Academic Medicine最新文献

{"title":"Does Knowledge of Clinical Case Outcome Influence Supervisor Evaluation of Resident Clinical Reasoning?","authors":"Charlotte van Sassen, Silvia Mamede, Walter van den Broek, Patrick Bindels, Laura Zwaan","doi":"10.1097/ACM.0000000000006122","DOIUrl":"10.1097/ACM.0000000000006122","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines whether outcome bias affects the assessment of general practice (GP) residents and explores supervisor feedback characteristics.</p><p><strong>Method: </strong>In a within-subjects experiment conducted in June 2023, Erasmus Medical Center GP supervisors reviewed 6 clinical vignettes with ambiguous diagnoses assessing residents' diagnostic decisions. Each vignette had 2 versions, differing only in the final sentence indicating favorable or adverse clinical outcome. Supervisors were randomly assigned to review half the vignettes with favorable clinical outcomes and half with adverse clinical outcomes. Supervisors provided scores (range of 1-10, with 10 indicating exceptional achievement and 1-5 indicating insufficient performance) and feedback, analyzed for valence, content specificity, process versus outcome focus, and politeness strategies.</p><p><strong>Results: </strong>Sixty-two supervisors participated in the study. Vignettes ending in adverse clinical outcomes received lower scores versus those ending in favorable clinical outcomes (mean [SE] scores, 5.25 [0.12] vs 6.26 [0.16]; P < .001) and prompted more negative feedback (mean [SE] negative idea units, 2.35 [0.11] vs 1.80 [0.09]; P < .001). Negative feedback exhibited greater specificity than positive feedback (mean [SE] proportion of specific idea units, 0.88 [0.02] vs 0.44 [0.03]; P < .001), regardless of clinical outcome. Most feedback addressed process-related aspects (grand mean proportion of process-related idea units, 0.97; 95% CI, 0.95-0.98). Polite language was more prevalent in negative versus positive feedback (mean [SE] proportion of feedback with politeness strategies, 0.50 [0.04] vs 0.15 [0.02]; P < .001), regardless of clinical outcome.</p><p><strong>Conclusions: </strong>The study identified outcome bias in the evaluation of GP residents, with adverse clinical outcomes leading to lower scores and more negative, specific, process-focused feedback. Although such feedback can enhance learning, it may also hinder learning by triggering negative emotions. The findings emphasize the educational value of diagnostic errors but stress the need for objective assessment strategies to optimize learning opportunities.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1194-1202"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250690","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":"Training Toward Health Justice: A Review of Community-Engaged Training in Primary Care Residency Programs in the United States.","authors":"Heather A Klusaritz, Kara Johnson, Laura Igarabuza, Giang T Nguyen, Elizabeth Harmon, Michael Bozzi, Peter F Cronholm","doi":"10.1097/ACM.0000000000006123","DOIUrl":"10.1097/ACM.0000000000006123","url":null,"abstract":"<p><strong>Purpose: </strong>A community-engaged approach to medicine, particularly primary care, is effective for health promotion. There is, however, limited evidence and no consensus on best training practices to ensure that physicians are trained adequately to practice community-engaged medicine. To define and determine how to fill this gap, the authors conducted a systematic review of the literature on community-engaged activities in primary care resident training programs. The study sought to evaluate the quality of studied interventions and assess future research needs.</p><p><strong>Method: </strong>For this systematic review, the study team searched PubMed, MEDLINE, and PsycINFO using key search terms related to graduate medical education, community engagement activities, and potential outcomes. The team selected and reviewed all English-language articles published through December 2024 that described interventions in which primary care residents participated in activities that occurred in community-based settings. The team analyzed studies with quantitative and qualitative results. They assessed study quality using the Medical Education Research Study Quality Instrument (MERSQI) and assessed the quality of the community-engaged educational activity using a novel instrument called the Medical Education Engagement Quality Index (MEEQI).</p><p><strong>Results: </strong>The study team identified and reviewed the full texts of 29 articles (10 quantitative, 10 qualitative, and 9 quantitative and qualitative articles). Interventions included community engagement activities with varied settings, study length, and learning objectives. Outcomes included a change in attitudes, knowledge, skills, and career choices. The mean MERSQI score was 9.0 (range, 5.5-11.5), and the mean MEEQI score was 6.2 (range, 4.0-10.0).</p><p><strong>Conclusions: </strong>The authors' findings revealed limited quality and substantial variability of the current literature. Future research should use more rigorous evaluation methods to determine which community-engaged curricular components can most effectively provide primary care resident physicians with the skills needed to provide high-quality primary care, particularly for vulnerable populations.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1226-1234"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250693","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":"Revitalizing Scientific Poster Sessions: A Gamification Approach at an Academic Conference.","authors":"Brian Rissmiller, Satid Thammasitboon, Jennifer Benjamin","doi":"10.1097/ACM.0000000000006094","DOIUrl":"10.1097/ACM.0000000000006094","url":null,"abstract":"<p><strong>Problem: </strong>Maintaining active engagement in learning and application of new knowledge in medicine is essential. Academic conferences, particularly poster sessions, are crucial for this purpose, yet limited attendee engagement and passive learning environments challenge these sessions. This report assesses the impact of gamification of the poster sessions at an international conference on engagement between poster presenters and attendees.</p><p><strong>Approach: </strong>The authors gamified the 2023 Pediatric Academic Societies (PAS) conference, April 28 to May 1, 2023, Washington, DC, using Landers' theory of gamified learning. Poster presenters created a multiple-choice question based on their poster, which was linked to a QR code via the PAS application. Conference attendees engaged with the poster presenter and scanned the QR code to answer the question. Attendees earned a point for each correct answer, with leaderboards displaying scores. The attendee(s) with the highest point totals earned prizes. Evaluation included application interaction metrics, attendee scores, and narrative feedback from presenters and attendees.