Journal of Medical Education and Curricular Development最新文献

Background: While issues related to lesbian, gay, bisexual, and transgender (LGBT) health are increasingly incorporated into medical training, there remains limited guidance and opportunities for continuing medical education in LGBT health. It is unclear how participation in LGBT-specific training is distributed across physician specialties and practice regions. Additionally, national data assessing cultural competency training for physicians are scarce and do not delineate LGBT-specific training or training completed prior to, during, or after graduate medical education.

Methods: Using data from the 2016 National Culturally and Linguistically Appropriate Services Physician Survey, this study evaluated patterns of post-residency cultural competency training, as well as associations between LGBT-specific training and provider perceptions of patient care outcomes.

Results: Provider specialty, practice region, and receiving cultural competency training as a trainee were associated with post-residency LGBT-specific training. Surgical providers (odds ratio [OR]: 0.42; confidence interval [CI] 0.25-0.73; p = .002) and those practicing in the South (OR: 0.49; CI: 0.26-0.92; p = .025) had lower odds of completing LGBT-specific cultural competency training while in independent practice. Post-residency LGBT-specific training was associated with provider agreement that cultural competency training improves the quality of care (OR: 2.76; CI: 1.44-5.28; p = .002), patient satisfaction (OR: 2.55; CI: 1.32-4.93; p = .005), and patient comprehension (OR: 2.03; CI: 1.05-3.90; p = .034).

Conclusions: Our findings provide disaggregated analyses that nuance the assessment of cultural competency interventions and support a broader effort to increase attention to LGBT health in continuing medical education.

Objectives: This pilot research study, conducted at a large academic healthcare facility, used mixed methodology to (1) administer a survey to a group of primary care trainees and faculty and (2) conduct key informant interviews with the program directors, or their delegates of these primary care training programs, so as to gain insight into respondents' perceptions about their training on adult obesity. To maintain confidentiality of the key informants, they were defined as "Administrators." Faculty and trainees were from family medicine and internal medicine residency programs, as well as family nurse practitioner and physician assistant training programs.

Methods: This study used a quantitative survey and four qualitative key informant (Administrator) interviews. Descriptive statistics, χ², or Fisher exact tests were used to analyze select survey responses. Administrator interviews were analyzed with thematic analysis.

Results: Survey respondents (n = 75) included primary care trainees (n=34), faculty (n=30), other (n=2), did not answer (n=9). Surveys indicated that additional training is needed for bariatric surgery, weight loss medications, and clinical nutrition. The three highest ranked topics in the surveys on adult obesity were basic nutrition, behavioral weight management, and a rotation on adult obesity. Most agreed on the need for interprofessional collaboration, a centralized obesity treatment center, and an introductory obesity course. Key themes from the four Administrator interviews revealed the need: for more training; to build upon current curriculum; use innovative technology; fiscal challenges; and time management.

Conclusions: Both faculty and trainees perceive that academic and clinical training on adult obesity is inadequate, and that trainees need more education on such topics as nutrition, physical activity, behavioral health, antiobesity medications, and bariatric surgery. Competency to treat varied by topic. It also showed that more interprofessional collaboration and a centralized obesity treatment center are needed. Recommendations included integrating modular units about obesity into already established primary care training programs and providing additional resources.

Purpose: Despite numerous mentoring strategies to promote academic success and eligibility in medicine, Black students remain disproportionately underrepresented in medicine. Therefore, we conducted a scoping review to identify the mentoring practices available to Black pre-medical students, medical students and medical residents, specifically the mentoring strategies used, their application, and their evaluation.

Method: Between May 2023 and October 2023, the authors conducted a literature review. Studies that described a mentoring strategy applied among Black learners were eligible for inclusion, and all years of publication were included. Two reviewers screened each article using the Covidence tool, and conflicts were resolved by a third author. All reviewers extracted the data to summarize the various mentoring practices.

Results: After screening 6292 articles, 42 articles met the criteria for full review. Of these, 14 studies were included in the study. Mentoring practices for Black students included peer mentoring, dyad mentoring, and group mentoring. Mentoring was typically offered through discussion groups, educational internships, and didactic activities. Evaluation of mentoring programs took into account (1) pass rates on medical exams (eg, MCAT, Casper), (2) receipt of an invitation to a medical school admissions interview, (3) successful match to a competitive residency program, and (4) a mentee's report of the overall experience and effectiveness of the program.

