Academic Medicine最新文献

{"title":"Creating Optimal Clinical Learning Environments Through Interprofessional Bedside Rounding Models: Lessons From the iPACE Story.","authors":"Sarah Hallen, Melissa I Zelaya, Patricia White, Kalli Varaklis","doi":"10.1097/ACM.0000000000005863","DOIUrl":"10.1097/ACM.0000000000005863","url":null,"abstract":"<p><strong>Abstract: </strong>The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and implemented at Maine Medical Center in 2017 as part of the Accreditation Council for Graduate Medical Education's Pursuing Excellence in Clinical Learning Environments (CLE) demonstration project. The model is based on the belief that, in optimal CLEs, residents are trained in team-based, interprofessional collaborative care and use clinical care experiences to innovate in the areas of patient safety and quality of care. The model's inclusion of systems engineering principles, such as design thinking, allows teams to design, customize, and iteratively improve their own iPACE model.The iPACE model was further developed and disseminated with support from an American Medical Association Reimagining Residency grant and from the MaineHealth system's medical education and clinical leadership. iPACE started as a small pilot project on a single inpatient unit and has evolved to become the standard for inpatient team rounds at the bedside. iPACE has received positive feedback from patients, demonstrated benefits to care team members and resident education, and proven its value to the health system through sustained reductions in length of stay and cost of care metrics. The iPACE project has fulfilled MMC's original goal of intentionally redesigning its CLEs to expose residents to high-functioning interprofessional teams with the goal of improving patient care and safety. The model has shown direct learner benefits through increased faculty observation and improved quality of feedback. Interprofessional bedside rounding models like iPACE have the potential to imprint learners with the skills and behaviors essential to provide collaborative patient-centered care. Strategies exist that improve resident and faculty engagement in bedside rounding models like iPACE and should be employed to encourage teaching and learning at the bedside.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S28-S34"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the Graduate Medical Education Clinical Learning Environment Through Community of Practice Forums.","authors":"James N Woodruff, Monica B Vela, Wei Wei Lee, John F McConville","doi":"10.1097/ACM.0000000000005862","DOIUrl":"10.1097/ACM.0000000000005862","url":null,"abstract":"<p><strong>Abstract: </strong>An optimal clinical learning environment (CLE) is associated with improved learning and patient care outcomes. Significant concerns exist about the state of the CLE in graduate medical education (GME). Research suggests that GME programming falls short in interpersonal aspects of training that promote trainee engagement and psychological safety. Furthermore, published educational interventions in the CLE lack adequate theoretical backing to inform a rational approach to interventions in the CLE that could address these important problems.The authors apply the 2002 work of Etienne Wenger on communities of practice (COP) to address these GME CLE concerns. To distinguish this COP intervention from earlier theoretical work on COPs, the authors refer to this management concept as \"COP forums.\" COP forums favorably influence the GME CLE through effects that complement experiential learning in patient care. COP forums support trainee psychological safety, mentorship from near peers, and opportunities to innovate-effects that can serve as a counterbalance to the time pressures, hierarchy, and compliance culture often experienced in the clinical environment. Deliverables of COP forums, including practice innovation and trainee self-efficacy, can favorably impact organization-wide performance and engagement.This article describes the historical position of COP forums in the evolution of COP theory and outlines the basic structure and function of COP forums. It contrasts COP forums to other COP-related concepts to explain their relevance to the GME CLE. Examples of innovative GME COP forums illustrate the structure and function of these interventions. Finally, the authors call for more research on the impact of COP forums on the GME CLE. To avoid confusion, such scholarship must account for the ongoing evolution of the larger COP framework and target specific dimensions of the theory most pertinent to the medical education research question at hand.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S20-S27"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing an Experience-Based Patient-Initiated Mistreatment Training.","authors":"Luke Fraley, Virginia Sheffield, Nathan Houchens","doi":"10.1097/ACM.0000000000005870","DOIUrl":"10.1097/ACM.0000000000005870","url":null,"abstract":"<p><strong>Problem: </strong>Mistreatment of health care workers and learners by patients and their families is prevalent at all levels of training. This mistreatment has negative consequences and disproportionately affects women and historically marginalized and excluded groups.</p><p><strong>Approach: </strong>The authors designed and piloted a preliminary practice-based curriculum consisting of a discussion of literature, a framework for responding to mistreatment in the moment, and interactive simulated mistreatment encounters with trained patient actors. Feedback was generally positive, but participants consistently requested greater diversity in the representation of mistreatment. Using funds from the Josiah Macy Jr. Foundation Catalyst Award for Transformation in Graduate Medical Education, the authors expanded and improved the curriculum to meet the needs of a diverse population of learners. Effectiveness of the curriculum was measured using pre- and post-curriculum surveys.