Academic Medicine最新文献

{"title":"The Data-Augmented, Technology-Assisted Medical Decision Making (DATA-MD) Curriculum: A Machine Learning and Artificial Intelligence Curriculum for Clinical Trainees.","authors":"Andrew Wong, Jeremy Sussman, Nicholson Price, Maggie Makar, Benjamin Li, Jun Yang, Cornelius James","doi":"10.1097/ACM.0000000000006089","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006089","url":null,"abstract":"<p><strong>Problem: </strong>Despite the rapidly expanding role of artificial intelligence (AI) and machine learning (ML) in health care, a significant knowledge gap remains among clinicians in their ability to evaluate and use AI and ML tools.</p><p><strong>Approach: </strong>The Data-Augmented, Technology-Assisted Medical Decision Making (DATA-MD) curriculum was developed to teach fundamental AI and ML concepts to clinical trainees. The curriculum contains 4 modules: (1) Introduction to AI/ML in Healthcare, (2) Epidemiology and Biostatistics in AI/ML, (3) Use of AI/ML to Augment Diagnostic Decisions, and (4) Ethical and Legal Considerations of AI/ML in Healthcare. The curriculum was piloted in May and June 2023 among University of Michigan internal medicine residents and delivered to 2 cohorts of 11 and 12 residents. All learners completed presession and postsession assessments on AI and ML knowledge before and after the curriculum and a retrospective pre-post survey to evaluate familiarity with AI and ML concepts, comfort with AI and ML literature appraisal, and attitudes toward AI and ML use.</p><p><strong>Outcomes: </strong>Twenty of 23 learners (87%) completed the presession knowledge assessment before participating in the DATA-MD sessions, and all 23 learners completed the postsession knowledge assessment and retrospective pre-post survey. Median knowledge scores significantly improved for modules 1 to 3 (module 1: 2.5 to 3.0, P = .008; module 2: 1.0 to 2.0, P = .049; module 3: 2.0 to 3.0, P < .001) but not module 4 (2.0 before and after testing; P = .80). Learners reported increased confidence in their abilities to appraise the AI and ML literature and use AI and ML tools in future practice.</p><p><strong>Next steps: </strong>The DATA-MD curriculum pilot demonstrates that a standardized AI and ML curriculum can improve trainees' knowledge and attitudes about clinical AI and ML. Next steps include expansion to learners from different medical specialties, health professions, and academic institutions.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081972","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":"State Laws on Reproductive Health and Graduating Medical Students' Choice of Specialty and Residency Location.","authors":"Laura Baecher-Lind, Jeffrey B Bird, Samara B Ginzburg, Stephanie Mann, Elizabeth M Petty, Courtney A Schreiber, Amy S Gottlieb","doi":"10.1097/ACM.0000000000006092","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006092","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the relationship between state restrictions on reproductive health access and students' decision-making regarding specialty choice and residency location.</p><p><strong>Method: </strong>The authors analyzed 2024 Graduation Questionnaire (GQ) data from medical students graduating from U.S. MD-granting medical schools pursuing all specialties. Abortion restrictiveness classifications were based on the Guttmacher Institute's US Abortion Policies and Access After Roe map.</p><p><strong>Results: </strong>Over half (7,855/15,513; 50.6%) and one-third (5,255/15,520; 33.9%) of all students reported state laws about reproductive health services influenced where they applied for residency and their choice of specialty, respectively, to some degree. Women were approximately twice as likely to report reproductive laws influenced their decisions, compared with men (specialty choice: relative risk [RR], 2.04; 95% confidence interval [CI], 1.94-2.15; residency location: RR, 1.70; 95% CI, 1.64-1.77; both P < .001). Students completing medical school in abortion protective (RR, 1.15; 95% CI, 1.12-1.19) or intermediate (RR, 1.14; 95% CI, 1.07-1.21) states were more likely to report being influenced by state laws when deciding where to pursue residency, compared with students in restrictive states (both P < .001). Students pursuing obstetrics and gynecology (ObGyn), family medicine (FM), or emergency medicine (EM) residencies were more influenced by state laws when choosing their specialty (ObGyn: RR, 2.45; 95% CI, 2.35-2.56, P < .001; FM: RR, 1.65; 95% CI, 1.56-1.74, P < .001; EM: RR, 1.11; 95% CI, 1.02-1.20, P = .02) and where to apply for residency (ObGyn: RR, 1.87; 95% CI, 1.83-1.93, P < .001; FM: RR, 1.30; 95% CI, 1.25-1.36, P < .001; EM: RR, 1.08; 95% CI, 1.02-1.15, P = .01), compared with students pursuing other specialties.