Conclusion: This review is the first, to our knowledge, to focus on mentoring strategies implemented among Black learners in medicine. The results will inform mentoring strategies adapted for Black learners and will therefore address the underrepresentation of Black students in medicine.

Communication about health often involves descriptions of risk: the probability or likelihood of an unfavorable outcome. Communicating risk helps individuals make choices about their own health by building understanding of potential outcomes and providing context for the importance of procedures, health interventions, and lifestyle choices. However, medical education in the United States does not provide future physicians with adequate statistical literacy to communicate risk effectively and rarely encourages them to practice communicating risk in pre-clinical years. Risk communication in military intelligence, a field with formalized risk language and training, offers a unique perspective into potential improvements for medical risk communication. With backgrounds in the military, public health, communication, surgery, and medical education, the authors offer the following recommendations to improve risk communication for medical students. (1) Encourage the use of numerical absolute risk when communicating among health practitioners to avoid varied interpretations of what different risk descriptors ("uncommon," "likely," or "low") might mean; (2) build efficient, teachable skills in use of patient-facing risk communication tools like comparative probabilities and visual aids; and (3) practice estimating risk through role-play of risk communication between medical students and standardized patients. By improving risk communication in medical education, future doctors will be better equipped to build trust through open communication and improve the health of the patients and the communities for whom they care.

Background: Despite scholarly activity being an accreditation requirement for residency programs by the Accreditation Council for Graduate Medical Education (ACGME) since 2006, many family medicine programs have struggled to meet this requirement. A myriad of approaches and curricula have been proposed to enhance the scholarly output of residency programs.

Objectives: To determine the impact of a multimodal curricular intervention consisting of clear expectations, structured roadmap, availability of resources, and standardized accountability on the scholarly activity of residents.

Methods: This is a quasi-experimental study with a retrospective data collection. The scholarly activities of residents completing training in the pre-intervention (2009-2012) and post-intervention period (2013-2017) were compared. Chi-square, Fisher's exact, Mann Whitney U, and Kruskal Wallis H tests were utilized to detect differences between the pre- and post-intervention groups. Multivariable Poisson regression models were used to detect independent predictors of per-resident scholarly activity. The institutional review board determined that the study was exempt from full review.

Results: A total of 67 residents, 20 (30%) pre-intervention and 47 (70%) post-intervention, were included in the analysis. The number of total scholarly activities per resident increased significantly in the post-intervention period after adjusting for confounding factors (1.9 vs 6.4). The number of scholarly activities per resident also showed an increasing trend over time (P = .04). Moreover, traditional scholarship, including published manuscripts (0.35 vs 2.43) and national-level presentations (0.35 vs 1.27) also increased in the post-intervention period.

Conclusion: Implementing this comprehensive curriculum increased the scholarly output of residents and helped enrich the scholarship culture in the residency program.

Objective: The COVID-19 pandemic affected in-person educational activities and required medical schools to adapt and enrich their curriculum to ensure ongoing professional development. During the height of the COVID-19 pandemic, students expressed a significant desire to contribute and continue their medical education. Service learning promotes experiential learning and Professional Identity Formation (PIF). This study examines the impact that a service-learning elective had on medical students' education and PIF.

Methods: Offering a service-learning elective allowed students to remain engaged in educational activities and pandemic-relief efforts. We conducted a qualitative analysis of 132 written reflections by medical students who completed a 2- or a 4-week service-learning elective to assess for major themes and impact on PIF.

Results: Participation in service learning had a favorable impact on PIF as expressed by the personal qualities student identified as having developed or improved upon because of their participation. Enhancement of communication skills, teamwork skills, compassion, and empathy were major themes conveyed in student reflections. Qualities of resilience were also portrayed through the write-up as students noted how the elective allowed for active engagement in community pandemic-relief efforts and created opportunities for overcoming obstacles related to service learning projects they participated in.

Conclusions: Service learning in medical school has a dual purpose of providing community support while imparting significant learning opportunities for PIF in medical students.

Introduction: Competency-based medical education (CBME) has transformed postgraduate medical training, prioritizing competency acquisition over traditional time-based curricula. Integral to CBME are Entrustable Professional Activities (EPAs), that aim to provide high-quality feedback for trainee development. Despite its importance, the quality of feedback within EPAs remains underexplored.

