Journal of graduate medical education最新文献

Background The topic of social determinants of health (SDH) is increasingly being integrated into medical education, yet there remains a lack of synthesized knowledge regarding how simulation is used to teach SDH in residency training. Objective To identify the extent and capacity in which simulation is being used to teach medical residents about SDH. Methods A scoping review was performed in 2023. A search using PubMed, Web of Science, Scopus, and Ovid was performed using keywords related to SDH, simulation, and residency training. The subsequent results were then analyzed to see if they fit the inclusion criteria of being related to SDH, having occurred during residency training, and having used simulation in the curriculum. One researcher (N.T.) reviewed every article, and a second researcher (T.S.) verified a portion of the articles. Results Sixteen studies met the inclusion criteria. The most used simulation method was patient-based scenarios (7 studies), followed by scenario-based learning, such as poverty simulations (5 studies). Financial instability was the most frequently addressed topic, appearing in 7 studies. Common themes drawn from the studies include a positive learner perception of using simulation to teach SDH (7 studies), perceived increase in resident knowledge of how to address patients' social needs (6 studies), improved ability to identify social risks (4 studies), a better understanding of SDH topics (4 studies), and enhanced knowledge of community resources (4 studies). Conclusions Simulation can provide various scenarios to learn about SDH in residency, and it is looked favorably upon by learners.

Background Faculty development (FD) is essential for acquiring skills needed to excel as a clinician educator (CE). The availability of FD resources through MedEdPORTAL, a comprehensive, peer-reviewed, free, online source, is currently unknown. Objective This study reviews MedEdPORTAL to identify trends in FD publications to highlight current gaps and areas of scholarship potential for educators. Methods A comprehensive search on MedEdPORTAL using the terms "faculty" or "development" from January 2005 through December 2022 was performed. Inclusion criteria were curricula for CEs across all medical specialties in the United States. Publications where the primary learners were nonphysicians were excluded. Key factors reviewed included FD domains, medical specialty, and target audience. Results Of 2133 initial articles, 275 met inclusion criteria. FD-specific publications ranged from a low of 5 in 2008 to a high of 42 in 2014. The teaching and learning domain was the most represented (38.2%, 105 of 275), while scholarly activity (12.4%, 34 of 275) was the least represented. Most (67.3%, 185 of 275) publications were not specifically targeted to one specialty, with pediatrics (17.1%, 47 of 275) and internal medicine (10.5%, 29 of 275) having the most resources. Graduate medical education (GME) residency educators formed the largest specified target audience (28.4%, 78 of 275) with GME fellowship educators least represented (8.4%, 23 of 275). Conclusions This review highlights data about domain distribution, specialties, and target audience with most resources focused on pediatrics and internal medicine. Most represented domains are teaching and learning, and assessment, evaluation, and feedback, while the fewest FD resources are available for scholarly activity.

Background Program directors need concrete indicators to monitor uptake of competency-based medical education (CBME). Entrustable professional activity (EPA) observation completion rates offer practical measures of CBME adoption. Objective In this study, we used residents' EPA observation data in clinical departments, specifically the submission and expiration of EPA observation forms and assessment scores, to explore the uptake of CBME practices across departments. Our research question asked: What are the patterns and contributing factors (department group, resident year, calendar year, program size) associated with EPA observation submission rates, expiration rates, and assessment scores? Methods We conducted exploratory analysis of de-identified EPA observation data (n=233 176) from residents' electronic portfolios (n=2110) across 45 programs in 12 departments at one Canadian institution from 2018 to 2023. Descriptive statistics summarized submission, expiration, and score distributions. Spearman correlations and logistic regression examined 4 predictors: department group, resident year, calendar year, and program size. Results EPA submission rates (81.0%), expiration rates (7.7%), and assessment O-scores (M=4.4 out of 5) did not differ significantly by training department. Calendar year increased odds of an independent or full score by 26.3% per year (OR, 1.263; 95% CI, 1.259-1.267) while resident year (OR, 0.818; 95% CI, 0.813-0.825) and program size (OR, 0.995; 95% CI, 0.994-0.996) decreased those odds. Conclusions EPA submission, expiration, and scoring patterns are consistent across departments and correlate with implementation year, resident training stage, and program size.

Background Self-directed learning (SDL) is crucial for physicians to remain current in a rapidly evolving medical environment, and graduate medical education (GME) is increasingly incorporating academic coaching to support this lifelong learning. Despite this, there is limited evidence on how residents practically implement SDL strategies, particularly within the cognitive load theory framework. Objective To investigate how internal medicine residents participate in SDL within an academic coaching program, focusing on how strategies align with cognitive load theory. Methods This qualitative study occurred in a single internal medicine residency program with a formal, longitudinal academic coaching curriculum. In October 2023, we conducted semistructured interviews with participating residents. We purposefully selected 16 of the 27 eligible residents (59%) and conducted semistructured interviews until we reached thematic sufficiency. We reanalyzed these transcripts using thematic analysis to identify SDL behaviors and resource utilization patterns. Results Three key themes emerged: (1) personalization and structure in learning: residents developed individualized, goal-oriented learning plans; (2) diverse learning strategies with emphasis on retrieval practice: residents frequently engaged in active recall and multimodal resource integration; and (3) deliberate repetition and spaced learning for retention: residents intentionally used repetition and temporal spacing to consolidate knowledge. Conclusions Internal medicine residents employ structured, cognitively informed SDL strategies when provided with academic coaching support.

Background In response to the ongoing primary care physician shortage and high attrition in primary care residency tracks, a large urban hospital unveiled the urban health (UH) internal medicine primary care track (IM PCT) and the combined internal medicine-pediatrics (MP) residency program 15 years ago. The 2 UH programs share a mission to create leaders in primary care who care for underserved populations in urban settings. Objective To evaluate whether the careers of graduates from the UH IM PCT and MP residency program align with the programs' 4-part mission: training physicians who (1) practice primary care; (2) practice in urban settings; (3) care for underserved populations; and (4) serve in leadership roles. Methods We developed a 10-minute, 38-item multiple choice and short-answer survey to evaluate the demographics, practice characteristics, and professional involvement of graduates from the UH IM PCT or MP programs between 2014 and 2021. We calculated the proportion of respondents whose careers align with the programs' 4-part mission. Chi-square tests compared demographics and career characteristics by graduation cohort (2014-2017 vs 2018-2021) and program (IM vs MP). Survey creation, data collection, and data analysis occurred between 2022 and 2024. Results Fifty-seven of 63 (91%) surveyed graduates responded. Seventy-nine percent (45 of 57) currently practice primary care; 86% (49 of 57) work in urban settings; 77% (44 of 57) care for primarily underserved populations; and 67% (38 of 57) have leadership roles. Conclusions Our study demonstrates that most graduates from the UH residency programs pursue careers aligned with the program's mission, with many practicing urban health primary care and taking on leadership roles.