after training. In light of the national evidence of a \"leaky physician-scientist pipeline,\" programs such as the PSTP can be critical to entry into early academic career positions and institutional retention.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"63-71"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869442","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":"Integration of Clinical Trial Development in Hematology-Oncology Fellowship Training.","authors":"Christine Auberle, Ningying Wu, John F Dipersio, Saiama N Waqar, Lee Ratner","doi":"10.1097/ACM.0000000000005773","DOIUrl":"10.1097/ACM.0000000000005773","url":null,"abstract":"<p><strong>Problem: </strong>Several barriers to physicians becoming clinical investigators exist, including inexperience, lack of available mentors, and inconsistent instructive approaches with varying degrees of participation during training. These barriers cause fewer hematology-oncology fellows to pursue academic careers. A consensus is needed on structuring education in clinical investigation paired with active participation in development of a clinical trial guided by a mentor with the goal of increasing fellow interest in clinical research and pursuit of careers in academic medicine.</p><p><strong>Approach: </strong>The clinical trial development (CTD) program was initiated at Washington University School of Medicine in St. Louis in 2002 as a hands-on learning experience for hematology and oncology fellows in the design, implementation, and publication of clinical trials. Each fellow was required to identify a mentor and propose at least 1 prospective investigator-initiated clinical trial.</p><p><strong>Outcomes: </strong>At the time of data abstraction in July 2023, 118 fellows had participated in the CTD program and initiated protocols in a variety of areas according to their interests. Fellows were included in data abstraction if their fellowship began in 2002 through 2021; the program is ongoing, and the most recent class will graduate in 2024. Disease types were evenly distributed between solid tumor oncology (60 [51%]) or classic and malignant hematology (58 [49%]). Ninety-three fellows (79%) obtained institutional review board approval, and 60 (65%) published their results. Among graduating fellows, 67 (66%) secured an academic faculty appointment. Fellows with institutional review board-approved projects had significantly higher odds of obtaining an academic faculty appointment (odds ratio, 4.96; 95% confidence interval, 1.54-15.98; P = .007).</p><p><strong>Next steps: </strong>Next steps will be to further evaluate the effect of the mentorship network on early career productivity of trainees that graduate and the feasibility of extending the program to another institution.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"38-41"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176865","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 Mean Delta Method: Quantifying Assessor Stringency and Leniency and Identifying Outliers in Workplace-Based Assessments.","authors":"Sebastian Dewhirst, Warren J Cheung, Timothy Wood, Nora D Szabo, Jason R Frank","doi":"10.1097/ACM.0000000000005802","DOIUrl":"10.1097/ACM.0000000000005802","url":null,"abstract":"<p><strong>Abstract: </strong>Assessor stringency and leniency (ASL)-an assessor's tendency to award low or high scores-has a significant effect on workplace-based assessments. Outliers on this spectrum have a disproportionate effect. However, no method has been published for quantifying ASL or identifying outlier stringent or lenient assessors using workplace-based assessment data. The authors propose the mean delta method, which compares the scores that an assessor awards to trainees with those trainees' mean scores. This novel, simple method can be used to quantify ASL and identify outlier assessors without requiring specialized statistical knowledge or software. As a worked example, the mean delta method was applied to a set of end-of-shift assessments completed in a large Canadian academic emergency department from July 1, 2017, to May 31, 2018, and used to examine the net effect of ASL on learners' assessment scores. A total of 3,908 assessments were completed by 99 assessors for 151 trainees, with a median (interquartile range) of 37 (12-39) completed assessments per trainee. Using cutoff values of 1.5 and 2 standard deviations, a total of 11 and 3 outlier assessors were identified, respectively. Moreover, ASL changed overall scores by more than the mean difference between years of training for nearly 1 in 4 learners. The mean delta method was able to quantify ASL and identify outlier lenient and stringent assessors. It was also used to quantify the net effect of ASL on individual trainees. This method could be used to further study outlier assessors, to identify assessors who may benefit most from targeted coaching and feedback, and to measure changes in assessors' tendencies over time or with specific intervention.