Academic Medicine最新文献

{"title":"The Intersection of Disability, Race, Ethnicity, and Financial Background on Food Insecurity Among Medical Students.","authors":"Mytien Nguyen, Bassel M Shanab, Pavan Khosla, Dowin Boatright, Sarwat I Chaudhry, Eric J Brandt, Nour M Hammad, Karri L Grob, Morgan Brinker, Caden Cannon, Katherine Cermack, Maha Fathali, John W R Kincaid, Yuxing Emily Ma, Yuu Ohno, Aishwarya Pradeep, Anitza Quintero, Neelufar Raja, Brendan L Rooney, Sasha Stogniy, Kiara K Smith, George Sun, Jahnavi Sunkara, Belinda Tang, Gabriella VanAken Rubick, JiCi Wang, Sanaea Z Bhagwagar, Nathan Luzum, Frank Liu, John S Francis, Lisa M Meeks, Cindy W Leung","doi":"10.1097/ACM.0000000000006156","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006156","url":null,"abstract":"<p><strong>Purpose: </strong>Food insecurity is negatively associated with college students' well-being and academic performance. Little is known about the prevalence of food insecurity among medical students. This study examined variations in food insecurity among medical students at 15 schools, analyzing differences by disability status, race, ethnicity, and financial background.</p><p><strong>Method: </strong>Between March-October 2024, 1,659 students across 15 MD-granting medical schools completed an online survey. Over the past 12 months, food insecurity was assessed using the 10-item U.S. Household Food Security Survey Module. Additional survey measures included age, gender identity, race, ethnicity, Pell Grant recipient status, disability status, and graduation year. Poisson regression models were utilized to estimate the relative risk of food insecurity based on self-reported disability, race, ethnicity, and financial background and their intersections.</p><p><strong>Results: </strong>In the analytic sample, a higher proportion of students with disability (33.7% vs 21.8%, P < .001), from low-income backgrounds (34.9% vs 20.3%, P < .001), and those underrepresented in medicine (URiM) reported food insecurity (37.6% vs 19.7%, P < .001). Across intersectional groups, URiM low-income students with disability have the highest rate of food insecurity (62.5% vs 16.8% for nondisabled non-URiM non-low-income peers, P < .001). In the fully adjusted model, compared to nondisabled non-URiM non-low-income students, non-URiM and URiM low-income students with disability (non-URiM aRR: 2.44, 95% CI 1.72-3.48; URiM aRR: 3.52, 95% CI 2.79-4.45) had a higher relative risk of food insecurity.</p><p><strong>Conclusions: </strong>In this study, nearly 1 in 4 medical students were food insecure. URiM, low-income, and students with disabilities reported food insecurity at a significantly higher rate than their peers, with over half of URiM low-income students with disabilities reporting food insecurity. These findings suggest a promising yet underutilized avenue for approaches to enhancing well-being. Proactive efforts should prioritize supporting marginalized students by linking them to nutrition resources and advocating for policies that address their essential needs.</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":"144477710","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":"Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education.","authors":"Cheryl L Holmes, Laura Yvonne Bulk, Naomi Lear, Lynn Ashdown, Quinten K Clarke, Laura Farrell, Rachel Giddings, Lisa Graves, Julia Ersilia Hanes, George Kim, Michael Quon, Saleem Razack, Francesco A Rizzuti, Ginger Ruddy, Alex Scott, Erene Stergiopoulos, Lee Toner, Laura Nimmon","doi":"10.1097/ACM.0000000000006132","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006132","url":null,"abstract":"<p><strong>Abstract: </strong>A socially accountable physician workforce must include disabled learners and providers. However, current Canadian Technical Standards (TS) for medical school admissions create barriers to their inclusion. These standards overlook advances in assistive technology, universal design, evolving inclusion practices, and legal protections. Replacing the TS required consensus, but traditional methods of achieving consensus on disability inclusion risk reinforcing ableism in medical education. To address challenges with existing TS, the Association of Faculties of Medicine of Canada (AFMC) formed the \"Re-envisioning TS Working Group,\" using a novel consensus approach grounded in disability inclusion and critical disability discourse. Guided by transparency, accessibility, and respect for disability as diversity, the group prioritized engagement with disabled physicians, educators, scholars, and learners. The WG followed five stages: (1) identifying key concepts and reviewing literature on TS reform and ableism; (2) examining relevant legislation and case law; (3) drafting functional Core Competencies; (4) consulting partners across the medical education continuum; and (5) presenting outcomes to the AFMC Board, highlighting a commitment to disability inclusion in undergraduate medical education. The AFMC Board unanimously endorsed the \"Report on Re-Envisioning Technical Standards,\" including the \"Desired Outcomes\" and the \"Core Competencies for Entering Medical Students.