Purpose: To avoid overreliance on metrics and better identify candidates who add value to the learning environment, some medical schools and residency programs have begun using holistic review for screening and selection, but limited data support or refute this use. This scoping review examines holistic review definitions and practice in medical education, summarizes research findings, and identifies gaps for future research.
Method: The authors searched 7 databases using the keywords holistic, attributes, mission-based, mission-centric , and socially accountable for articles on holistic review within undergraduate medical education (UME) and graduate medical education (GME) published from database inception through July 5, 2024. Author pairs independently screened articles for inclusion and extracted data. Discrepancies were resolved via discussion. Quantitative and qualitative synthesis was performed.
Results: A total of 6,511 articles were identified, with 33 included in this review. Twenty-five studies (76%) focused exclusively on GME, with only a few assessing holistic review in UME. Holistic review was implemented at 3 main stages: screening, interviewing, and ranking. Common rationales included service patterns, patient-physician identity concordance, enhancing patient trust, professional advocacy, and educational benefits. Holistic review elements varied, with most falling within the Association of American Medical Colleges experiences, attributes, and metrics framework. Nearly all studies reported an increase in the percentage of underrepresented in medicine trainees interviewed or selected. Several studies also demonstrated increases in other groups (e.g., women, lower socioeconomic status). Many studies included additional interventions to promote diversity, limiting the ability to assess holistic review in isolation.
Conclusions: This scoping review summarizes the literature on rationale, development and implementation process, structure and components, outcomes assessed, barriers, and strategies for success for holistic review. This work can inform institutions and departments seeking to develop or refine their own holistic review systems and serve as a nidus for future research.
Metacognition is the ability to monitor and evaluate one's thoughts about learning and has been shown in some studies to improve the effectiveness of instructors. With dissection-based gross anatomy, instructors dynamically use their metacognition to monitor student learning and adapt their teaching at tableside. This study explored the metacognition of instructors as they taught in an anatomy course for allied health students. All instructors in a doctoral-level gross anatomy course at a single institution, including faculty, associate instructors (AIs), and teaching assistants (TAs), were invited to participate. At the start and end of the course, participating instructors completed pre- and post-questionnaires, which included the Teacher Metacognition Inventory (TMI), a 28-item survey that assesses metacognition as it relates to teaching. After labs, instructors completed reflective journals to provide deeper insight into their metacognition. Reflective journals were then thematically analyzed. Thirteen (52%) instructors participated in this study, including five faculty, three AI, and five TAs. Between the start and end of the course, total TMI score increased from 108.8 to 114.3 (p = 0.046). TAs exhibited the greatest change in total TMI score (Δmean = +11.4) followed by faculty (Δmean = +3.2) and AIs (Δmean = -0.7). Several themes were also identified. For example, TAs were more internally focused on content mastery, whereas faculty were externally focused on interpersonal factors (e.g., inclusive language). These insights into the metacognition of anatomy instructors, though limited in reliability and generalizability, may inform how to best support their professional development. Novices may benefit from content reviews, while experienced instructors may benefit from inclusivity or communications training.
Gross anatomy is a crucial course in medical school; it sets the foundation for future coursework and is highly valued by clinicians. While both medical students and faculty recognize the importance of pre-medical school anatomy experience, few medical schools require it as a prerequisite. Consequently, medical school gross anatomy courses have a diverse range of prior anatomy experience among students. Prior studies have shown mixed results regarding the impact of pre-medical school anatomy experience on medical school gross anatomy performance, often using final exam scores as the metric of analysis. In this study, we investigated the relationship between pre-medical school anatomy experience and medical school gross anatomy performance among students at New York Institute of Technology, College of Osteopathic Medicine. We surveyed students from all four matriculated years and analyzed their individual anatomy laboratory exam scores and final anatomy laboratory course scores. We found that students with prior anatomy experience performed significantly better on the first anatomy laboratory exam, leading to an overall positive effect on their final anatomy laboratory score. However, this advantage seemed to diminish in subsequent exams, suggesting that students without prior experience rapidly adjusted to the course challenges. Students with prior anatomy experience felt more prepared for the anatomy course, reported lower stress levels, and believed they had an advantage over peers without prior experience. Our study highlights the importance of pre-medical school anatomy experience, particularly for early performance in the anatomy course.
