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By adopting a holistic perspective that looks 'upstream' at the underlying determinants of health, physicians can develop more effective strategies for promoting wellness and reducing health inequities in an increasingly diverse and complex society. Public health focuses on disease prevention and promotion of health through organized efforts by individuals and society. Population health focuses on the health outcomes of a group of individuals. We designed the Clinical Public Health curriculum, a pedagogical framework designed at the George Washington University School of Medicine & Health Sciences that breaks down traditional silos between didactic public and population health teaching, patient care and community engagement for medical students. It aims to train socially accountable clinician-citizens through an integrated, longitudinal curriculum across the four years of medical school. In this article we describe one aspect of the curriculum - four self-contained 'summits' - which can be used as a template for others seeking to develop a curriculum focusing on social accountability and engagement with community and governmental partners. During these multi-day applied educational experiences, medical students engage with key stakeholders, community members, community-based organizations, and state and national agencies to develop innovative approaches to engage in advocacy and population health. Enhanced medical school curricula focusing on the development of socially accountable clinician-citizens is an urgent need to develop more meaningful clinical-community interventions, support professional development, put context on the impact of health-related social needs on patients and families, and transform healthcare delivery and policy through greater community connection and advocacy.

The remote Objective Structured Clinical Examination (OSCE) is a cornerstone of medical education, enabling structured and objective assessment of clinical skills, communication, and patient-centered care. However, its widespread adoption has introduced challenges related to cost-effectiveness and efficient use of rater resources. Traditional double scoring (DS) ensures reliability but is labor-intensive and costly, especially in large-scale assessments. To address these challenges, this study introduces Targeted Double Scoring (TDS), a novel methodology that selectively applies DS to specific score ranges, particularly those near the pass/fail threshold. The study was conducted using data from a pilot remote OSCE administered to 550 clinical medicine undergraduates in China. The OSCE consisted of three stations: Clinical Reasoning (CR), Physical Examination (PE), and Fundamental Skills (FS). Each station was scored remotely by two raters, with a cut-off score of 60 out of 100. The TDS methodology was modeled based on the OSCE's DS design and fitted with scoring data. A decision-theoretic approach identified optimal Critical Score Ranges (CSRs) for targeted double scoring, balancing reliability and cost-effectiveness. The findings show that TDS significantly reduces rater workload and costs while maintaining high reliability and fairness. For instance, TDS achieved up to 70% cost savings compared to traditional DS under certain configurations. The study also highlights the flexibility of TDS, which can be tailored to different OSCE designs and scoring rubrics. These results have broad implications for medical education, especially in resource-constrained settings where optimizing assessment efficiency is critical. This study provides a practical solution to the cost-related challenges of remote OSCEs and offers a framework for adopting TDS in assessments. By focusing raters on critical score ranges, TDS maintains rigorous and fair evaluations without overburdening faculty or exceeding budgets. Future research should explore TDS scalability and its integration with emerging technologies like artificial intelligence to enhance efficiency and reliability.

Objectives: With the health impacts of climate change becoming increasingly evident, there is a pressing need to prepare and educate future physicians to address these challenges. This study therefore aims to explore in depth the perspectives of final-year medical students (FYMS) on the integration of Planetary Health Education (PHE) into medical curricula (i.e. content, methods, exams). Additionally, it seeks to understand how FYMS perceive the relevance of this topic to their future profession and their perceived responsibility.

Methods: FYMS at the Heidelberg University Hospital were invited to participate in this qualitative interview study, resulting in 10 interviews conducted between December 2021 and March 2022. Using a semi-structured guide, students' views on the role of climate change in their future profession and their preferences for integrating climate change into medical curricula were explored. Interviews were audio-recorded and transcribed verbatim. Data analysis followed a structuring qualitative content analysis approach according to Kuckartz, utilizing deductive and inductive methods. Coding was performed using MAXQDA24, with iterative revisions by the authors.

Results: Participating FYMS recognized the relevance of climate change to their future practice but expressed varying degrees of perceived responsibility in addressing it with patients, e.g. depending on their desired specialization. While often struggling to identify specific content for a PHE-curriculum, FYMS emphasized the wish for knowledge on health impacts of climate change, communication skills and interactive, practice-oriented teaching methods. FYMS also reported several reservations and perceived challenges, e.g. concerning the integration of basic climate science or the introduction of mandatory exams.

Conclusion: This study provides unique insights into FYMS' perceptions of PHE, emphasizing the importance of integrating climate change and health topics into medical curricula and revealing perceived limitations. By aligning educational approaches with students' preferences and especially their concerns, appealing curricula can ultimately foster a more climate-sensitive medical practice.

Background: Medical Humanities (MH) curricula integrate humanities disciplines into medical education to nurture essential qualities in future physicians. However, the impact of MH on clinical competencies during formative training phases remains underexplored. This study aimed to determine the influence of MH curricula on internship performance.

Methods: The academic records of 1364 medical students across 8 years of admission cohorts were analyzed. Performance in basic sciences, clinical skills, MH, and internship rotations were investigated, including the subgroup analysis of MH curricula. Ten-fold cross-validation machine learning models (support vector machines, logistic regression, random forest) were performed to predict the internship grades. In addition, multiple variables regression was done to know the independent impact of MH on internship grades.

