Journal of graduate medical education最新文献

Background Despite undergraduate training in geriatric care, gaps persist throughout residency, highlighting limitations of current assessment methods in evaluating medical expertise across geriatric dimensions. Objective We developed a case-based assessment using the geriatric 5Ms framework (Mind, Mobility, Medications, Multicomplexity, Matters Most), aligned with undergraduate objectives and North American internal medicine milestones. We present feasibility data and preliminary validity evidence of using the geriatric 5Ms framework to evaluate residents' geriatric medical expertise. Methods During a 2023 mandatory academic session at a single site, 68 first- to third-year internal medicine residents were randomly assigned to complete assessment and management plans for 3 of 6 geriatric cases within 1 hour. Two blinded educators rated performance on 5Ms dimensions and non-geriatric medical expertise using a 3-level rating scale (0 to 2). We collected feasibility data (logistical integration, participation rates, time to design cases, rate responses) and validity evidence, based on Messick's framework, in part through a post-assessment questionnaire. Results Sixty-five residents completed 3 cases each, and 3 residents completed 2 cases each, resulting in 201 total cases, each integrating all 5Ms dimensions. Scores across the 5Ms dimensions ranged from 0.8 to 1.3, indicating partial assessment and management. All 5Ms dimensions (mean=1.1, SD=0.3) scored significantly lower than non-geriatric medical expertise (mean=1.5; SD=0.3; t(64)=9.58; P<.001). Interrater reliability was moderate to strong (ICC=0.67-0.85, P<.001). Most residents rated the cases (59 of 67, 88%; mean=4.4; SD=0.7) and the assessment (56 of 67, 84%; mean=4.1; SD=0.7) as representative of clinical practice. Conclusions A case-based assessment using the geriatric 5Ms framework demonstrated feasibility and preliminary validity for evaluating residents' geriatric medical expertise.

Background Despite increasing focus on developing senior residents' teaching and supervisory skills, few studies have identified the components of the supervisory resident role. To develop curricula to prepare residents for this role, we must clearly define the supervising role. Objective To summarize the literature regarding the characteristics and behaviors of effective supervising residents and to propose a model of the supervisory resident role. Methods We performed a narrative review, searching PubMed and SCOPUS for literature discussing the supervisory resident role. Titles, abstracts, and articles were screened for inclusion, as were the reference sections of included articles. Using inductive thematic analysis, we coded qualitative statements, survey items, and curriculum goals and organized them into themes based on iterative, reflexive discussion. We used these themes to present a model of the supervisory role. Results Thirty-six works met our inclusion criteria. The articles represented perspectives from faculty members, residents, and medical students and utilized qualitative and quantitative methods. They indicated that the supervising resident is responsible for teaching, managing daily tasks, advocating on behalf of their team members' well-being, and creating a psychologically safe learning environment. Emphasis on each of these components varied by role on the medical team. Conclusions This is one of the first studies to incorporate multiple perspectives to describe the multifaceted role of the supervising resident, and suggests that individuals' positions on the medical team guide their perception of this role. The literature lacks adequate exploration of junior residents', medical students', interdisciplinary team members', and patients' and families' descriptions of this role.

Background Busy physician educators teaching in rural and underserved communities face challenges finding time and resources to support their professional development. Objective We developed and assessed the feasibility and utility of delivering 25-minute virtual educator development sessions for educators in residency training programs located in rural and underserved communities. Methods This study evaluated a monthly 25-minute web-based education program designed to develop residency program directors' and other educators' teaching and assessment skills in training programs located in rural and underresourced communities. Participants included educators from Oregon and California between September 2021 and October 2023. Feasibility was evaluated by educator attendance and technology use. Utility was measured by continuing medical education credit requests regarding educational value and participant-reported application of skills. Results Ninety-one educators participated, 59 from Oregon and 32 from California. Most were female (64.8%, 59 of 91), between the ages of 30 and 49 (68.1%, 62 of 91), White (85.7%, 78 of 91), and non-Hispanic/Latinx (90.1%, 82 of 91). Physicians made up 75.8% (69 of 91), while 18.7% (17 of 91) were other program educators. Feasibility in terms of technology use was found to be 50% or greater by desktop computer connection, with the remaining by mobile devices. Regarding utility, continuing medical education credit was requested for 48 (29.8%) of the 161 viewed sessions. Conclusions Brief, web-based educator development sessions are feasible to implement in residency training sites located in remote and underresourced communities. Participants self-reported their intention to apply what they learned in their work with trainees.

Background Race has long been treated as a biological determinant in medicine, and many US faculty still reference it in clinical contexts. As the field shifts away from this model, the medical community faces the challenge of addressing how race shapes patients' experiences and outcomes without reinforcing harmful practices. Internal medicine residents must navigate this transition amid conflicting guidance on incorporating race into clinical reasoning. Understanding how residents currently conceptualize and apply race in clinical contexts is essential to preparing them to deliver equitable, patient-centered care. Objective To understand residents' beliefs regarding race in clinical decision-making. Methods We conducted a qualitative study using semistructured interviews with residents from 3 US internal medicine residency programs within a single institution between February and April 2023. Participants were recruited via email, presented with a clinical vignette, and asked about clinical management and the impact of race on their decisions. We conducted an inductive thematic analysis to identify emergent themes and interpreted the findings through Jean Piaget's framework of cognitive conflict and learning. Results Twenty-four residents completed the study. Three main themes emerged: (1) a persistent belief in race-based medicine where beliefs and clinical reasoning aligned around the idea of race as biological; (2) a disequilibrium defined by discrepancy between beliefs and clinical reasoning; and (3) a new equilibrium marked by alignment around race as a social construct and recognition of racism's impact on individual health. Conclusions Residents described dissonance between understanding race as a social construct and encountering clinical norms treating it as biological, revealing a process of questioning and reframing how race is used in clinical care.

Background Aspiring clinician educators (CEs) need formal training and community as they transition into academic roles. To address this, we launched the Health Educators and Academic Leaders (HEAL) program at our institution in 2021, integrating communities of practice (CoP) principles and innovative curricular design. Objective To report HEAL outcomes using a principles-focused program evaluation approach. Methods HEAL's curriculum was guided by the Kern 6-step approach and incorporated seminars, reflective teaching portfolios, mentorship, video-based coaching (VBC), and the Clinician Educator Self-Assessment Toolkit (CESAT). This 2-year program centered on 3 principles: CoP; reflective practice; and use of innovative curricula, like CE milestones. From 2021 to 2023, a mixed-methods, developmental evaluation informed the iterative refinements, emphasizing evolving principles over fixed outcomes. Data were collected from trainees via de-identified surveys and focus groups. Results Postgraduate trainees from 9 disciplines joined the inaugural HEAL cohort, with a 92.9% (13 of 14) completion rate. Seventy percent of HEAL trainees in the first year (7 of 10) ranked VBC sessions as the most valuable curricular component, while 80% (8 of 10) ranked the CESAT tool as least valuable. Qualitative feedback emphasized the value of real-time, individualized feedback and challenges with milestone-based self-evaluation tools. Eighty-nine percent (8 of 9) of HEAL trainees in the second year reported improved confidence as CEs. Conclusions By centering educational strategies on principles essential to CE development, including CoP, HEAL's developmental evaluation approach has sustained 5 years of curricular innovation and increased the confidence of CE graduates.