\" The AFMC's adoption of functional Core Competencies is a significant step toward inclusion and support for learners with disabilities in Canadian medical education. Medical schools should adopt these competencies, combat ableism, and invest in universal design to promote access. Accommodation support should extend from admission through postgraduate training to independent practice. Finally, efforts to foster an inclusive culture and contribute to a healthy, diverse physician workforce must be evaluated as part of medical schools' social accountability mandate.</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":"144486857","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":"Evaluating Disability-Inclusive Content on U.S. Medical Schools' Websites: A National Study.","authors":"Ifeoma Ikedionwu, Kirsten Ludwig, Dominique Cook, Marjorie Fitzsimmons, Allison Liu, Benjamin Case, Eli Falk, Jeanne Farnan, Lisa M Meeks","doi":"10.1097/ACM.0000000000006133","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006133","url":null,"abstract":"<p><strong>Abstract: </strong>PurposeDespite national calls for disability inclusion in medical education, medical students with disabilities (MSWD) continue to face systemic barriers. One understudied but critical factor is how medical schools publicly communicate their commitment to inclusion, especially through their websites, which often serve as the initial point of reference for prospective applicants. In this research report, the authors evaluate the presence and quality of disability-inclusive content on the websites of U.S. MD-granting medical schools and assess alignment with best practices.MethodFrom May 2023 to July 2023 a cross-sectional content analysis was performed on the websites of all but one U.S. MD-granting medical schools listed in the annual Association of American Medical Colleges' (AAMC) Organizational Characteristics Database. Websites were independently reviewed by trained coders using a 5-item rubric based on AAMC and American Medical Association recommendations and scored on 5 themes: (1) disability in diversity statements, (2) accommodations request instructions, (3) affiliation with national MSWD organizations, (4) comprehensive technical standards, and (5) public technical standards. The \"total disability inclusion\" score ranged from 0 to 8.ResultsThe national average disability inclusion score was 5.9/8. Most school websites (96.1%) provided accommodation instructions, but only 38.3% included disability in public diversity statements. Technical standards were publicly available in 92.9% of cases but varied in clarity and accessibility. No significant associations were found between inclusion scores and institutional characteristics, though regional patterns were observed.ConclusionsDespite progress, public messaging on disability inclusion remains inconsistent. Clear, inclusive website content is essential to attract and support MSWD and should be guided by national standards and mechanisms for accountability.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477690","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":"Promoting Disability Inclusion Through an Expanded Conceptual Framework of the Learning Environment.","authors":"Alexandra C P Theall, Joanne E Crandall, Haley N Gamboa, Michael Chichioco, Sarah E Hughes, Larry Gruppen, Erick Hung","doi":"10.1097/ACM.0000000000006148","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006148","url":null,"abstract":"<p><strong>Abstract: </strong>The inclusion of people with disabilities in medicine is imperative to ensuring a diverse, culturally adept physician workforce. Despite increasing representation in U.S. medical schools, medical students with disabilities (MSWD) continue to face considerable challenges in pursuing medical education due to systemic discrimination, entrenched biases, and insufficient support and program accessibility. To systematically address the disparities and challenges faced by MSWD, there is a pressing need for a comprehensive framework to design, implement, and evaluate the breadth of initiatives employed across learning contexts needed to promote disability equity, inclusion, and belonging. Here, the authors expand on Gruppen and colleagues' existing conceptual framework of the Learning Environment (LE) in the health professions by considering the role of societal influence on students' educational experiences. The