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"12-18"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581372","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":"Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey.","authors":"Irene Alexandraki, Nora Osman, Temple Ratcliffe, Wendy Simon, Elexis McBee, Michael Kisielewski, Cindy J Lai","doi":"10.1097/ACM.0000000000005820","DOIUrl":"10.1097/ACM.0000000000005820","url":null,"abstract":"<p><strong>Purpose: </strong>Clerkship grades are important in the residency selection process but can be influenced by individual bias and grading tendencies. Although clinical competency committees are standard in graduate medical education, in undergraduate medical education, they have not gained widespread traction. This study describes structures and processes of grading committees in internal medicine (IM) clerkships and strategies used to mitigate grading bias.</p><p><strong>Method: </strong>From September to December 2022, the Clerkship Directors in Internal Medicine conducted its annual survey of IM core clerkship directors at 140 U.S. and U.S. territory-based medical schools. This study was based on 23 questions about grading committees in IM clerkships.</p><p><strong>Results: </strong>The survey response rate was 80% (n = 112/140). Forty-seven respondents (42%) reported using grading committees in their IM clerkship (median committee size, 7; range, 3-20) (primarily clerkship leadership and faculty). Responsibilities included determining grades for all students (31 [66%]) and students at borderline of failing (30 [64%]), adjudicating on students with professionalism concerns (25 [53%]), and reconciling discordant clinical evaluations (24 [51%]). To mitigate deliberation bias, committees most frequently used multisource assessments (38 [81%]) and adoption of a shared mental model (36 [77%]). Approximately one-third of grading committees \"rarely\" discussed gender (14 [30%]) and race or ethnicity (15 [32%]), and 7 committees (15%) \"never\" discussed gender and race or ethnicity. Clerkship directors perceived developing a shared mental model (60 [92%]), promoting consistency (59 [91%]) and transparency (57 [88%]) in the process, mitigating assessment bias (58 [89%]), improving student satisfaction (54 [83%]), and sharing grading responsibility (44 [68%]) as potential benefits.</p><p><strong>Conclusions: </strong>This study found that grading committees in IM clerkships are not widely used and that existing committees vary in structure and process. These findings highlight an opportunity for medical schools to consider using grading committees to improve grade assignment and address grading inconsistencies.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"78-85"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857050","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":"What Are We Teaching Medical Students and Physician Learners About the Social Determinants of Health? A Scoping Review.","authors":"Loel S Solomon, Robert S Nocon, Jazmin Jimenez, Robert E Johnson, Carla Lupi, Jacqueline Xu, Ashti A Doobay-Persaud, Abraham Gallegos, Caleb Cohen","doi":"10.1097/ACM.0000000000005795","DOIUrl":"10.1097/ACM.0000000000005795","url":null,"abstract":"<p><strong>Purpose: </strong>Curricula about social determinants (drivers) of health (SDOH) are becoming more common in medical education, reflecting increasing expectations from payers and accreditors that health care systems do more to address health-related social needs and close pervasive health equity gaps. Few previous reviews have addressed the content of SDOH-related curricula. This review examines the scope and focus of medical education on SDOH and adjacent concepts.</p><p><strong>Method: </strong>The authors screened 2,442 articles describing curricula delivered in undergraduate, graduate, and continuing medical education settings between 2010 and 2023 using PubMed and 2 field-specific databases, yielding 289 articles. Data on course duration, pedagogic approach, assessment methods, and curricular content were extracted and analyzed. Curricular content was categorized using the National Academies of Science, Engineering, and Medicine's (NASEM's) 5As framework, which recommends 5 key activities health care can undertake to mitigate social risk (awareness, adjustment, assistance, alignment, and advocacy).</p><p><strong>Results: </strong>A total of 289 articles were included in this review. Curricula covering SDOH-related concepts have increased over time. Of the included articles, 190 (65.7%) referenced at least 1 of NASEM's 5 key activities. Training on social risk screening and other awareness activities were noted most frequently [123 (42.6%)], followed by curricula on helping patients get social care [assistance; 86 (29.8%)] and providing social risk-adjusted health care [adjustment; 81 (28.0%)]. Curricula on system- and policy-level activities, including alignment of health care and social care organizations (alignment), and advocacy (advocacy) were described less frequently [43 (14.9%) and 49 (17.0%), respectively]. Ninety-four articles (32.5%) referenced only general information about SDOH without describing specific actions to adjust care or reduce social adversity.</p><p><strong>Conclusions: </strong>NASEM's 5As framework provides a useful construct for characterizing SDOH-related curricula. Medical educators should teach not only the prevalence and pathophysiology of SDOH but also what physicians can do to address these factors.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"103-112"},"PeriodicalIF":5.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477904","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}