Journal of Medical Education and Curricular Development最新文献

Despite the widespread inclusion of statistics in medical school curricula as per the Liaison Committee on Medical Education requirements, the statistical competency among medical students and clinicians remains low. A 2007 study of 277 medical residents revealed only 41.1% scored correctly on a statistical knowledge survey, with minimal understanding of key concepts such as confidence intervals and adjusted odds ratios. A more recent 2023 study of 898 clinicians showed similar deficiencies in understanding efficacy, p-values, and discrimination metrics despite high confidence. This perspective argues for a paradigm shift from teaching statistical applications to focusing on statistical communication. We believe current statistics instruction lacks emphasis on communicating statistical results to patients. Teaching statistical concepts as tools for patient communication, rather than extensions of mathematics, can enhance understanding and ensure patients make informed decisions. Reframing statistical education to focus on communication could potentially address traditionally perceived learning barriers, improve understanding, and foster confidence. In this article, we outline several example reframings of teaching classical statistical concepts emphasizing interpretation and communication. Future strategies such as aligning statistics education closer to residency, revising exam content, updating accreditation requirements, and developing standardized communication primers can help ensure future clinicians are well-equipped to practice evidence-based medicine and effectively communicate statistical information in our increasingly data-driven world.

Purpose: With the transition of USMLE Step 1 to Pass/Fail, Step 2 CK carries added weight in the residency selection process. Our goal was to develop a Step 2 predicted score to provide to students earlier in medical school to assist with career mentoring. We also sought to understand how the predicted scores affected student's plans.

Method: Traditional statistical models and machine learning algorithms to identify predictors of Step 2 CK performance were utilized. Predicted scores were provided to all students in the Class of 2024 at a large allopathic medical school. A cross-sectional survey was conducted to assess if the estimated score influenced career or study plans.

Results: The independent variables that resulted in the most predictive model included CBSE score, Organ System course exam scores and Phase 2 (Third Year Clinical Clerkships) NBME percentile scores (Step2CK = 191.984 + 0.42 (CBSE score) + 0.294 (Organ Systems) + 0.409 (Average NBME). The standard error of the prediction model was 7.6 with better accuracy for predicted scores greater than 230 (SE 8.1) as compared to less than 230 (SE 12.8). Nineteen percent of respondents changed their study plan based on the predicted score result. Themes identified from the predicted score included reassurance for career planning and the creation of anxiety and stress.

Conclusion: A Step 2 Predicted Score, created from pre-existing metrics, was a good estimator of Step 2 CK performance. Given the timing of Step 2 CK, a predicted score would be a useful tool to counsel students during the specialty and residency selection process.

Objectives: To identify community preceptors' views on the qualities and abilities required of physicians in community medicine, the education to acquire those qualities and abilities, and the factors affecting preceptors' involvement in community-based teaching.

Methods: We conducted semi-structured interviews with 13 male community preceptors in northern Japan who had at least 5 years of experience in community medicine and prior teaching experience with preclinical students. Participants were selected using purposive sampling to ensure diversity in clinical roles and institutional affiliations. A thematic analysis was conducted on verbatim transcripts to identify recurring themes.

Results: Participants emphasized "communication skills," "understanding the perspectives and backgrounds of patients and their families," and "love for the community and its people" among the essential qualities and abilities for community physicians. They cited deepening relationships with and fostering an attachment to the community as necessary to cultivate these skills. The factors identified as facilitating community-based teaching included "positive emotions felt throughout the teaching experience," "supporting hospitals and the wider community," and "devotion to students." Factors that hindered involvement included "perceived difficulty of teaching preclinical students" and "education-related issues at universities assigning students on placement," such as the lack of opportunities for community-based teaching within the curriculum.

Conclusions: In line with the "social axis" in Worley's four Rs model, deep community involvement is essential to developing communication skills and patient-centered medicine. This study identified the qualities and abilities required for community physicians, as well as the educational activities needed to cultivate them from the early years of medical school. Strengthening collaboration between universities and community preceptors is vital to advancing community-engaged medical education (CEME). Cross-cultural studies could further explore how CEME operates in diverse contexts, contributing to socially accountable and community-responsive medical education.

Background: The evaluation of Competence by Design (CBD) residency programs is crucial for enhancing program effectiveness. However, literature on evaluating CBD programs is limited. We conducted a 2-phase mixed-methods study to (a) assess the extent of program evaluation activities in CBD residency programs in Canada, (b) explore reasons for engaging or not engaging in these activities, (c) examine how CBD programs are conducting program evaluations, and (d) identify ways to build capacity for program evaluation.