authors offer this updated conceptualization of the LE as an approach to perform detailed assessments of the broader educational climate, identify areas for improvement, implement interventions that advance equity and inclusion, and evaluate these important initiatives.The framework conceptualizes the LE as consisting of 2 dimensions-the material, which includes physical and virtual components, and the psychosocial, which adds personal, social, organizational, and societal components. These 6 components profoundly affect medical students' educational opportunities and learning outcomes. By thoughtfully considering these factors, medical schools can assess the LE in a dynamic, iterative manner. Furthermore, medical schools can foster disability equity and inclusion through the development of interventions that strategically address a spectrum of LE domains. This framework can be applied in real-world settings to support the design, implementation, and evaluation of accessibility and equity initiatives across diverse institutional contexts. By leveraging this systems-oriented framework to guide these efforts, medical schools can thoughtfully create inclusive environments that support the success of all learners.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477705","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":"Inclusion in Surgery: Case Study of a Deaf Surgical Resident in Otolaryngology.","authors":"Kris Merrill, Duncan A Meiklejohn","doi":"10.1097/ACM.0000000000006139","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006139","url":null,"abstract":"<p><strong>Abstract: </strong>Deaf and hard-of-hearing (DHH) trainees may be underrepresented in graduate medical education (GME) programs, including surgical specialties, and there is a paucity of data on the transition to GME after medical school for such learners. This case study describes the collaboration between the trainee, program leadership, and disability services to optimize the training environment for a deaf surgical trainee with bilateral cochlear implants at a major academic medical center. The authors review the implementation of communication strategies and adaptive technologies for a period spanning from July 2024 to December 2024 during the first half of the trainee's intern year in Otolaryngology-Head and Neck Surgery. Interventions included trainee-initiated proactive education of clinical team members, trainee-specific communication strategies, and personalized accommodations. Key operating room accommodations included the use of wireless Phonak Roger Microphones, which stream audio directly to hearing devices, and background noise reduction in the operating room environment.Interventions demonstrated improved communication and team dynamics as well as increased trainee confidence. Self-advocacy, individualized accommodations, and collaboration between DDH surgical trainees and colleagues foster an inclusive culture in surgery. The study highlights the potential for accommodations and adaptive technologies to support DHH learners in surgical training, contributing to increased diversity in the field. The authors plan to conduct a longitudinal study of accommodation efficacy and investigation of further adaptive technologies.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477693","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":"Large Language Model Clinical Vignettes and Multiple-Choice Questions for Postgraduate Medical Education.","authors":"Frank I Jackson, Nathan A Keller, Insaf Kouba, Wassil Kouba, Luis A Bracero, Matthew J Blitz","doi":"10.1097/ACM.0000000000006137","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006137","url":null,"abstract":"<p><strong>Abstract: </strong>ProblemClinical vignette-based multiple-choice questions (MCQs) have been used to assess postgraduate medical trainees but require substantial time and effort to develop. Large language models, a type of artificial intelligence (AI), can potentially expedite this task. This report describes prompt engineering techniques used with ChatGPT-4 to generate clinical vignettes and MCQs for obstetrics-gynecology residents and evaluates whether residents and attending physicians can differentiate between human- and AI-generated content.ApproachThe authors generated MCQs using a structured prompt engineering approach, incorporating authoritative source documents and an iterative prompt chaining technique, to refine output quality. Fifty human-generated and 50 AI-generated MCQs were randomly arranged into 10 quizzes (10 questions each). The AI-generated MCQs were developed in August 2024 and surveys conducted in September 2024. Obstetrics-gynecology residents and attending physician faculty members at Northwell Health or Donald and Barbara Zucker School of Medicine at