Academic Medicine最新文献

{"title":"State-based limited license pathways: implications for graduate medical education, patient safety, and the U.S. physician workforce.","authors":"Madison R McCraney, Casey C Glymph, Jaclyn M Hall, Christopher R Cogle","doi":"10.1093/acamed/wvag261","DOIUrl":"https://doi.org/10.1093/acamed/wvag261","url":null,"abstract":"<p><p>Each year a competitive pool of over 52,000 applicants vying for 40,000 available residency positions in the United States leaves thousands of qualified graduates, particularly international medical graduates, without residency placements. At the same time, the nation faces a projected physician shortage of up to 86,000 by 2036, deepening concerns about health care access in underserved and rural communities. In response, several states have introduced limited license pathways, which allow unmatched medical school graduates who have passed licensing exams to practice under supervision without completing a residency program. As of May 2026, 12 states have implemented limited license pathways, signaling a shift in how physician readiness and medical licensure are defined in the United States. A comparative analysis of Canadian and U.S. state models offers insights into pathway variations and deficiencies in standardized oversight and longitudinal assessment of limited licensees. While these pathways aim to reengage unmatched graduates and alleviate workforce shortages, they raise critical concerns about the erosion of educational standards, patient safety, and professional development. This article examines the ethical and educational risks of these parallel license pathways and proposes 4 foundational components for minimum standards-educational oversight and quality standards, transparency and patient disclosure, career development support, and policy framing and communication. The academic medicine community has both the expertise and responsibility to lead a coordinated response, engaging national medical education organizations and state lawmakers, to ensure these licensure innovations enhance rather than compromise the integrity of the physician workforce pipeline and do not come at the cost of physician competence or patient safety.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809327","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":"Academic societies in medicine: functions, benefits, challenges, and opportunities.","authors":"William N Robiner, Robert T Brodell, Denise M Dupras, Neel B Shah, Eric Weissman, Andrea S Garrod, Laura A Shaffer, Claude Abdallah, Kimberly M Lumpkins","doi":"10.1093/acamed/wvag262","DOIUrl":"https://doi.org/10.1093/acamed/wvag262","url":null,"abstract":"<p><p>Health and biomedical science-related academic societies have played significant roles in the development and evolution of science and medicine, as well as the evolution of disciplines, including the diversification of medicine into specialties and subspecialties. They have also had formative roles in the development of clinical practice, professionalism, and training standards. The communities they establish promote knowledge creation and dissemination, provide career and professional development opportunities, articulate professional matters, offer networking opportunities, provide recognition, support members, and perform public engagement and advocacy work. They also play increasingly important roles in educating the public and disseminating objective, evidence-based medical and scientific information. Academic societies face challenges related to membership (recruiting new members and engaging and retaining current members), technology, hosting meetings and conferences, generational shifts (e.g., in demographics and attitudes toward working conditions, career paths, work-life integration), costs and logistics related to operations, and morale within institutions and professions. The Council of Faculty and Academic Societies of the Association of American Medical Colleges plays a unique role in supporting academic medical and related societies by providing an interprofessional forum for their interaction and dialogue, and is a vehicle for asserting their collective voice. To the extent that past is prologue, future advances in health care and science will depend, in part, on the resilience of academic societies and on the health professional workforces that they nourish.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801229","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":"Building new frameworks on old foundations.","authors":"Adam Neufeld, Aliya Kassam","doi":"10.1093/acamed/wvag260","DOIUrl":"https://doi.org/10.1093/acamed/wvag260","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801173","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 arc of failure: how medical students move through self-perceived failure in clinical training.","authors":"Kiran Raja, Caitlin B Clancy, Keith W Hamilton, Deepa Rani Nandiwada","doi":"10.1093/acamed/wvag258","DOIUrl":"https://doi.org/10.1093/acamed/wvag258","url":null,"abstract":"<p><strong>Purpose: </strong>Failure is inevitable in medical training, yet what comes next remains poorly understood. This study examined how fourth-year medical students experienced self-perceived failure and moved through recovery or sustained distress.</p><p><strong>Method: </strong>Between November 2023 and February 2024, 20 fourth-year medical students at a single private, urban, allopathic medical school in the United States completed semi-structured interviews. Using reflexive thematic analysis, the research team coded transcripts inductively and interpreted findings through the lens of Transformative Learning Theory.