Medical Teacher最新文献

Introduction: Competency-Based Medical Education (CBME) has transformed postgraduate medical education worldwide. In 2017, Canada adopted the Competence by Design (CBD) model. While widely promoted as a successful large-scale curricular reform, emerging critiques suggest limited empirical evidence and unintended consequences. We critically examined a recent article promoting CBD's success via citation analysis and evidence appraisal.

Methods: We analyzed the article's 169 references, categorizing each by type and empirical relevance. We synthesized Canadian-situated empirical studies on Entrustable Professional Activities (EPAs) and their role in feedback within CBD systems. Additionally, we consulted the Royal College of Physicians and Surgeons of Canada's (RCPSC) 2024 CBD Adaptations Plan to contextualize recent developments.

Results: Empirical studies accounted for 49.2% of the citations, and only 59.4% of those directly addressed CBME. We observed many (25.3%) self-citations, suggesting limited diversity of perspectives. Synthesized studies revealed mixed outcomes: although EPAs aimed to enhance feedback, trainees reported increased stress, administrative burden, and inconsistent feedback quality. These challenges were largely unacknowledged in the analyzed article but were recognized in the 2024 CBD Adaptations Plan's proposed reforms.

Discussion: Our findings challenge the narrative of CBD's unequivocal success in Canada. We highlight the need for context-sensitive empirical research to guide future reforms.

Introduction: Medical education has a responsibility to foster diversity, benefiting individuals, healthcare, and society. Admission procedures are often seen as central to shaping diverse student cohorts, raising concerns about bias and fairness. In this study, we take a step back and review different routes to formal eligibility: direct or indirect routes to meet the requirements to qualify for admission regarding the level of secondary education and the subjects that students have taken. We look at the effects of different routes to formal eligibility combined with the selection process on the composition of cohorts of medical students.

Methods: We performed a longitudinal, population-based study in the Netherlands (2011-2022). Populations included: all first-year medical students, all pre-university graduates with the required subjects (the most direct route to eligibility), and the general population. Using chi-square goodness-of-fit tests (α = 0.001), we compared diversity across these groups by country of origin, and-for some comparisons-added socioeconomic indicators.

Results: Medical school cohorts more closely resembled the general population than pre-university graduates. Students with a Dutch and Indonesian origin were most underrepresented compared to the general population; students with a Dutch origin were also underrepresented compared to pre-university graduates. Most other origins were over-represented or showed no significant difference from the general population.

Discussion: Our findings show that diversity is diminished in the direct pathway to eligibility for medical school, and candidates with diverse backgrounds must follow winding pathways to formal eligibility. However, many candidates follow these winding pathways, as the diversity in medical school mostly reflects the general population's. School-specific admission procedures do not seem to impede students from diverse backgrounds from getting into medical schools. Research and policy should study and remove upstream obstacles and support winding pathways, turning them into an asset for diversity.

Context: Situational judgment tests (SJTs) are increasingly considered in medical school admissions to assess non-academic competencies within holistic review. Questions remain regarding accessibility, variation in performance across applicant groups, and their relationship to admissions outcomes. This study examines the association between AAMC PREview SJT scores and admissions outcomes in a real-world applicant pool, where scores were not used in decision-making and were reviewed retrospectively.

Methods: We conducted a retrospective analysis of 5,993 applicants to the Icahn School of Medicine at Mount Sinai during the 2022-2023 application cycle. Of these, 4,046 (67.5%) completed the PREview SJT. Scores were not available to the admissions committee at any stage and did not influence interview or acceptance decisions. Applicants were categorized by socioeconomic status (SES) and first-generation college status. Logistic regression models evaluated associations between PREview scores, interview invitations, and post-interview committee evaluations, adjusting for demographic variables. Outcomes were compared between test takers and non-takers.

Results: Applicants from lower SES and first-generation backgrounds were more frequently represented among lower PREview score categories. PREview scores were not associated with post-interview committee evaluations. However, lower PREview scores were associated with a lower likelihood of interview invitation. Among interviewed applicants, neither PREview score nor demographic variables were associated with committee outcomes.

Conclusions: In a setting where PREview scores were not used in admissions decisions, lower scores were associated with interview invitation status but not with post-interview committee evaluations. These findings suggest limited alignment between PREview scores and the outcomes of holistic admissions review and underscore the importance of careful evaluation before incorporating SJTs into admissions processes.