Methods: We employed a cross-sectional study to explore feedback quality within EPAs, and to examine factors influencing length of written comments and their relationship to quality. We collected and analyzed 1163 written feedback comments using the Quality of Assessment for Learning (QuAL) score. The QuAL aims to evaluate written feedback from low-stakes workplace assessments, based on 3 quality criteria (evidence, suggestion, connection). Afterwards, we performed correlation and regression analyses to examine factors influencing feedback length and quality.

Results: EPAs facilitated high-quality written feedback, with a significant proportion of comments meeting quality criteria. Task-oriented and actionable feedback was prevalent, enhancing value of low-stakes workplace assessments. From the statistical analyses, the type of assessment tool significantly influenced feedback length and quality, implicating that direct and video observations can yield superior feedback in comparison to case-based discussions. However, no correlation between entrustment scores and feedback quality was found, suggesting potential discrepancies between the feedback and the score on the entrustability scale.

Conclusion: This study indicates the role of the EPAs to foster high-quality feedback within CBME. It also highlights the multifaceted feedback dynamics, suggesting the influence of factors such as feedback length and assessment tool on feedback quality. Future research should further explore contextual factors for enhancing medical education practices.

Objective: During the SARS-CoV-2 pandemic, hospital visitation restrictions hindered patients' access to vital social support. This study explores the impact and feasibility of a student-led program facilitating audiovisual communication between inpatient rehabilitation patients and their caregivers.

Methods: The study design employed a prospective observational approach, and convenience sampling enrolled 99 participants, including 33 patients, 33 caregivers, and 33 medical students. From September 2021 to March 2022, eligible patients admitted to an inpatient rehabilitation hospital identified a caregiver and participated in a 30-minute audiovisual call organized by a medical student. Post-visit surveys via RedCap were completed by all participants and covered limitations in video calls, program benefits, comfort levels in video conferencing, and overall program ratings. The study adopted a quantitative research paradigm for data analysis. Statistical analysis utilized pairwise McNemar's and Wilcoxon's test for inter-group comparison.

Results: Patients, caregivers, and medical students all reported positive outcomes in program offerings including providing social support, decreasing feelings of isolation, and providing a feeling of connection. Patients rated the program 4.82 ± 0.47 on a Likert scale, with 97% recommending it to others, even beyond visitation restrictions. The most common diagnosis among patients was stroke (30%), highlighting the program's potential applicability across diverse patient populations. Caregivers rated the program 4.59 ± 0.87 and expressed a desire for its continuation post-restrictions (80%). Medical students (81%) recommended the program, citing benefits in reducing social isolation and gaining clinical experience. No statistical differences were observed between groups in emotional and humanistic domains.

Conclusion: This study highlights the potential for programs to utilize technology to address social isolation in the healthcare setting. When public health restrictions occur, medical educators should consider opportunities to support and foster innovation for student-led programs. Further research should explore broader impacts on healthcare outcomes and medical education.

Background: With a growing population of older people in all Western countries, interprofessional education (IPE) can help to prepare students for the complex care for these patients. Which aspects of this complex care could benefit from IPE? In this study we evaluated the differences in content of health care plans made by students who participated in IPE.

Methods: Undergraduate nursing and medical students were included and attended four sessions in which they wrote a health care plan for a paper-based geriatric patient case. Approximately half of the students were included in the IPE-group. To evaluate the content of interprofessional collaboration between the students, the other half of the students were included in a 'uniprofessional education' (UPE) group. UPE-students made the health care plan alone. In the IPE-group a medical and a nursing students compiled the health care plan together. All health care plans were assessed by comparing them with a validated health care plan. We zoomed into the differences in the content of the health care plans, and calculated a score ratio, proportion of correct items.

Results: The health care plans made by IPE-students had an average score ratio of 0.31. The health care plans made by UPE-students had an average score ratio of 0.22. Most differences were found in the subcategories medication, nursing actions and aftercare. Specific items within these categories were more frequently thought of in the IPE-group than in the UPE-group, for example delirium interventions and consultation with a transfer nurse.

Conclusion: This study gives insights into which health care actions are more often considered by interprofessional couples in IPE than by students in UPE. Awareness of these items in clinical practice could make a difference in the care for older patients.