</p><p><strong>Conclusions: </strong>This study provides further evidence that restrictions on abortion care are likely to impede efforts to develop a future physician workforce capable of reducing health care inequities and improving maternal health outcomes.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081884","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 Expectations in the Transition to the Pass/Fail Step 1 Exam: Tensions and Recommendations From Student Leaders of the NEXT Step 1 Project.","authors":"Paige A Romer, Ryan B Ko, Dhweeja Dasarathy, Olivia R Negris, Alyson K Win, Lynn A Leveille, Bianca A Duah, Joseph R Geraghty","doi":"10.1097/ACM.0000000000006088","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006088","url":null,"abstract":"<p><strong>Abstract: </strong>The transition of the United States Medical Licensing Examination (USMLE) Step 1 from 3-digit to pass/fail scoring set the stage for one of the most significant changes in medical education in several decades. Although originally designed for a binary competency decision around licensure, the Step 1 exam score was famously used as a major criterion for residency interview selection. The transition to pass/fail grading sought to address the issue of students focusing on Step 1 exam preparation at the expense of their formal medical school curriculum and their well-being. However, trainees, advisers, faculty, and residency program directors quickly identified several unintended consequences of this decision. In response, a collaborative grassroots effort was formed among multiple stakeholders, including an extensive network of trainees. The Navigating Expectations in the Transition to Pass/Fail Step 1 (NEXT Step 1) project aims to study this scoring change and develop consensus recommendations for all shareholders affected. In this study, student leaders of the NEXT Step 1 project use their lived experiences as trainees and members of this collaborative project to identify key tensions that arose due to the scoring change. Tensions were described within 3 domains: curriculum, student advising, and residency applications. The authors discuss each tension and provide recommendations for medical schools, faculty, residency programs, and students to consider moving forward in the era of the pass/fail Step 1 exam. Although most students involved in the project think the transition to pass/fail scoring on the Step 1 exam has been positive, there are many downstream consequences that need to be addressed to improve student well-being and fairness in the residency application process. The authors provide student-centered recommendations for these challenges and aim to provide an example of meaningful trainee engagement in academic medicine.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990606","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":"Should Medical School Grading Be Tiered or Pass/Fail? A Scoping Review of Conceptual Arguments and Empirical Data.","authors":"Alexander A Iyer, Cameron Hayes, Bernard S Chang, Susan E Farrell, Anne Fladger, Karen E Hauer, Richard M Schwartzstein","doi":"10.1097/ACM.0000000000006085","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006085","url":null,"abstract":"<p><strong>Purpose: </strong>Medical school grading has implications for student well-being, motivation, equity, and residency selection. However, despite more than 50 years of debate, there remains no consensus on whether grading should be tiered or pass/fail, particularly in core clerkships. This scoping review examines conceptual arguments, empirical data, and knowledge gaps regarding tiered versus pass/fail grading in medical school.</p><p><strong>Method: </strong>OVID MEDLINE, Embase, Web of Science, and ERIC were searched on November 15, 2023, for articles published from 2000 to 2023 focused on (1) conceptual arguments regarding tiered versus pass/fail grading in U.S. medical schools and/or (2) empirical data relevant to this debate. Two reviewers independently assessed eligibility. The authors performed meta-synthesis to group arguments into domains and cross-reference them with relevant data, appraising empirical studies using the Medical Education Research Study Quality Instrument (MERSQI).</p><p><strong>Results: </strong>Forty articles met the inclusion criteria, including 22 empirical studies of variable quality (MERSQI scores, 8.5-13.5 of 18). Conceptual arguments and empirical data spanned 10 domains. Better-supported arguments included the association of pass/fail preclerkship grading with improved short-term well-being and preserved academic performance, low reliability of individual tiered grades, and racial and ethnic disparities in clerkship grading. Areas of uncertainty included the effects of pass/fail clerkship grading on well-being, motivation, learning, and achievement; potential stress displacement with pass/fail grading; validity of tiered clerkship grades; residency application concerns; and subinternship grading considerations.