Academic Medicine最新文献

{"title":"Two-Phase Individual Assessments: A Second-Chance Assessment Strategy With Individualized Feedback to Promote Assessment for Learning.","authors":"Munder Zagaar, Sandra B Haudek, Peter Boedeker","doi":"10.1097/ACM.0000000000005876","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005876","url":null,"abstract":"<p><strong>Problem: </strong>High-stakes multiple-choice question (MCQ) exams in medical education typically focus on assessment of learning at a single point without providing feedback for improvement. Educators can achieve a more balanced approach to MCQ exams by combining efficient assessment of learning with the feedback and improvement opportunities of assessment for learning.</p><p><strong>Approach: </strong>As part of a curriculum renewal at Baylor College of Medicine's MD program, the Two-Phase Individual Assessment (TPIA) model was launched within a 4-week preclinical Foundations of Medicine course in August 2023. The TPIA model featured weekly assessments, each consisting of 2 MCQ exams given on the same day with a 4-hour study period in between. Exams were paired, consisting of an equal number of items that addressed the same learning objectives. After the initial exam, students received an individualized feedback report indicating correctly and incorrectly answered objectives. Students applied individualized feedback reports to self-identify and remediate deficiencies in preparation for the second-chance exam. Only the highest score counted toward the final grade.</p><p><strong>Outcomes: </strong>Among 230 medical student participants, significant performance improvements between morning and afternoon exams were observed across the first 3 weekly TPIAs, with mean score increases of 4.93, 5.06, and 10.86. Mean change in performance in week 4 was not significant. Student end-of-course survey responses indicated a strong preference for the TPIA format. Responses highlighted the value of offering individualized feedback, providing unstructured time to address knowledge gaps, and ensuring a corresponding opportunity for improvement.</p><p><strong>Next steps: </strong>Future research will extend TPIA's implementation in more clinical-oriented courses to validate TPIA's effectiveness and explore its effect on long-term knowledge retention through more cumulative examinations. Integrating TPIA-based approaches may advance educational systems toward developing a culture of feedback and embracing second chances to support learning and professional growth, thereby preparing medical professionals for the demands of 21st-century medicine.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300182","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":"Diversity and Inclusion Through Collaboration: Co-Producing a Simulation Curriculum to Address Discrimination Against Trainees.","authors":"Christian Torres,David Morales,Amber Whitley,Barbara Porter,Richard Greene,Sondra Zabar","doi":"10.1097/acm.0000000000005874","DOIUrl":"https://doi.org/10.1097/acm.0000000000005874","url":null,"abstract":"Discrimination toward trainees is a pervasive problem, with surveys showing it is often perpetrated by patients. For several years, residents and faculty in an internal medicine residency have participated in a workshop offering a framework for responding to discriminatory behavior by patients. As part of a larger effort to reinforce this teaching and promote an inclusive environment, the authors pursued a multi-pronged simulation curriculum that could be incorporated into graduate medical education programs across their institution. First, the authors conducted trainee and faculty focus groups to better understand their experiences. Qualitative data was collected, including recommendations for responding to discrimination, characteristics of the most common experiences, and trainees' own ideas for worthwhile simulation scenarios. Trainees and faculty were then brought together in a collaborative process to co-develop simulation cases that were later implemented in curricula across multiple learner levels, specialties, and contexts. Participants in these simulations reported improved comfort in responding to discrimination in the moment and/or in the wake of such incidents. Through trainee-faculty collaboration, the project yielded authentic and impactful simulation experiences for learners, while also giving trainees an opportunity to turn previous trauma into constructive learning opportunities that promote an inclusive environment.","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"2 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254166","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":"Peer Support Ambassadors: A Program to Advance a Supportive and Inclusive Clinical Learning Environment.","authors":"Kendra A Moore,Peter Ureste,Denise L Davis,Christy Boscardin,Larissa R Thomas","doi":"10.1097/acm.0000000000005867","DOIUrl":"https://doi.org/10.1097/acm.0000000000005867","url":null,"abstract":"Peer support is beneficial to physicians in distress, but few institutions have created formal programs that train residents and fellows to effectively support their peers. Existing curricula also do not address the differential experience of residents from historically excluded groups, who are more likely to experience distressing mistreatment and discrimination in the clinical learning environment. The Graduate Medical Education (GME) Peer Support Ambassador (PSA) Program aimed to address this gap by: (1) offering peer support skills and trauma-informed care training to a diverse cohort of resident leaders representing a range of specialties, (2) deploying these leaders to support their peers, and (3) facilitating opportunities for participants to train other residents in these skills. In the PSA program's inaugural year, 10 residents