</p><p><strong>Results: </strong>Students described failure as a recognizable arc: an event, a response of shame, a period of processing, and a transformation in how they understood themselves as learners. Three domains shaped how students moved through this arc, stalled, or recovered without transformation. Personal intrinsic factors included the identity, mindset, and support that students brought to the moment. The immediate clinical environment, through team relationships and dynamics, steered students toward recovery or stalling. The broader external environment set the bar at which students perceived themselves as failing. We developed a conceptual model that situates the failure cycle within these three domains and maps the arc onto Transformative Learning Theory.</p><p><strong>Conclusions: </strong>Failure can be transformative in medical training, but only under the right conditions. Personal factors alone helped students survive failure. Whether students transformed depended on their clinical teams, who could offer safety, feedback, and a meaningful role. The broader external environment, meanwhile, set the stakes of failure itself.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801163","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":"Sustaining scholarship in fragile and conflict-affected health systems: an early-career call for adapted academic norms.","authors":"Azzam Zrineh, Muhammad M Elsharkawy","doi":"10.1093/acamed/wvag259","DOIUrl":"https://doi.org/10.1093/acamed/wvag259","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801140","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":"Bias mitigation skills in diagnostic reasoning: utilizing a situated cognition approach.","authors":"Laksmita Candrisari, Alison H Oh, Binh An P Phan, Katherine C Brooks","doi":"10.1093/acamed/wvag247","DOIUrl":"https://doi.org/10.1093/acamed/wvag247","url":null,"abstract":"<p><strong>Problem: </strong>Diagnostic errors are common in healthcare and often stem from a failure to consider the social and contextual factors that influence clinician decision-making. Systemic inequities and clinician bias disproportionately contribute to diagnostic inaccuracies among marginalized communities. Medical schools are well-positioned to address this challenge by providing curricula that explore the impact of social context on diagnostic reasoning and equip students with strategies to mitigate harms associated with clinician bias.</p><p><strong>Approach: </strong>The authors developed a novel curriculum grounded in situated cognition theory and evidence-based bias mitigation strategies to enhance diagnostic reasoning among medical students. Third-year medical students on their Internal Medicine clerkship explored key cognitive concepts, engaged in case-based discussions to explore the impact of social context on the diagnostic process, and learned bias mitigation strategies. Instructors prompted students to apply these skills in clinical settings through a written assignment, and authors analyzed responses using qualitative methods.</p><p><strong>Outcomes: </strong>Thirty students participated between January 2023 and June 2024. Students demonstrated a clear understanding of how patient identity, clinician bias, and systemic barriers influence diagnostic processes. Students identified how language, substance use disorders, mental health, and health literacy impacted the diagnostic process of patients they had cared for. Students applied strategies such as individuation, promoting positive emotions, and enhancing motivation to mitigate bias. They also engaged in patient advocacy and highlighted opportunities for system-level improvements.</p><p><strong>Next steps: </strong>This curriculum is the first to combine the framework of situated cognition theory with practical bias mitigation strategies to teach diagnostic reasoning. Next steps include expanding educator training, introducing the curriculum earlier in medical education, and longitudinal integration across clerkships and clinical sites. Repeated exposure to these concepts throughout training can help solidify the importance of recognizing social contexts and utilizing bias mitigation strategies as a fundamental component of diagnostic reasoning and patient care.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801168","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":"Failing, not failure: how shame shaped my medical education.","authors":"David A Deemer","doi":"10.1093/acamed/wvag254","DOIUrl":"https://doi.org/10.1093/acamed/wvag254","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801209","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 2026 RIME foreword: a decade of Research in Medical Education (RIME): trends and future directions.","authors":"Michael S Ryan, Binbin Zheng, Tai Lockspeiser, Lynn Shaull, Jorie Colbert-Getz","doi":"10.1093/acamed/wvag256","DOIUrl":"https://doi.org/10.1093/acamed/wvag256","url":null,"abstract":"<p><p>Since its inception in the 1950s, medical education research has evolved to become a distinct field with its own culture and traditions. Throughout this history, the Research in Medical Education (RIME) program has played an instrumental role in advancing the field by elevating the rigor of empirical studies and increasing the inclusivity of the research community. In this commentary, the authors-writing as members of the RIME program committee-reflect on the last decade of published articles in the RIME program (RIME articles) to serve as a lens for examining how medical education research has evolved from 2016-2025. The authors conducted a content analysis of all RIME articles exploring four key areas: topics, methodology, theory, and application to practice. A total of 135 RIME articles were reviewed. Assessment (n = 