</p><p><strong>Conclusions: </strong>Significant controversy about grading exists across 10 domains. Cross-cutting challenges include the diverse purposes of grading leading to conflicting opinions and data interpretations, limited study quality, and overreliance on opinion over data or theory. Recommendations include caution when interpreting small numbers of tiered grades, transparency and research regarding potential clerkship grading disparities, and consideration of all relevant dimensions in system-level assessment approaches. The authors hope these steps encourage assessment that benefits learners and patients.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056051","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":"Perceptions of the Learning Environment Among Medical Students with Disabilities and the Impact of Program Access.","authors":"Christopher J Moreland, Melissa Plegue, Zoie C Sheets, Karina Pereira-Lima, Neera R Jain, Erene Stergiopolous, Ben Case, Amy Addams, Lisa M Meeks","doi":"10.1097/ACM.0000000000006086","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006086","url":null,"abstract":"<p><strong>Purpose: </strong>Negative learning environment experiences may contribute to burnout for medical students with disabilities (MSWD). This study explores MSWD's perceptions of the learning environment and the effects of program access (having received or not needing accommodations).</p><p><strong>Method: </strong>The authors analyzed Association of American Medical Colleges Year Two Questionnaire data from 2019 and 2020, comparing non-disabled students, MSWD with program access, and MSWD without program access (having not received or requested an accommodation, despite a need). Three learning environment measures were examined: how schools fostered students' personal and professional development; a shortened Medical School Learning Environment Scale (MSLES); and subscales on emotional climate, student-faculty interactions, and student-student interactions. Responses were compared across the 3 groups using chi-square and ANOVA tests with post-hoc pairwise comparisons.</p><p><strong>Results: </strong>Of the 23,898 respondents, 10.2% (2,438) self-reported a disability. Among those, 83.6% (2,039) reported program access, 13.9% (340) lack of program access. Students without disabilities (21,008) reported higher agreement that their school fostered their development as a person (72.2%, 15,172) and physician (90.9%, 19,089) compared with MSWD with access (65.6%, 1,312 and 89.0%, 1,778, P < .001). MSWD without access reported lower agreement than both groups (43.7%, 149 and 80.1%, 273, P < .001). There were no differences regarding the MSLES statement about high-performance standards (F(2, 23742) = 2.35, P = .095). For the 8 remaining MSLES statements and for all 3 subscales, non-disabled students reported significantly higher agreement than MSWD with and without access and MSWD with access had higher agreement than those without.</p><p><strong>Conclusion: </strong>This nationally representative study demonstrates that MSWD perceive the learning environment less favorably than their non-disabled peers. Program access partially mitigates these differences, underscoring the critical role of accommodations and the need to address structural barriers to access.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049625","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":"In reply to Cohn et al.","authors":"Emily Hawes, Lori Rodefeld, Debra Weinstein","doi":"10.1097/ACM.0000000000006084","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006084","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030821","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":"Aligning Competencies Without Abandoning Personal and Professional Development.","authors":"Timothy Kuchera, Jillian Zavodnick, Gretchen Diemer","doi":"10.1097/ACM.0000000000006082","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006082","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040198","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":"Investigating the Impact of a National Institutes of Health Loan Repayment Program Preparedness Program.","authors":"Megan G Flores, Annah J Chollet, Stephanie A Rolin","doi":"10.1097/ACM.0000000000006083","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006083","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014248","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":"Updated Geriatrics Competencies for Graduating Medical Students: Training Physicians to Provide Age-Friendly Care.","authors":"Andrea Wershof Schwartz, Mandi Sehgal, Catherine M P Dawson, Lisa J Granville, Becky B Powers, Amit A Shah, Amy M Sullivan, Rosanne M Leipzig","doi":"10.1097/ACM.0000000000005958","DOIUrl":"10.1097/ACM.0000000000005958","url":null,"abstract":"<p><strong>Purpose: </strong>Medical student education in geriatrics is a critical need for every doctor-in-training as the population ages, with fewer than 7,000 geriatricians, and older patients, who now approach 20% of the U.S. population, having unique health care needs. This study presents the updated competencies in geriatrics for graduating medical students, framed by the Geriatrics 5Ms (Mind, Mobility, Medications, Multicomplexity, and What Matters Most).