</p><p><strong>Outcomes: </strong>The curriculum was delivered over multiple sessions from January 2022 to March 2024 with grant-funded interventions starting in January 2024. Participants included medical students, house officers, and faculty, and 678 participants completed pre-curriculum surveys. Upon implementation of grant-funded interventions, post-curriculum surveys showed improvements in respondents' self-reported plan to use skills demonstrated in the session (4.76 to 4.85, P = .006) and plan to address mistreatment with their teams moving forward (4.75 to 4.81, P = .045).</p><p><strong>Next steps: </strong>All health care workers and learners deserve to feel safe, respected, and welcome in their work and in training. The foundation of this curriculum will support expansion to meet the needs of all patient-facing health care workers and learners at the pilot institution and beyond.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S80-S86"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300181","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":"Developing CLOUT: A Longitudinal, Cross-Program Chief Resident Curriculum to Increase Psychological Safety in the Clinical Learning Environment.","authors":"Dana Dunne, Andrea Asnes, David Berg, Alissa Chen, Jeff Dewey, Shaili Gupta, Claudia-Santi Fernandes, Stephen J Huot","doi":"10.1097/ACM.0000000000005871","DOIUrl":"10.1097/ACM.0000000000005871","url":null,"abstract":"<p><strong>Abstract: </strong>Psychological safety in the clinical learning environment is essential for learning and thriving. The authors aimed to leverage the leadership position and influence that chief residents hold and invited them to participate in a longitudinal professional development curriculum designed to provide them with the tools to promote psychological safety. A total of 66 chief residents from 25 residency programs, along with 18 faculty allies, participated in 5 workshops, which were designed to increase their understanding of and effective responses to workplace mistreatment or bias directed toward trainees. These skills-based workshops focused on effective coaching, conflict management, and self-regulation of emotions for themselves and their trainees. There was a significant improvement in self-reported efficacy in these domains at the completion of the curriculum and evidence of behavior change as assessed by baseline and final case scenario responses. Additionally, the relationship building that resulted by bringing all chief residents together further enhanced the curriculum's impact as assessed qualitatively. Providing chief residents with skills and resources to become change agents through a longitudinal curriculum in a cohort model improves individual self-efficacy and responses to exemplar cases. Assessment of the overall impact on individual programs and institutional climate is planned.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"99 12S Suppl 1","pages":"S87-S91"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734307","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 Critical Look at Racism in the Clinical Learning Environment.","authors":"Patricia Poitevien, Sylk Sotto-Santiago","doi":"10.1097/ACM.0000000000005872","DOIUrl":"10.1097/ACM.0000000000005872","url":null,"abstract":"<p><strong>Abstract: </strong>Academic medicine has long acknowledged the importance of diversity, equity, and inclusion (DEI) in the pursuit of health equity. Despite this recognition, the clinical learning environment (CLE) has struggled to foster an equitable and inclusive ecosystem that supports diverse learners and faculty.Efforts to dismantle racism in medicine represent an important approach to supporting diverse learners and faculty in the CLE, but they have fallen short of their intended impact. The reasons for this failure are complex and may include a limited understanding of the impact of racism and a misguided conviction that knowledge of harm suffered by minoritized groups is a sufficient driver of change.To advance understanding and increase motivation to dismantle racist systems within academic medicine, this paper posits 2 frameworks, Interest Convergence (IC) and Critical Whiteness Study (CWS). IC asserts that racial equity progresses only when it aligns with the interests of the majority, while CWS examines how Whiteness as a social construct upholds power and privilege, often to the detriment of White individuals themselves.Utilizing these frameworks, the authors detail how Whiteness negatively impacts the health of White people and impedes entry to medical school for low- and middle-income, first-generation White students. The authors illustrate how practices-such as patient- and family-centered care and competency-based medical education-which are intended to improve care and medical education for all, are fully aligned with and integral to DEI principles. The authors conclude that racism and upholding Whiteness cause harm to majority as well as minoritized peoples, while DEI principles provide the foundation for best practices in the CLE and improve outcomes for all.