Academic Medicine最新文献

{"title":"Rethinking Milestone Validity in Graduate Medical Education.","authors":"Joel Yager, Richard F Summers, Sidney Zisook","doi":"10.1097/ACM.0000000000005957","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005957","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848377","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":"Validity Evidence for Using Virtual, Interactive Patient Encounters to Teach and Assess Clinical Reasoning for First-Year Medical Students.","authors":"John K Roberts, Nancy Weigle, James W Fox, Sreeja Natesan, David Gordon, Saumil M Chudgar","doi":"10.1097/ACM.0000000000005952","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005952","url":null,"abstract":"<p><strong>Purpose: </strong>Despite universal agreement on the importance of clinical reasoning skills, inadequate curricular attention to these skills remains a problem. To facilitate integration of clinical reasoning instruction and assessment into the preclerkship phase, the authors created a clinical reasoning curriculum using technology-enhanced patient simulations.</p><p><strong>Method: </strong>In 2023, first-year medical students at Duke University School of Medicine were enrolled in a biomedical science course using diagnostic reasoning sessions and 16 virtual, interactive patient (VIP) encounters to teach and assess clinical reasoning. The encounters were enhanced with interactive pop-in windows that assessed multiple clinical reasoning domains. Student responses were independently evaluated by faculty. Cumulative VIP clinical reasoning composite (CRC) scores were calculated, and growth mixture modeling was used to define students by growth trajectory. Clinical reasoning was assessed in a summative objective structured clinical examination (OSCE).</p><p><strong>Results: </strong>Of the 118 students who participated in the curriculum, 1 was excluded from analysis for inadequate participation in the VIP encounters, leaving 117 students. The aggregate VIP encounter response rate was 95% (1,783 of 1,872 assessments completed). Clinical reasoning was assessed through cumulative performance across multiple domains. The mean (SD) scores were 58 (13) for information gathering, 46 (13) for illness script identification, 64 (14) for hypothesis generation, 59 (12) for differential diagnosis, and 77 (21) for management and plan. To identify latent classes of growth in cumulative VIP-CRC scores, growth mixture modeling was performed for 1-, 2-, and 3-class models. The 2-class model showed the best fit due to having the lowest bayesian information criterion (11,765.17) and Akaike information criteria (11,737.55).</p><p><strong>Conclusions: </strong>Integrated clinical reasoning instruction and deliberate, formative practice through authentic simulations were effective at teaching and assessing clinical reasoning in the preclerkship phase. VIP and OSCE can be used to identify students at risk of low performance in the clerkship year.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848378","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":"Premedical Course Requirements in U.S. Medical Schools.","authors":"Ahmed Ahmed, Yoseph Boku, Emma Korolik, Blake Shultz","doi":"10.1097/ACM.0000000000005951","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005951","url":null,"abstract":"<p><strong>Purpose: </strong>This study characterizes required or recommended premedical coursework, coursework fulfillment, and congruence among U.S. medical schools.</p><p><strong>Method: </strong>This cross-sectional study examined course requirements and recommendations of U.S. allopathic medical schools, using data from the 2023 to 2024 Association of American Medical Colleges Medical School Admission Requirements database. Courses required and recommended, credit hours, medical schools accepting pass/fail credits, advanced placement credits, online courses, and community college credits were evaluated.</p><p><strong>Results: </strong>Of 157 medical schools, 154 had at least 1 premedical course requirement or recommendation. No schools had the same requirements or recommendations; 113 (72.0%) required or recommended 10 or more courses. The most commonly required courses were biology (107 [68.2%]), physics (106 [67.5%]), organic chemistry (105 [66.9%]), and inorganic chemistry (90 [57.3%]). The most commonly recommended courses were social sciences (96 [61.1%]), genetics (96 [61.1%]), and psychology (86 [54.8%]). Humanities had the highest range of credit hours expected (median, 6; range, 3-24) and cell and molecular biology, computer science, physiology, microbiology, and ethics the smallest (median, 3; range, 3-3). College mathematics had the highest proportion of schools accepting pass/fail (n = 15/26 [57.7%]) and AP (n = 51/65 [78.5%]) credits and biochemistry the lowest (n = 18/54 [33.3%] and n = 57/116 [49.1%], respectively). Statistics had the highest proportion of schools accepting online courses (n = 41/54 [75.9%]) and inorganic chemistry the lowest (n = 60/127 [47.2%]). College English had the highest proportion of schools accepting community college credits (n = 102/109 [93.6%]) and cell and molecular biology the lowest (n = 11/15 [73.3%]).</p><p><strong>Conclusions: </strong>These results show substantial variability in premedical course requirements or recommendations among U.S. medical schools, which could be challenging for premedical students planning their undergraduate studies. Additional research is needed on the effect of this variability on students interested in attending medical school.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848376","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":"Medical Education in the Context of War in Ukraine.","authors":"Bohdan O Koshak, Svitlana I Smiyan, Anastasia V Bilukha","doi":"10.1097/ACM.0000000000005956","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005956","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848375","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":"Laugh, Listen, and Fold.","authors":"Shahaan S Razak","doi":"10.1097/ACM.0000000000005950","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005950","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830788","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":"Unacknowledged Moral Rights of Authorship in Academic Medicine Presentations.","authors":"Sharon Feldman, Giuliana C Antolovich, Monica S Cooper","doi":"10.1097/ACM.0000000000005949","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005949","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830789","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":"Financial Barriers to Rural Graduate Medical Education: Medicare Funding Methods for Sole Community and Medicare-Dependent Hospitals.","authors":"Mukesh Adhikari, Emily M Hawes, Jacob Rains, Christopher L Francazio, George M Holmes","doi":"10.1097/ACM.0000000000005948","DOIUrl":"10.1097/ACM.0000000000005948","url":null,"abstract":"<p><strong>Purpose: </strong>Policymakers are exploring options to address rural-urban physician maldistribution, including reducing rural residency training barriers. This study estimated Medicare graduate medical education (GME) reimbursement that sole community hospitals (SCHs) and Medicare-dependent hospitals (MDHs) are disqualified from receiving compared with hospitals under the Prospective Payment System (PPS) and calculated the GME reimbursement per resident for MDHs and SCHs under different scenarios.