</p><p><strong>Method: </strong>From 2019-2022, a working group of the American Geriatrics Society (AGS) drafted the updated medical student geriatrics education competencies, using a modified Delphi approach.The working group reviewed the literature, conducted an initial survey of working group members, and drafted and refined proposed updates to the competencies. The 27 resulting competencies were disseminated as a national survey to geriatrics experts and medical school education deans. Following the national survey, the competencies were updated and presented at the 2021 AGS Annual Scientific Meeting and open to public comment before they were finalized.</p><p><strong>Results: </strong>The 27 updated geriatrics competencies for medical students included several new competencies, such as a focus on health equity, frailty, deprescribing, and patient priorities. A total of 211 respondents completed the national survey, including geriatrics experts (187/398, response rate: 47.0%) and education deans (24/191, response rate: 12.6%). All 27 proposed competencies met the predetermined threshold of 70% cumulative agreement, with a range of 93.0% (174/187) to 100% (187/187) among geriatrics experts and 87.5% (21/24) to 100% (24/24) among education deans.</p><p><strong>Conclusions: </strong>The updated Geriatrics Competencies for Graduating Medical Students met with broad agreement among the geriatrics experts and medical school education deans who responded to the national survey. By focusing on the Geriatrics 5Ms, the competencies highlight key knowledge and skills graduating medical students need for the first day of internship to be prepared to deliver age-friendly care to older adults under their care.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"592-599"},"PeriodicalIF":5.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928503","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":"Implementing Core Entrustable Professional Activities in Undergraduate Medical Education: A Psychometric Study.","authors":"Claudio Violato, Robert Englander, Esther Dale, Jacqueline L Gauer","doi":"10.1097/ACM.0000000000005907","DOIUrl":"10.1097/ACM.0000000000005907","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines the feasibility and psychometric results of an assessment of entrustable professional activities (EPAs) as a core component of the clinical program of assessment in undergraduate medical education, assesses the learning curves for each EPA, explores the time to entrustment, and investigates the dependability of the EPA data based on generalizability theory (G theory) analysis.</p><p><strong>Method: </strong>Third-year medical students from the University of Minnesota Medical School in 7 required clerkships from May 2022 through April 2023 were assessed. Students were required to obtain at least 4 EPA assessments per week on average from clinical faculty, residents supervising the students, or assessment and coaching experts. Student ratings were depicted as curves describing their performance over time; regression models were used to fit the curves.</p><p><strong>Results: </strong>The complete class of 240 (138 women [58.0%] and 102 men [42.0%]) third-year medical students at the University of Minnesota Medical School (mean [SD] age at matriculation, 24.2 [2.7] years) participated. There were 32,614 EPA-based assessments (mean [SD], 136 [29.6] assessments per student). Reliability analysis using G theory found that an overall score dependability of 0.75 (range, 0-1) was achieved with 4 assessors on 4 occasions. The desired level of entrustment by academic year end was met by all 240 students (100%) for EPAs 1, 6, and 7, 237 (98.8%), 236 (98.3%), and 218 (90.8%) students for EPAs 2, 5, and 9, respectively, 197 students (82.1%) for EPA 3, 178 students (74.2%) for EPA 4, and 145 students (60.4%) for EPA 12. The most rapid growth was for EPA 2 (β 0 = .286), followed by EPA 1 (β 0 = .240), EPA 4 (β 0 = .236), and EPA 10 (β 0 = .230).</p><p><strong>Conclusions: </strong>The study findings suggest that EPA ratings provide reliable and dependable data to make entrustment decisions about students' performance.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"585-591"},"PeriodicalIF":5.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559324","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}