Results: MH showed the important roles in predicting internship performance in the machine learning model, with substantially reduced predictive accuracy after excluding MH variables (e.g. Area Under the Curve (AUC) declining from 0.781 to 0.742 in logistic regression). Multiple variables regression revealed that MH, after controlling for the scores of other subjects, has the highest odds ratio (OR: 1.29, p < 0.0001) on internship grades. MH explained 29.49% of the variance in internship grades as the primary variable in stepwise regression. In the subgroup analysis of MH curricula, Medical Sociology and Cultural Studies, as well as Communication Skills and Interpersonal Relationships, stood out with AUC values of 0.710 and 0.705, respectively, under logistic regression.

Conclusion: MH had the strongest predictive association with clinical competence during formative internship training, beyond basic medical sciences. Integrating humanities merits greater prioritization in medical curricula to nurture skilled, compassionate physicians. Further research should investigate the longitudinal impacts of humanities engagement.

Background: The practice of evidence-based medicine (EBM) has become pivotal in enhancing medical care and patient outcomes. With the diffusion of innovation in healthcare organizations, EBM can be expected to depend on medical professionals' competences with digital health (dHealth) and artificial intelligence (AI) technologies.

Objective: We aim to investigate the effect of dHealth competences and perceptions of AI on the adoption of EBM among prospective physicians. By focusing on dHealth and AI technologies, the study seeks to inform the redesign of medical curricula to better prepare students for the demands of evidence-based medical practice.

Methods: A cross-sectional survey was administered online to students at the University of Montreal's medical school, which has approximately 1,400 enrolled students. The survey included questions on students' dHealth competences, perceptions of AI, and their practice of EBM. Using structural equation modeling (SEM), we analyzed data from 177 respondents to test our research model.

Results: Our analysis indicates that medical students possess foundational knowledge competences of dHealth technologies and perceive AI to play an important role in the future of medicine. Yet, their experiential competences with dHealth technologies are limited. Our findings reveal that experiential dHealth competences are significantly related to the practice of EBM (β = 0.42, p < 0.001), as well as students' perceptions of the role of AI in the future of medicine (β = 0.39, p < 0.001), which, in turn, also affect EBM (β = 0.19, p < 0.05).

Conclusions: The study underscores the necessity of enhancing students' competences related to dHealth and considering their perceptions of the role of AI in the medical profession. In particular, the low levels of experiential dHealth competences highlight a promising starting point for training future physicians while simultaneously strengthening their practice of EBM. Accordingly, we suggest revising medical curricula to focus on providing students with practical experiences with dHealth and AI technologies.

The use of narrative comments in medical education poses a unique challenge: comments are intended to provide formative feedback to learners while also being used for summative grades. Given student and internal medicine (IM) grading committee concerns about narrative comment quality, we offered an interactive IM Grand Rounds (GR) session aimed at improving comment quality. We undertook this study to determine the quality of comments submitted by faculty and post-graduate trainees on students' IM Clerkship clinical assessments, and to explore the potential impact of our IM-GR. Archived comments from clerkship cohorts prior to and immediately following IM-GR were reviewed. Clinical clerkship assessment comments include three sections: Medical Student Performance Assessment (MSPE), Areas of Strength, and Areas for Improvement. We adapted a previously published comment assessment tool and identified the performance domain(s) discussed, inclusion of specific examples of student performance, evidence that the comment was based on direct observations, and, when applicable, the inclusion of actionable recommendations. Scoring was based on the number of domains represented and whether an example within that domain was provided (maximum score = 10). Analysis included descriptive statistics, t-test, and Pearson correlation coefficients. We scored 697 comments. Overall, section ratings were MSPE 2.51 (SD 1.52, range 0-9), Areas of Strength 1.53 (SD 1.09, range 0-6), and Areas for Improvement 1.27 (SD 1.06, range 0-8). Significant differences were noted after Grand Rounds only in the MSPE mean scores. Within domains, trends toward increased use of specific examples in the post-GR narratives were noted. Assessment of both the breadth and depth of the included comments revealed low-quality narratives offered by our faculty and resident instructors. A focused session on best practices in writing narratives offered minimal change in the overall narrative quality, although we did notice a trend toward the inclusion of explanative examples.

Interprofessional teaching rounds are a practical application of interprofessional education in bedside teaching, yet there is a lack of research on how interprofessional teaching rounds should be implemented into medical education. This study aimed to describe our experience in developing and implementing interprofessional teaching rounds during a clerkship rotation for medical students, and compares its strengths and weaknesses relative to traditional teaching rounds. Medical students were assigned to either the interprofessional teaching round group (n = 24) or the traditional teaching round group (n = 25), and each group participated in their assigned type of teaching round. A quiz including medical knowledge of gynecological and obstetric diseases was used to assess the students' diagnostic and treatment abilities after teaching rounds. Additionally, a survey was conducted among students to evaluate whether the interprofessional teaching rounds were helpful. The results showed that when using interprofessional teaching rounds, the test score for medical knowledge related to the diagnosis and treatment of gynecological and obstetric diseases was significantly higher than the traditional teaching round group (85.5 ± 11.2 vs 78.3 ± 12.5, p = 0.038). Additionally, the interprofessional teaching rounds significantly enhanced understanding of clinical application, identification, and appropriate problem-solving in cases, as well as examination of different disciplinary aspects of a case, and improvement of interdisciplinary collaboration skills compared to traditional teaching rounds. Our study demonstrates that interprofessional teaching rounds can serve as an effective teaching method for enhancing medical students' ability to collaborate interprofessionally and to solve clinical problems comprehensively.