Methods: Phase 1 involved surveying 149 program directors from specialty/subspecialty programs that transitioned to CBD between 2017 and 2020. We calculated descriptive statistics for 22 closed-ended survey items. Phase 2 comprised interviews with a subset of program directors from Phase 1. Data analysis followed a 3-step iterative process: data condensation, data display, and drawing and verifying conclusions.

Results: In Phase 1, we received 149 responses, with a 33.5% response rate. Of these, 127 (85.2%) indicated their programs engage in evaluation, while 22 (14.8%) do not. Among the 127 programs that engage in evaluation, 29 (22.8%) frequently or always develop evaluation questions, and 23 (18.1%) design evaluation proposals/plans. Reasons for engaging in evaluation included decision-making and stimulating changes in educational practices. Conversely, reasons for not engaging included lack of knowledge, personnel, and funding. In Phase 2, 15 program directors were interviewed. They reported that CBD programs face challenges such as limited resources and buy-in, rely on ad hoc evaluation methods, and use a team-based evaluation format. To enhance evaluation capacities, interviewees suggested (a) developing expertise in program evaluation, (b) acquiring evaluation resources, and (c) advocating for clear evaluation expectations.

Conclusions: Most CBD residency programs are engaged in program evaluations, but the quality is often questionable. To fully realize the potential of program evaluation, CBD programs need additional resources and support to improve evaluation practices and outcomes.

Objectives: While there has been increasing awareness of the importance of social determinants of health (SDOH) learning for internal medicine residents and physicians, only a few residency programs have incorporated training into their curricula. For those who did, the curricula were often didactic and lacked action-driven components or community partnership. Therefore, we built an experiential SDOH curriculum with an action-driven element and emphasis on community partnerships in a newly established residency program in rural New York.

Methods: Over 24 months, 22 internal medicine residents were engaged in SDOH lectures, workshops, and action-driven learning through implementing screening tools in residency clinics and working with community partners. After the curriculum, residents' competency in addressing SDOH needs was assessed through Likert-scale questionnaires. Focused interviews were conducted among participating residents and faculty to obtain qualitative feedback on the curriculum.

Results: Participating resident physicians demonstrated competency in recognizing and addressing SDOH needs after curriculum completion (mean competency score = 4.04). A significant increase in residents' self-rated confidence in addressing SDOH was observed after training (P = .002). Residents reported enhanced relationships with patients, effective utilization of community resources, and readiness to apply SDOH knowledge and skills to their future practice. Residents and faculty also discussed the SDOH challenges unique to rural primary care through their experiences.

Conclusion: This curriculum provides insights into an educational framework that improves residents' SDOH awareness, integrates SDOH into resident physicians' daily practice, and facilitates community collaboration. While challenges unique to rural primary care exist, this curriculum demonstrated the feasibility of longitudinal, action-driven, and community-centered SDOH education in rural areas that may inform future programs' curricular design.

Introduction: Residency programs face increasing expectations to grow competency in system-based practice and quality improvement (QI) among trainees. Organizations like the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education have included QI knowledge in their recertification and accreditation requirements. We describe our experiences over a decade of sustaining a longitudinal experiential QI curriculum at a large Internal Medicine residency program.

Methods: Each resident participated in interactive seminars as well as a faculty-mentored, team-based QI project. Each project was formally evaluated at an end-of-year poster presentation.

Results: One hundred thirty-six projects were completed between 2007 and 2016. A presurvey of 51 PGY-1 residents (59%) and a postsurvey of 50 PGY-2 and PGY-3 residents (46%) demonstrated increased comfort leading a QI project and improved knowledge of QI principles. We continue a modified version of the curriculum to accommodate the residency program's restructured ambulatory teaching experiences and the impacts of the COVID-19 pandemic.

Conclusion: Implementing a performance improvement curriculum based in a resident continuity clinic is feasible and affords several advantages. In applying QI methodologies, residents learn how to measure adherence with current evidence-based medicine guidelines and develop interventions to maintain positive momentum within the reality of busy clinical practice.

Objective: In the United States, physicians and residents report inadequate training in managing adolescents and young adults (AYAs) during the transition from pediatric to adult care, particularly AYAs with chronic illnesses such as sickle cell disease (SCD). We developed an intervention where medical students serve as similar-aged "peer" mentors to offer informational and developmentally appropriate support to AYA patients during the period of transition. Our initial work showed the feasibility and acceptability of this intervention for young adults with SCD. In this report, we evaluate the feasibility, acceptability, and preliminary effects of this non-randomized trial on medical student mentors.