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S13-S19"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143466","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":"Navigating the Impact of Social and Digital Media in Academic Medicine.","authors":"Amrit Kirpalani","doi":"10.1097/ACM.0000000000005853","DOIUrl":"10.1097/ACM.0000000000005853","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"1320"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Hippocrates: An Oath in Entering Medicine and Milestones: A Meditation on Growth.","authors":"Emily M Pang","doi":"10.1097/01.ACM.0001095460.72331.3d","DOIUrl":"10.1097/01.ACM.0001095460.72331.3d","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"99 12","pages":"1345"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734290","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":"Shifting the Paradigm in Workforce Diversity: Prioritizing an Inclusive Environment in Graduate Medical Education.","authors":"Shaunte Y Anum-Addo, Jessica Hippolyte, Aisha Barber","doi":"10.1097/ACM.0000000000005864","DOIUrl":"10.1097/ACM.0000000000005864","url":null,"abstract":"<p><strong>Abstract: </strong>A diverse physician workforce is important to achieving the goal of health equity. Recruitment efforts are often the focus of graduate medical education (GME) workforce diversity efforts. However, to achieve the goal of workforce diversity, a foundation of inclusivity is essential to address the experiences of trainees whose race and ethnicity are underrepresented in medicine (UIM).Professional identity formation (PIF) describes the process through which trainees integrate their personal and professional identities as they learn to not only act but also feel like they belong in their professional role. The concept of PIF provides a framework to consider how GME leaders can intentionally address inclusivity in training programs. The process of PIF is influenced by many factors, including trainees' clinical and nonclinical experiences, their treatment by others, as well as the training program's structure, policy, and physical environment. The authors describe these factors influencing PIF and then, through the lens of PIF, describe approaches that programs and institutions have taken to address inclusivity by investing in the workforce, disrupting the hidden curriculum, revisiting policies and procedures, and examining the physical environment.The authors encourage programs, institutions, and the greater GME community to leverage each learning environment's unique strengths and root out challenges to enhance inclusivity for UIM trainees.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S35-S41"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114506","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":"Simulation vs RISE UP: A Comparative Study of Approaches for Teaching Emergency Medicine Trainees How to Manage Microaggressions.","authors":"David Fernandez, Sophia Gorgens, Molly McCann-Pineo, Michael Sperandeo, Michael Cassara, Tiffany Moadel","doi":"10.1097/ACM.0000000000005869","DOIUrl":"10.1097/ACM.0000000000005869","url":null,"abstract":"<p><strong>Purpose: </strong>Microaggressions are discriminatory actions or words targeted at people for their perceived or expressed identities. The study aimed to address the critical need for training emergency medicine (EM) resident-physicians to manage microaggressions. The authors compared the effectiveness of the Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP) curriculum from Inova Children's Hospital and a simulation (SIM) curriculum created by a research team specifically for this study. The new SIM curriculum was guided by the original RISE UP curriculum but incorporates simulation as a learning tool. These 2 educational modalities were selected based upon previous literature showing their efficacy as tools in medical education.</p><p><strong>Method: </strong>Through a collaboration with residency leadership, EM residents were recruited to participate in a comparison study in which they received either the RISE UP or newly created SIM curriculum as part of their regular simulation training. Pre- and post-intervention surveys assessed perceived knowledge on handling microaggressions. A follow-up survey was sent 1 month post-intervention to evaluate retention of self-reported knowledge.</p><p><strong>Results: </strong>Out of 81 eligible residents, 69 residents participated: 37 in the new SIM curriculum group and 32 in the RISE UP curriculum group. Participants in both groups self-reported significant improvements in perceived knowledge immediately post-intervention. At the 1-month follow-up, both intervention groups retained higher levels of perceived knowledge. Additionally, while both curricula were effective, the RISE UP group showed slightly higher retention rates of self-reported knowledge compared with the SIM group, although this difference was not statistically significant.</p><p><strong>Conclusions: </strong>Both the SIM and RISE UP curricula were effective in improving resident knowledge about handling workplace microaggressions, with participants in the RISE UP curriculum showing marginally better retention of skills. Implementing such educational programs may enhance workplace awareness and response to microaggressions among EM residents.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"S73-S79"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143473","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":"Why Storytelling in Medicine Matters.","authors":"Laura Weiss Roberts","doi":"10.1097/ACM.0000000000005879","DOIUrl":"10.1097/ACM.0000000000005879","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"99 12","pages":"1317-1318"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734296","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}