34, 25%), learning environment (n = 27, 20%), and instructional design (n = 21, 16%) were the most common topics. Qualitative research (n = 54, 40%) was the most frequent methodology, while quantitative studies declined in recent years and review articles became more prominent. Theory use increased substantially across the decade (from 25% in 2016 to 88% in 2025), whereas application to practice remained consistently represented. These findings suggest important patterns in the modern era of medical education research, including the increasing importance of qualitative research and the value of both theoretical grounding and practical application. As RIME and the Association of American Medical Colleges enter a period of structural transition, these findings offer an opportunity to reflect on how the field can continue advancing scholarly excellence while supporting inclusion, access, and the next generation of medical education researchers.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766433","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 ritualization of group handoff: a qualitative exploration of emergency medicine residents' experiences with patient handoffs.","authors":"Ivan Zvonar, Max Griffith, Alexander Garrett, Bjorn Watsjold, Laura Welsh, Allison Beaulieu, Jonathan S Ilgen, Joshua Jauregui","doi":"10.1093/acamed/wvag252","DOIUrl":"10.1093/acamed/wvag252","url":null,"abstract":"<p><strong>Purpose: </strong>The transition of patient care responsibility-known as handoff-is a critical moment of information transfer for ensuring appropriate care and patient safety. Often occurring in group settings during residency due to the presence of multiple trainees, it is an essential skill for physicians to develop. Structured approaches to handoff have been developed and are considered best practice, yet implementation remains a challenge. The aim of this study was therefore to examine resident experiences with group handoff. In particular, as handoff is a shared experience, the authors sought to illuminate its underlying social aspects in hopes of elucidating implicit parts of the process that may impact resident education and structured handoff implementation.</p><p><strong>Method: </strong>Residents from 2 emergency medicine residency programs were invited to participate in the study between August 2024-November 2025. Using constructivist grounded theory, the authors employed semi-structured interviews exploring participant experiences with group handoff. Through constant comparison, the authors identified the theoretical framework of ritual practice, and subsequently generated a theory regarding how residents engage with and experience group handoff.</p><p><strong>Results: </strong>The authors interviewed 14 residents from across the PGY spectrum. Residents noted group handoff as distinct from other routine clinical tasks. They described a ritualized practice that led to the evolution and reinforcement of underlying social structures. This was achieved by maintaining consistency throughout handoff, ensuring boundaries were respected, and engaging in choreography. Residents thereby integrated community, established norms, and cemented the hierarchy of those involved.</p><p><strong>Conclusions: </strong>Residents ritualize handoff as part of their learning during training, resulting in outcomes separate from the information transfer that has traditionally been studied. Reframing handoff as a form of ritualized behavior has implications for how group processes are implemented within training environments, and provides fertile ground to rethink other practices in medical education that face similar barriers to change.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725042","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":"Signaling what matters: artifacts, values, and underlying assumptions in medical education.","authors":"Adam P Sawatsky, Chi Chang","doi":"10.1093/acamed/wvag257","DOIUrl":"https://doi.org/10.1093/acamed/wvag257","url":null,"abstract":"<p><p>Medical education transmits more than formal knowledge; it signals what matters through formal, informal, and hidden curricula. Drawing on Schein's theory of organizational culture, this commentary synthesizes insights from three 2026 Research in Medical Education (RIME) studies to examine how artifacts, values, and underlying assumptions shape learning environments. The reviewed studies-on multimorbidity in undergraduate medical education, ritualized group handoff in residency, and learner recovery from failure-illustrate how educational practices encode organizational priorities in distinct ways. In curricular structures, multimorbidity is often marginalized or abstracted, signaling the privileging of specialized over integrative, generalist care. In clinical routines, ritualized handoffs align shared values with practices while simultaneously reinforcing hierarchical assumptions. In learner-teacher interactions, responses to failure communicate whether growth and psychological safety are genuinely supported. Together, these studies highlight three mechanisms through which the hidden curriculum operates: invisibly through structural design, explicitly through tightly aligned rituals, and relationally through interpersonal enactment. Highlighting these mechanisms, this research underscores the need for deliberate alignment between educational artifacts and espoused values. Ongoing attention to these signals is essential to cultivating organizational cultures that prepare physicians to navigate complexity, engage meaningfully in practice, and develop resilient professional identities.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761344","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}