were trained in fundamentals of peer support, trauma-informed care, and the restorative mindset. The training increased participants' confidence and skills in these areas, increased their understanding of when to refer a co-resident for additional levels of support, and their awareness of resources for mental health care and addressing mistreatment and discrimination. Beyond the skills training, the program broadened participants' perspectives about other residents' experiences and helped them feel more connected to residents in other specialties. Opportunities to improve the PSA program include creating more opportunities for program participants to connect between sessions and after the training, publicizing the program more effectively to residents experiencing distress, and training a larger number of residents in peer support skills.","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"128 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254163","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 Effect of Spaced Repetition on Learning and Knowledge Transfer in a Large Cohort of Practicing Physicians.","authors":"David W Price,Ting Wang,Thomas R O'Neill,Zachary J Morgan,Prasad Chodavarapu,Andrew Bazemore,Lars E Peterson,Warren P Newton","doi":"10.1097/acm.0000000000005856","DOIUrl":"https://doi.org/10.1097/acm.0000000000005856","url":null,"abstract":"PURPOSESpaced repetition is superior to repeated study for learning and knowledge retention, but literature on the effect of different spaced repetition strategies is lacking. The authors evaluated the effects of different spaced repetition strategies on long-term knowledge retention and transfer.METHODThis prospective cohort study, conducted from October 1, 2020, through July 20, 2023, used the American Board of Family Medicine Continuous Knowledge Self-Assessment (CKSA) to assess learning and knowledge transfer of diplomates and residents. Participants were randomized to a control group or 1 of 5 spaced repetition conditions during 5 calendar quarters (January 1, 2021, to March 31, 2022). Participants in the spaced repetition groups received 6 repeated questions once or twice. Incorrectly but confidently answered questions were prioritized for repetition, with decreasing priority for questions answered incorrectly with lesser confidence. All participants received 6 rewritten questions corresponding to their initial questions chosen for repetition in quarter 10 (second quarter of calendar year 2023).RESULTSA total of 26,258 family physicians or residents who completed the CKSA in the baseline period were randomized. Spaced repetition was superior to no spaced repetition for learning at quarter 6 (58.03% vs 43.20%, P < .001, Cohen d = 0.62) and knowledge transfer at quarter 10 (58.33% vs 52.39%, P < .001, Cohen d = 0.26). Double-spaced repetitions were superior to single-spaced repetitions for learning (62.24% vs 51.83%, P < .001, Cohen d = 0.43) and transfer (60.08% vs 55.72%, P < .001, Cohen d = 0.20). There were no meaningful differences in learning or transfer between repetition strategy chosen in the single- or double-repetition groups.CONCLUSIONSThis study affirms the value of spaced repetition in improving learning and retention in medical education and ongoing professional development.","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"19 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175673","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 Potential of Using ChatGPT-4 Vision for Detecting Image Manipulation in Academic Medicine Articles.","authors":"Lingxuan Zhu, Haoran Zhang, Peng Luo","doi":"10.1097/ACM.0000000000005873","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005873","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143474","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 and the Erasure of DEI Efforts.","authors":"Patricia Poitevien, Sylk Sotto-Santiago","doi":"10.1097/ACM.0000000000005872","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005872","url":null,"abstract":"<p><strong>Abstract: </strong>Academic medicine has long acknowledged the importance of diversity, equity, and inclusion 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 diversity, equity and inclusion (DEI) principles. The authors conclude that racism and upholding Whiteness causes 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":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","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":"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":"https://doi.org/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 one 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, 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 to 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":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","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":"Championing Civility in the Clinical Learning Environment: Evaluation of a Novel Training Program.","authors":"Sharon L Shofer, Jane P Gagliardi, Stephanie Bryant, Apurva M Khedagi, Dinushika Mohottige, Ada Gregory, Aimee K Zaas, Tracy Truong, Betty B Staples","doi":"10.1097/ACM.0000000000005866","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005866","url":null,"abstract":"<p><strong>Problem: </strong>Incivility in the health care workplace is increasing and negatively impacts everyone in the environment, including health care team members and the patients and families they serve. This study examined the efficacy and impact of Civility Champions (CCs), a novel training program for a multidisciplinary cohort of faculty and graduate medical education (GME) trainees based in principles of trauma-informed care, nonviolent communication, and restorative practices.