</p><p><strong>Method: </strong>This simulation study used Healthcare Cost Report Information System data on hospitals that had been SCHs or MDHs between 2011 and 2021 and did not have any resident full-time equivalents (FTEs) in the most recent year. Reimbursements were calculated under the PPS and hospital-specific rate (HSR), assuming all other hospital financing elements remained unchanged, apart from adding resident FTEs.</p><p><strong>Results: </strong>A total of 242 hospitals were identified as current or recent SCHs or MDHs with an average daily census of 25 or more and no residents in their most recent cost reports; 139 (57.4%) were paid under the HSR. The median (interquartile range) reimbursement per resident was $179,442 ($153,078-$208,412) under PPS and $107,294 ($85,134-$128,259) under HSR, a difference of nearly $70,000 per resident. The median opportunity cost per FTE was approximately $73,000 for SCHs and approximately $65,000 for MDHs. No significant per-resident differences were observed in the GME payments based on program size. Due to higher GME payments from PPS vs HSR, the number of hospitals defaulting to HSR decreased, and by the end of the third year of the program, more than 10% hospitals switched from HSR to PPS.</p><p><strong>Conclusions: </strong>Under the current health care and GME reimbursement method, SCHs and MDHs face considerable financial barriers to launching or participating in GME programs. Policy adjustments to address this barrier may incentivize more rural facilities to launch or participate in GME, potentially mitigating the geographic maldistribution of physicians.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787739","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":"Secondary Traumatic Stress in Medical Students During Clinical Clerkships.","authors":"Kira A Grush, Wendy Christensen, Tai Lockspeiser, Jennifer E Adams","doi":"10.1097/ACM.0000000000005940","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005940","url":null,"abstract":"<p><strong>Purpose: </strong>Health care workers exposed to traumatic events while working with patients are at risk for secondary traumatic stress (STS). Data on this phenomenon in medical students are limited. This prospective study examines the trajectory and prevalence of STS among medical students at clerkship year end.</p><p><strong>Method: </strong>The study at The University of Colorado School of Medicine was conducted in 2 phases: the first evaluated STS across multiple time points in a single year (n = 187); the second assessed STS prevalence at the end of the clerkship year in 3 separate cohorts (2020-2023) (n = 496). The study used a validated Secondary Traumatic Stress Scale (STSS). Multilevel growth curve modeling was used to explore the change trajectory of STSS scores across the clerkship year after controlling for covariates.</p><p><strong>Results: </strong>In phase 1, the quadratic trend coefficient was negative (-1.56), indicating a predicted trajectory in STSS total scores that started lower at clerkship year start, reached an apex during the year, and decreased by clerkship year end (P < .001). The intercept (32.73) and linear (5.17) coefficient estimates together (37.90) predicted a total score increase indicating mild STS to a total score at the cutoff for moderate STS between July and October (P < .001). The only statistically significant covariate was reporting an influential psychiatric condition (4.86, P < .001). Phase 2 revealed an end-of-year prevalence of moderate to severe STS of 35.7%, stable across all 3 cohorts. In phase 2, STS categories were significantly different for those reporting a psychiatric condition (P = .007).</p><p><strong>Conclusions: </strong>Medical student STS symptoms increase during clerkship year and do not return to baseline for many students by the year's end. More research is warranted to understand risk and protective factors for STS, strategies to mitigate symptom development, and how much of the observed STS is attributable to the COVID-19 pandemic.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787740","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":"Ecological Psychology: A Framework for Mentoring and Career Development in Academic Medicine.","authors":"John C Penner, Steven J Durning, Joseph J Rencic, Anthony A Donato, Jennifer A Cleland","doi":"10.1097/ACM.0000000000005941","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005941","url":null,"abstract":"<p><strong>Abstract: </strong>Effective mentoring can help individuals navigate the complex, dynamic environment of academic medicine as they work to develop meaningful and fulfilling careers. Despite robust research into the characteristics of effective mentoring relationships and successful mentoring programs, resources that support mentors and mentees in engaging in career development in academic medicine are limited. Ecological psychology, a theory focusing on how the dynamic interplay between individuals and their environment influences cognition and behavior, offers a promising framework for exploring how mentors and mentees can support positive career development outcomes. In this article, the authors introduce selected principles derived from ecological psychology and supplement these principles with practical, hypothetical examples that demonstrate the use of ecological psychology across the continuum of career development (e.g., from early to middle to late career decisions). By focusing on interactions between individuals and their environment, ecological psychology offers a valuable and practical complement to other theories and frameworks that address career development, such as social cognitive career theory and landscapes of practice. By centering on the dynamic interactions between individuals and their professional environments, ecological psychology offers mentors, mentees, and academic medical centers a practical structure for navigating the intricacies and challenges of career development in academic medicine.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787737","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 Medical Education to Improve Patient Safety.","authors":"Laura J Fochtmann","doi":"10.1097/ACM.0000000000005945","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005945","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787738","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}