Hofstra/Northwell completed an online survey, answering each MCQ and indicating whether they believed it was human or AI written or if they were uncertain.OutcomesThirty-three participants (16 residents, 17 attendings) completed the survey (80.5% response rate). Respondents correctly identified MCQ authorship a median (interquartile range [IQR]) of 39.1% (30.0%-50.0%) of the time, indicating difficulty in distinguishing human- and AI-generated questions. The median (IQR) correct answer selection rate was 62.3% (50.0%-75.0%) for human-generated MCQs and 64.4% (50.0%-83.3%) for AI-generated MCQs (P = .74). The difficulty (0.69 vs 0.66, P = .83) and discriminatory (0.42 vs 0.38, P = .90) indexes showed no significant differences, supporting the feasibility of large language model-generated MCQs in medical education.Next StepsFuture studies should explore the optimal balance between AI-generated content and expert review, identifying strategies to maximize efficiency without compromising accuracy. The authors will develop practice exams and assess their predictive validity by comparing scores with standardized exam results.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477695","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":"Student Engagement in Undergraduate Medical Education: A Longitudinal Study of Medical Students in China.","authors":"Hongbin Wu, Zehua Shi, Xuanxuan Ma, Xiaoming Xu","doi":"10.1097/ACM.0000000000006145","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006145","url":null,"abstract":"<p><strong>Purpose: </strong>Understanding the changing patterns of student engagement in undergraduate medical education is crucial for effective learning outcomes and overall academic success as well as for improving the quality of medical education. This study examines the dynamics of student engagement in 4 dimensions-behavioral, emotional, cognitive, and agentic engagement-within the context of undergraduate medical education in China.</p><p><strong>Method: </strong>This longitudinal study uses data from the 2020 and 2021 China Medical Student Survey. The study comprises 4 cohorts spanning all 5 grades of undergraduate medical education in China. Student IDs were matched to track the same students across years, yielding a sample size of 67,439 from 94 medical schools. The multilevel growth curve model and Latent Markov Model were used for data analysis based on a cohort-sequential design.</p><p><strong>Results: </strong>While emotional, cognitive, and agentic engagement show a similar tendency to decline with grade level until they rebound slightly between grades 4 and 5, behavioral clinical engagement increased significantly as students' progress through grade levels. High-, moderate-, and low-engagement statuses were defined using Bayesian Information Criterion, and the initial probabilities of medical students in grade 1 being in the low-, moderate-, and high-engagement status were 15.34%, 13.47%, and 71.19%, respectively. Transition matrices show that high-engagement students usually maintain their high-engagement status (range: 80.33%-99.92%), moderate-engagement individuals fluctuate though most remain in this status (range: 53.96%-81.81%) or move to the low-engagement status (range: 14.85%-45.42%), and low-engagement students demonstrate a limited propensity for transitioning to a high-engagement status (range: 0.18%-7.53%).</p><p><strong>Conclusions: </strong>This study demonstrates changing patterns of student engagement in the Chinese undergraduate medical education context. Identifying these patterns offers valuable insights for educators and policymakers to enhance student engagement.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477708","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 Roadmap (5 Ps) for Completion of an Educational Research Project.","authors":"Bani M Ratan, Sanika Rane, Nital P Appelbaum","doi":"10.1097/ACM.0000000000006131","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006131","url":null,"abstract":"<p><strong>Abstract: </strong>While education research often necessitates a structured approach to project completion, there is little guidance on how to systematically engage with a mentee through the process.1 This guide, utilizing 5 Ps (prepare, plan, project, present, publish), is a step-by-step approach to completing an educational research project, highlighting the iterative process of project development and the importance of multiple phases to build foundational knowledge and produce effective scholarship.