</p><p><strong>Approach: </strong>Participants were 39 faculty and GME trainees representing 6 departments in a major academic medical center. The concurrent, mixed-methods study employed the Kirkpatrick New World Model as a framework for the creation of the evaluation tools as well as to analyze and report the results of the study. Quantitative and qualitative data analysis examined participants' reactions, perceived learning, workplace use of the skills following training, and initial indicators of whether the program is on track to meet its goals.</p><p><strong>Outcomes: </strong>Participants found CCs training to be valuable (84.6% agree or strongly agree that training was relevant and would recommend it to others). Post-training, CCs felt an increased sense of confidence and commitment using the skills and knowledge learned as indicated by a positive average change score (P < .05) on all measures. At the 6-month survey, 70% of CCs had employed the skills. Results on the implementation of the CCs program found that key success factors include improving program visibility, providing opportunities for skill refreshment, and fostering a supportive community.</p><p><strong>Next steps: </strong>This study expanded a novel training program to multidisciplinary departments and provided early evaluation of the efficacy of the training in the health care workplace. CCs training showed significant measurable benefit using both quantitative and qualitative measures. Future iterations will include training interdisciplinary cohorts and will attempt to assess the program's impact on institutional culture.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143468","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":"Reports of Burnout Among Historically Marginalized and Female Graduating Medical Students During the COVID-19 Pandemic.","authors":"Liselotte N Dyrbye, Danielle E Brushaber, Colin P West","doi":"10.1097/ACM.0000000000005854","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005854","url":null,"abstract":"<p><strong>Purpose: </strong>To examine graduating medical student reports of burnout by sex, race and ethnicity, and sexual orientation and explore trends within intersectional demographic groups from 2019-2021 in a national sample.</p><p><strong>Method: </strong>The authors obtained medical student responses to the 2019-2021 Association of American Medical Colleges (AAMC) Graduation Questionnaires (GQs) linked to data from other AAMC sources. The dataset included year of GQ completion, responses to a modified Oldenburg Burnout Inventory (exhaustion subscale range: 0-24; disengagement subscale range: 0-15), and demographics previously shown to relate to the risk of burnout in medical students, residents, or physicians. Multivariable linear regression analysis was performed to evaluate independent associations between demographics and burnout.</p><p><strong>Results: </strong>Overall response rate was 80.7%. After controlling for other factors, mean exhaustion scores were higher among Asian (parameter estimate [PE] 0.38, 95% confidence interval [CI] 0.21, 0.54), bisexual (PE 0.97, 95% CI 0.76, 1.17), and gay or lesbian (PE 0.55, 95% CI 0.35, 0.75) students than those who did not identify with each of those respective groups. Mean disengagement scores were lower among female (PE -0.47, 95% CI -0.52, -0.42), Hispanic (PE -0.11, 95% CI -0.22, -0.01), and White (PE -0.10, 95% CI -0.19, 0.00) students and higher among Asian (PE 0.17, 95% CI 0.07, 0.27), Black or African American (PE 0.31, 95% CI 0.18, 0.44), bisexual (PE 0.54, 95% CI 0.41, 0.66), and gay or lesbian (PE 0.23, 95% CI 0.11, 0.35) students than those who did not identify with each of those respective groups. From 2019-2021, mean exhaustion and disengagement scores were relatively stable or improved across nearly all intersectional groups.</p><p><strong>Conclusions: </strong>Male, Asian, Black or African American, and sexual minority students had a higher risk of burnout, while female, Hispanic, White, and heterosexual or straight students had a lower risk of burnout.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143471","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 Training to Interrupt Microaggressions.","authors":"Sushant Srinivasan, Claudia E Evaristo, Haroon Ali, Gina E Tranel, Shannon M DiMarco, Naomi Takahashi, Shiva Bidar-Sielaff, Emily Ruedinger","doi":"10.1097/ACM.0000000000005868","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005868","url":null,"abstract":"<p><strong>Abstract: </strong>Microaggressions in health care occur frequently and negatively impact the well-being of trainees. High-realism simulation can effectively train health care providers to communicate in emotionally difficult situations. In 2023, we developed and piloted 4 simulation scenarios for pediatric residents centered on addressing microaggressions in the clinical environment that built on an existing didactic curriculum. These scenarios included single and intersecting forms of oppression including racism, sexism, ableism, ethnocentrism, and weight bias. We also trained faculty, who had no prior simulation debriefing experience, to facilitate and debrief the simulation sessions. Thirty-three residents participated and reported an increase in confidence immediately following the simulation training; this increase was sustained at 3 months. Faculty participants reported increased empathy for residents, recognition of microaggressions, and confidence facilitating conversation after microaggressions that occur both in the simulated setting and in real life. High-realism simulation holds promise as a way to bridge the gap between classroom and real-life interruption of microaggressions, a necessary skill to improve the health care environment for learners and patients.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143472","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}