</p><p><strong>Outcomes: </strong>The conference had 7,753 attendees with 2,680 poster presentations, with 1,889 poster presenters (70%) and 1,361 attendees (18%) participating in the initiative for 2,761 interactions. Of the 2,600 survey respondents, 51 (2%) thought that the gamification detracted from their poster experience, 198 (8%) reported that it enhanced their experience, 489 (19%) were unsure of its impact, 511 (20%) were not aware of the gamification, and 1,351 (52%) perceived that it had no impact. Although many conference attendees were unaware of the gamification, attendees who participated and won prizes showed a marked increase in their desire to win prizes on subsequent days.</p><p><strong>Next steps: </strong>Future studies should assess the technology required for optimal gamified poster sessions and determine whether the costs are beneficial. By expanding gamification features to reward more nuanced forms of engagement, the value of this approach could be better assessed and understood.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1158-1162"},"PeriodicalIF":5.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121168","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":"Changes in Burnout and Satisfaction With Work-Life Integration Among U.S Residents and Fellows and the General U.S. Working Population Between 2012 and 2023.","authors":"Tait D Shanafelt, Liselotte N Dyrbye, Christine Sinsky, Mickey Trockel, Michael Tutty, Hanhan Wang, Lindsey E Carlasare, Colin P West","doi":"10.1097/ACM.0000000000006294","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006294","url":null,"abstract":"<p><strong>Purpose: </strong>This study compares the prevalence of occupational burnout, depression, and satisfaction with work-life integration (WLI) among U.S. residents and fellows (trainees) with that of U.S. physicians and the general U.S. workforce and examines the current point prevalence of burnout and satisfaction with WLI among trainees relative to 2012.</p><p><strong>Method: </strong>Between November 30, 2023, and January 2, 2024, U.S. trainees were surveyed using methods similar to a 2012 study. A sample of practicing U.S. physicians and a probability-based sample of the U.S. working population were surveyed at a similar timepoint. Burnout was assessed using the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory, depression using the Patient Reported Outcome Measurement Information System depression scale, and satisfaction with WLI with a previously used standardized item.</p><p><strong>Results: </strong>Surveys were completed by 3,486 of 58,127 trainees (6.0%). Nonresponder analysis suggested participants were representative of U.S. trainees with respect to burnout and depression. A higher proportion of trainees than practicing physicians had burnout symptoms (1,376 of 3,486 [50.0%] vs 3,023 of 7,643 [45.2%]; P < .001). In pooled analysis of trainees and similarly aged U.S. workers in other fields, adjusting for age, gender, and relationship status, trainees were at higher risk for burnout (odds ratio [OR], 1.51; 95% CI, 1.27-1.80) but lower risk for moderate or severe depression (OR, 0.80; 95% CI, 0.52-0.98). In pooled multivariable analysis of trainees from the 2012 and 2023 surveys, adjusting for year in training, relationship status, and specialty, trainees in 2023 had lower odds of burnout than those who responded in 2012 (OR, 0.71; 95% CI, 0.61-0.81).</p><p><strong>Conclusions: </strong>Burnout among U.S. trainees was lower in 2023 than 2012. Despite this improvement, trainees remain at higher risk for burnout than workers in other fields. Continued efforts are needed to optimize trainee education, preparedness for practice, and well-being.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092951","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":"Focusing on \"Precision\" in Precision Education.","authors":"Catherine Patocka, Lea Harper, Rachel H Ellaway","doi":"10.1097/ACM.0000000000006293","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006293","url":null,"abstract":"<p><strong>Abstract: </strong>Precision medicine has been described in the literature as a new approach to health care delivery, prompting those in health professions education (HPE) to explore and articulate how this paradigm might be realized as \"precision education.\" In this Scholarly Perspective, the authors critically examine the multifaceted dimensions of precision, exploring its implications across varied aspects of HPE.Precision can refer to many things, including degrees of accuracy, consistency, fidelity, exactitude, clarity and meticulousness. There are also many approaches to precision in HPE, including precision in personalized learning opportunities and educational trajectories; precision in instructional and assessment methods; precision in data, analytics, and evaluation (where most focus has been); precision in admissions, credentialing, and hiring; precision in the learning environment; precision in systems; and precision in meeting social accountability, workforce needs, and other external drivers.While pursuing precision in specific aspects of HPE may achieve localized gains, it is likely to result in a net decrease in precision across the broader HPE system. Precision inherently comes with limitations, trade-offs, and complexities that can undermine its practicality or even its effectiveness in certain contexts. Scholars and educators are encouraged to consider what aspects and levels of precision are desirable and worth pursuing, and to be ready and able to engage in a broader and more nuanced dialogue about precision education in HPE.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092695","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 Big Deal.","authors":"Sydney Katz, Laura Greisman, Kimberly Bloom-Feshbach","doi":"10.1097/ACM.0000000000006290","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006290","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071106","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 Softest Words Illuminate the Deepest Need for Change.","authors":"Ria Tilve","doi":"10.1097/ACM.0000000000006281","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006281","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071142","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":"Between Two Sides of the Surgical Drape: Intertwining Medical Science and Human Dignity.","authors":"Shems Hamdan","doi":"10.1097/ACM.0000000000006282","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006282","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071101","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":"Tracing Toxic Stress Through Telomeres: A Future Physician-Scientist's Path.","authors":"Austin D Le","doi":"10.1097/ACM.0000000000006283","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006283","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071145","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 We Carry.","authors":"Brandon Anderson","doi":"10.1097/ACM.0000000000006288","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006288","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071099","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}