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477671","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":"Dismantling Barriers in the Medical Curriculum for Learners With Hearing Loss: A Case Study.","authors":"Angelika I Martin, Leslie A Hoffman, Abigail Russell","doi":"10.1097/ACM.0000000000006144","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006144","url":null,"abstract":"<p><strong>Abstract: </strong>Despite the Americans with Disabilities Act (ADA), deaf and hard of hearing (DHH) individuals remain underrepresented in medical education due to the lack of adequate support systems in many institutions. This case study, authored by a DHH student and basic science faculty who worked closely with her, documents the comprehensive support strategies implemented to assist a learner in overcoming challenges related to her hearing loss throughout her undergraduate medical education. The student matriculated to Indiana University School of Medicine-Fort Wayne in August 2021 and graduated in May 2025.The student, who has severe hearing loss in one ear and profound loss in the other, successfully navigated barriers, including poor acoustics, overlapping communications, background noise, and the need for clear visual cues. To interact in different educational environments, including classrooms and patient care rooms, she utilized a combination of oral communication, lip-reading, a Bluetooth-enabled hearing aid, and a cochlear implant. The student also employed key adaptive strategies, including speech-to-text services, assistive devices such as amplifying stethoscopes, strategic positioning to optimize acoustics, and the \"teach-back\" strategy.This case study offers a comprehensive review of accommodations for a DHH medical student across both didactic and clinical curricula. The authors provide valuable insights for educators aiming to support DHH students by detailing the successful integration of tailored and proactive accommodations. Their experience underscores the importance of creating an equitable and accessible environment, paving the way for a more diverse physician workforce, and enhancing healthcare for the DHH community. The student's successful completion of the program and subsequent residency match underscores the potential for DHH individuals to thrive in medical education with appropriate support.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477688","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":"Clerkship Assessment Reliability Based on Assessor Type and Assessor-Student Contact Frequency: A Generalizability Theory Analysis.","authors":"Christopher D Mattson, Celia L O'Brien, Yoon Soo Park, Sandra M Sanguino, Mary E McBride, Brigid M Dolan","doi":"10.1097/ACM.0000000000006143","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006143","url":null,"abstract":"<p><strong>Purpose: </strong>Workplace-based assessments (WBAs), such as clinical performance assessments (CPAs), often comprise a significant portion of clerkship assessment systems. This study explores the reliability of CPAs in clerkships based on assessor characteristics, including assessor type and assessor-student contact frequency.</p><p><strong>Method: </strong>The CPAs of third-year medical students at Northwestern University Feinberg School of Medicine completed during 5 clerkships in academic year 2021 to 2022 were compiled. Analyses compared clerkship assessments per student and breakdown of assessor characteristics by clerkship. Generalizability analysis divided assessments by clerkship, assessor type (resident vs attending), and assessor-student contact frequency (daily vs not daily). Decision studies examined the number of assessments needed per student to achieve reliability of 0.7 (D0.7).</p><p><strong>Results: </strong>A total of 4,062 CPAs completed by 734 assessors on 179 students were analyzed. The number of attending versus resident assessors and daily versus not daily assessors varied by clerkship. Assessments completed by residents were more reliable than assessments completed by attendings (resident φ coefficient = 0.62; student variance, 8.5%; D0.7 = 19; attending φ coefficient = 0.48; student variance, 5.6%; D0.7 = 34). Assessments completed by assessors with daily contact were more reliable than assessments completed by assessors with not daily contact (daily contact φ coefficient of = 0.63; student variance, 7.6%; D0.7 = 22; not daily contact φ coefficient = 0.31; student variance, 5.7%; D0.7 = 34). Residents with daily contact were most reliable (φ coefficient = 0.38, D0.7 = 16).</p><p><strong>Conclusions: </strong>Differences in assessor type and assessor-student contact frequency may explain between-clerkship differences in assessment reliability. These findings provide an opportunity to consider assessor characteristics in the design of assessment systems, thus improving assessment reliability and working toward systems that can be trusted by all stakeholders.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477674","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}