Background: Project ECHO has emerged as a leading telementoring modality for continuing medical education, particularly for providers practicing in rural and underserved areas with limited access to specialty care. The efficacy and utility of the ECHO model in healthcare training is well documented, though there is less literature focused on the determinants of ECHO implementation.

Objective: This study aims to assess facilitators and barriers to implementing the ECHO model.

Methods: We conducted virtual focus groups with eight Project ECHO implementation teams (n = 29 individuals) across the United States. Guided by the Consolidated Framework for Implementation Research (CFIR), focus groups explored experiences implementing the ECHO model and assessed facilitators and barriers to program uptake, delivery, and sustainability.

Results: Qualitative analysis revealed implementation determinants across CFIR levels. Participants recognized the advantage of ECHO's virtual, learner-centric, case-based learning approach compared to other continuing medical education modalities. Participants recommended recruiting subject matter expert presenters with skills as educators and understanding of the ECHO model. Because of Project ECHO's emphasis on case-based learning, participants highlighted the importance of balancing didactics with case presentations and discussion. Scheduling and finding time to participate was reported as a challenge for provider engagement, though most participants suggested that the length, frequency of sessions, and number of participants can be tailored for each program to accommodate needs. Providing CME credit and setting expectations for attendance and case presentation were said to improve provider engagement. Support and mentorship from the ECHO Institute was described as a facilitator in planning for ECHO implementation and delivery. Funding was reported as a barrier to sustainability.

Conclusion: By addressing barriers prior to implementing the ECHO model, future ECHOs can be tailored to leverage program resources, maximize attendance, expand reach, and ultimately improve outcomes.

Background: Texas is one of the states with the lowest access to usual sources of primary care; most critically, family medicine (FM) has been projected to have the greatest physician shortage increase between 2018 and 2032. Texas Tech University Health Sciences Center (TTUHSC) School of Medicine developed the Family Medicine Accelerated Track (FMAT), a 3-year curriculum that culminates in the MD degree and links medical students to FM residency programs at TTUHSC campuses in Lubbock, Amarillo or the Permian Basin. This article reflects on 10 years of experience with the program, and particularly its impact on the primary care physician workforce in Texas.

Curriculum design: TTUHSC medical students in the traditional curriculum complete the Phase 1 pre-clinical curriculum in Lubbock and are distributed for Phases 2 and 3 (MS3/MS4 years) among campuses in Lubbock, Amarillo and the Permian Basin. Similarly, FMAT students complete Phase 1 in Lubbock. For Phase 2 clinical clerkships, their curriculum is delivered on the campus (which may include Lubbock) where they will typically complete 3 years of FM residency training.

Program outcomes: In the 2 years prior to the graduation of the first FMAT class, just over 11% of the graduating class matched into FM. In the decade since, the numbers have varied from year to year (often as high as 17-19% of the class matching into FM) but have always exceeded the pre-FMAT numbers. For the classes 2013 through 2023, 115 students began FMAT training; 90 of them (78%) graduated in 3 years with the MD degree and began FM residency training. Of those 90, 56 have now graduated from residency and taken positions in the primary care physician workforce. Of that group, 86% are practicing in Texas, 64% are in West Texas, and 69% are in rural or underserved communities.

Purpose: At LUMC, a Small Private Online Course (SPOC) was developed complementary to the clinical learning environment of the internal medicine clerkship. The developers used the self-determination theory in the design of the SPOC's assignments aiming to improve learners' intrinsic motivation. This study investigates the impact of the SPOC and its specific assignments on student motivation.

Methods: The study uses a mixed-methods approach. The authors describe a quantitative analysis of students' responses on an intrinsic motivation inventory (IMI), and a qualitative thematic analysis of semi-structured group interviews, respectively.

Results: Seventy-eight students (response rate 42%) filled out the IMI. Their scores were (7-point Likert scale): interest/enjoyment 3.76, competence 4.02, choice 3.53, value/usefulness 4.20, relatedness 3.85. Thematic analysis of the interviews (14 students) revealed seven themes: collaboration with peers, usefulness, SPOC-related factors, workload, motivation, and performance.

Conclusions: Motivation could be optimized creating useful, authentic cases that train skills that are directly transferrable to clinical practice. Challenging, interesting and student-generated assignments positively influenced students' autonomy and motivation. Lack of awareness of online performance negatively affected the feeling of competence. Perceptions of online collaboration were suboptimal. The study can be helpful for other teachers to enhance motivation while developing online courses.