Methods: Following training, medical student mentors were paired 1:1 with an AYA with SCD who was transitioning from pediatric to adult care. They conducted monthly video calls with mentees to address specific transition and disease self-management topics. Students completed baseline and follow-up surveys regarding knowledge of SCD and empathy. Satisfaction was measured at follow-up via survey and an exit interview.

Results: Nine medical students were paired with a total of 24 patients. Student retention was 100%, but only eight completed the follow-up survey. Students reported increased knowledge about managing a chronic illness and transition and improved understanding about the patient's experience navigating the healthcare system. Students expressed high satisfaction.

Conclusions: A medical student mentor intervention was feasible and acceptable to medical students and may provide an opportunity for value-added role in medical education. Further research is needed to evaluate the efficacy of this type of intervention on both student and patient outcomes.

Objectives: Despite decades of effort, programs continue to struggle to integrate competencies related quality improvement (QI) and interprofessional collaborative practice (ICP) into health professions education. Additionally, while QI and ICP may seem intuitively linked and there exists some examples of a coordinated approach, the literature regarding competencies, including knowledge, skills, and attitudes (KSAs), is still largely focused on QI and ICP as separate fields of knowledge and practice. This study explored distinctions and connections between quality improvement (QI) and interprofessional collaborative practice (ICP) competency domains in health professions education.

Methods: The authors used a qualitative case study approach with an instrumental case, that is, the University of Missouri-Columbia (MU), where QI and ICP were intentionally integrated as part of core curricula in health professional schools and programs. Eleven faculty members from medicine, nursing, pharmacy, and health care administration participated in interviews exploring their teaching choices in either classroom or clinical settings.

Results: Study participants defined the goal of teaching QI and ICP as enabling learners to deliver safe and patient-centered care and described the knowledge and skills required for QI and the attitudes and skills required for ICP. Furthermore, they described the relationship between QI and ICP as one mediated by systems thinking, where ICP is backgrounded as a critical pre-requisite and QI is foregrounded as a vector for developing interprofessional competencies.

Conclusions: The MU case elucidates the potential synergies that occur when faculty address quality improvement and interprofessional collaborative practice competencies with an integrated approach that leverages connections, while also respecting distinctions. For health professions education programs looking to improve the effectiveness and efficiency of their curricular approach to these fields, it may be fruitful to consider ICP as background and QI as foreground, remembering that without each other, ICP risks losing meaning and QI risks losing impact.

Background: Telemedicine is widely used in medical treatment and education systems. Therefore, it is essential to investigate the attitudes and awareness of medical students about it. We aimed to examine the awareness and attitudes of medical students, interns and residents toward telemedicine in medical education during the COVID-19 pandemic.

Method: This cross-sectional study was conducted after new educational approaches were implemented due to the COVID-19 pandemic. Two questionnaires were used to assess the new educational methodologies. Participants included residents (R), interns (I), and students (S) from the internal medicine department. A census sampling method was employed, inviting all medical education members who met the entry criteria to participate. The data were analyzed descriptively, and group differences were tested using chi-square, independent samples T-test, Mann-Whitney, and Kruskal-Wallis tests.

Result: Out of 278 medical education members eligible to participate, 249 (89.5%) completed the study. The mean score for participants' attitudes was above 3 (M = 3.78, SD = 0.24) indicating a generally favorable view of telemedicine. A significant gap was noted between participants' awareness and attitudes, with residents showing the lowest scores in both areas (P-value = .02). Our assessment revealed that "Satisfaction with the platform and facilities for e-classes" received the highest consensus from residents and interns, rated moderately agreeable by students (R: 64.5%, I: 59.7%, S: 48.8%). Responses to "Using e-learning courses alongside postcrisis face-to-face courses" and "Using e-learning courses alone postcrisis" varied among the groups (R: 58.1% and 54.9%, I: 59% and 58.2%, S: 47.6% and 45.3%).

Conclusion: The results of this survey reveal that medical students and interns may demonstrate a favorable awareness and attitude toward telemedicine. Consequently, developing educational programs and enhancing exposure to telemedicine should be considered since these elements could be vital for the future training of medical professionals.

Storytelling is a crucial yet often overlooked skill for scientists, essential in seminars, manuscripts, grant applications, and professional interactions. Drawing from my experiences across Brazil, the United States of America, India, and South Africa, I explore how crafting compelling narratives enhances scientific communication, increasing the likelihood of publishing, securing funding, and building collaborations. Reflecting on formative "hot seat" sessions at the National Institutes of Health, in the United States, I emphasize the importance of structuring ideas clearly, regardless of language fluency. Storytelling brings clarity, engagement, and logic to science, making research more relatable and impactful. Mastering this skill is essential for advancing scientific careers and effectively conveying complex ideas.