Embryology is an essential component to understanding human anatomy. It requires an in-depth understanding of 3D knowledge but is primarily taught with 2-dimensional resources. In particular, the development of the human heart is a complex process and difficult to understand using traditional teaching methods. We present here a series of heart embryology models created to supplement embryology education and aid students in understanding this complex process. Using Polydoh moldable plastic, models representing six different critical steps in heart formation are described, including: the fusing of the heart tubes (days 21-23), beginning of the cardiac loop (early day 23), fully formed cardiac loop (late day 23), four-week heart, formation of the endocardial cushions and septi (late fourth week), and heart with fully formed septi with functioning foramen ovale (sixth week). These models not only improve embryology education but also the understanding of heart pathologies. This method provides an affordable option for embryology education and provides students with learning tools that assist with the comprehension of the development of a complex organ.
Purpose of the article: Medical undergraduates at St George's, University of London (SGUL) study a weekly clinical case during their clinical science years. Audit of the human stories demonstrated lack of diversity, mono-professionalism, and objectification of some patients. A collaborative partnership with staff, student and patient representation implemented curriculum change, including an inclusive case-writing initiative. We explored whether the reformed written cases supported the development of positive attitudes by sampling perceptions of the cases amongst students.
Methods: Sixteen semi-structured interviews were conducted (Feb-November 2022) with first year medical students. We applied an interpretative phenomenological analysis approach. Verbatim transcripts were coded and analysed to elucidate themes.
Results: Four themes were identified: (i) effective learning, (ii) clinical authenticity, (iii) authentic human stories, and (iv) opportunity for rehearsing the role of a doctor. Students perceived the cases as an effective, contextual learning method, with a high degree of clinical authenticity, allowing mentalisation of doctor attitudes and behaviours in relation to patient-centredness, multidisciplinary team working and diversity.
Conclusion: The results suggest the reformed cases created positive attitudinal change amongst students and supported transition to clinical roles. Memorable human stories had the greatest impact. Dynamic, inclusive, and collaborative case writing initiatives which integrate realism, diversity and multi-professionalism may help to foster positive experiences in students undertaking CBL sessions.
Generative Artificial Intelligence (GenAI) caught Health Professions Education (HPE) institutions off-guard, and they are currently adjusting to a changed educational environment. On the horizon, however, is Artificial General Intelligence (AGI) which promises to be an even greater leap and challenge. This Guide begins by explaining the context and nature of AGI, including its characteristics of multi-modality, generality, adaptability, autonomy, and learning ability. It then explores the implications of AGI on students (including personalised learning and electronic tutors) and HPE institutions, and considers some of the context provided by AGI in healthcare. It then raises the problems to address, including the impact on employment, social risks, student adaptability, costs, quality, and others. After considering a possible timeline, the Guide then ends by indicating some first steps that HPE institutions and educators can take to prepare for AGI.
Anatomy with human dissection may help to develop respect for the human body and professionalism; however, dissection may worsen students' attitudes about body weight and adiposity. The purpose of this study was to measure weight bias among Doctor of Physical Therapy (DPT) students enrolled in gross anatomy and determine if, and how the experience of dissection impacts weight bias. Ninety-seven DPT students (70 University of Colorado [CU], 27 Moravian University [MU]) were invited to complete a survey during the first and final weeks of their anatomy course. The survey included demographic items, two measures of weight bias-the Modified Weight Bias Internalized Scale (M-WBIS) and the Attitudes Towards Obese Persons (ATOP) Scale-and open-ended questions for the students who participated in dissection (CU students) that explored attitudes about body weight and adiposity. At baseline, there were no significant differences (p > 0.202) in ATOP, M-WBIS, or BMI between the two universities. The mean scores on both the ATOP and M-WBIS indicated a moderate degree of both internalized and externalized weight bias. There were no significant changes in ATOP (p = 0.566) or M-WBIS scores (p = 0.428). BMI had a low correlation with initial M-WBIS scores (⍴ = 0.294, p = 0.038) and a high correlation with change scores in CU students (⍴ = 0.530, p = 0.011). Future studies should utilize the same measures of weight bias in other healthcare trainees to facilitate comparison and incorporate larger populations of DPT students.
We address defining and identifying students with dyslexia within the context of multi-tier systems of support (MTSS). We review proposed definitions of dyslexia, evidence for proposed definitional attributes, and emphasize the role of instructional response in identifying students with dyslexia. We identify dyslexia as individuals with specific deficits in reading and spelling single words combined with inadequate response to evidence-based instruction. We propose a hybrid identification process in which assessment is utilized within school-wide MTSS allowing for integration of routinely collected progress monitoring data as well integrating with more formal diagnostic measures. This proposed "hybrid" method demonstrates strong evidence for valid decision-making and directly informs instruction. We close proposing a revised definition of dyslexia that incorporates these elements.