Background and aims: Emotional intelligence (EI) is an essential competency for physicians. Medical educators seek educational interventions to cultivate EI in their learners. This scoping review aimed to conceptualize current knowledge about educational interventions for developing EI in medical education. Methods: This study adopted the first five stages of Levac et al.'s scoping review framework, which builds on Arksey and O'Malley's scoping review methodology. The authors accessed three databases-PubMed, CINAHL, and PsycINFO-to review the literature from 2014 to February 2025. Two authors (WI and TS) independently screened the literature for eligibility. A third author (BAAW) resolved any discrepancies. Two authors (WI and BAAW) charted the eligible articles. Results: Of the 638 studies, 64 were eligible. Approximately one-third of eligible studies focused on interventions for medical students. Stress management, leadership, communication, and professionalism were key topics integrated into EI development interventions. Various methods were employed, such as small-group discussions, case-based discussions, and simulations. Most studies used self-rating questionnaires as assessment tools. Half of the studies (56.25%) reported positive impacts from their interventions. Conclusions: The findings could serve as a guide for educators and researchers seeking to implement or study such interventions.

A curriculum map is a visual representation of key components in a medical curriculum, designed to address the challenge of navigating a dense and complex curriculum. Conventional curriculum maps are often fragmented, as they are developed incrementally by faculty members at different times. Over time, this can make them difficult to navigate, irrelevant and incoherent to faculty and student end-users. To address these issues, we developed an in-house curriculum map, MEduCompass, featuring an easy-to-navigate interface. MEduCompass was created through a participatory approach involving students and faculty to ensure it met their needs. Guided by Design Thinking principles, the platform has a structured and cohesive design, incorporating a continuous feedback system for iterative, user-centred feature updates. This was piloted with an undergraduate module on the topic of gastrointestinal systems. Initial feedback from faculty members was that it allowed them to view the curriculum holistically and helped bridge the gap between clinical and pre-clinical years to meet learners' need. This adaptable, feedback-driven approach ensures that stakeholders' needs are addressed, keeping the platform relevant to evolving educational demands and learning outcomes, while also adapting to both technical and pedagogical requirements.

What is the educational challenge?: The Kingdom of Bhutan is a low-middle income, mountainous country that faces severe healthcare workforce shortage. With no medical school, it sent students to other countries for medical training.

What are the proposed solutions?: A technical working group was tasked with planning a medical school affordable within the government's financial resources, leveraging existing postgraduate specialty training programs. Using a strategic roadmap, the group planned 13 steps including stakeholder meetings and developed a curriculum that reflected the unique culture of the country. Costs were calculated, and the number of faculty limited to control the costs.

What are the potential benefits to a wider global audience?: The new medical school in Bhutan is a historic milestone for the country that offers an opportunity to be a model for the region. The planning strategy used, and lessons learned, could be helpful to other countries, especially other low and low middle income countries contemplating initiating or expanding medical education programs.

What are the next steps?: The new school will diligently monitor its finances and revenue generation to align with the budgets approved by government and continuously assess the quality of the curriculum and teaching methods implementation.

Introduction: Questioning has, since Socrates, been touted as an effective teaching technique, but its use in health professions education is controversial due to the risk of inducing counterproductively negative trainee experiences. While much has been written on optimal methods of questioning, disconnects continue to arise between well-intentioned preceptors and how questioning is experienced. Thus, the authors explored if and how learners try signalling to preceptors when questioning leads to a positive learning experience and when it ceases to be educationally valuable.

Methods: The authors conducted semi-structured interviews with 12 senior internal medicine residents to elicit perspectives on how they try to signal their wishes to preceptors during questioning interactions. This was followed by one focus group with 5 additional participants. The methodology was constructivist grounded theory and rigour was enhanced through iterative data collection and analysis, constant comparison, and theoretical sampling.

Results: Signalling was confirmed to be an important concept in resident-preceptor interactions because comfort with questioning was not universally positive or negative. Rather, participants signalled their openness to questioning in context-dependent ways influenced by a variety of factors. In addition to their own signalling, participants reported recognizing and responding to signals from their juniors, peers and attendings, further highlighting the communicative nature of cues being sent.

Discussion: With a better understanding of the contextual factors to be considered before entering a questioning interaction and identification of cues that residents believe they offer as signals of encouraging or discouraging engagement in such interactions, attending physicians should be better able to navigate clinical teaching moments to optimize resident learning.