Academic Medicine最新文献

Purpose: Given varying preference signal numbers and structures across residency specialties, this study investigates the impact of preference signaling on match outcomes in highly competitive medical specialties.

Method: Data were from University of Texas Southwestern Medical School's Texas Seeking Transparency in Application to Residency survey of applicants to the top 10 most competitive specialties using signaling between 2021 and 2024. Bivariate statistical testing compared groups across categorical and continuous variables. Multivariate logistic regression compared outcomes between 10 or fewer and 20 or more signals.

Results: The dataset contained 4,469 applications from 4,391 unique students. Number of signals used did not affect number of overall matches (2,458 of 2,908 [84.5%] for 3-5 signals, 94 of 112 [93.9%] for 6-10 signals, 178 of 203 [86.7%] for 21-25 signals, and 585 of 662 [88.4%] for 26-30 signals; P = .08). Higher signal numbers were associated with significantly higher matching rates at signaled institutions (916 of 2,098 [37.2%] vs 525 of 662 [89.6%], P < .001). Away rotations (odds ratio [OR], 9.25; 95% CI, 6.37-13.43; P < .001), signaling gold (OR, 7.74; 95% CI, 3.85-15.55; P < .001), geographic connections (OR, 4.12; 95% CI, 3.01-5.64; P < .001), and signaling programs (OR, 3.38; 95% CI, 2.43-4.68; P < .001) were significantly associated with matching. Away rotations were ranked as most important (β = 2.23) followed by gold signals (β = 2.05), geographic connection (β = 1.42), and program signals (β = 1.22). Program signals had a stronger impact for applicants with 10 signals or fewer vs 20 signals or more (OR, 5.99 [95% CI, 3.96-9.08] vs 3.00 [95% CI, 1.33-6.77]; P < .001).

Conclusions: Specialties with more signals favor successful matching to signaled programs, but signal effectiveness diminishes as quantity increases. Applicants should prioritize impactful strategies to improve their chances of matching.

Purpose: Clinician educators are essential to the academic medicine workforce, yet understanding how they assess their own teaching competencies is limited. The Clinical Educator Milestones (CEMs) guide growth across key educator domains, but their use and perceived relevance remain underexplored. This study aims to (1) evaluate clinician educators' self-reported performance on the CEMs; (2) examine differences by career level, specialty, and experience; and (3) inform faculty development efforts through a clearer understanding of educators' perceived strengths and gaps.

Method: Clinician educators from 9 US academic institutions completed a self-assessment rating their performance across 4 universal pillars and 11 educational theory and practice competencies on a 1- (novice) to 5- (expert) point scale in 0.5-point increments from August to November 2024. Descriptive statistics and mean difference tests were used to analyze variation across demographic and professional characteristics.

Results: A total of 484 responses to at least 1 CEM were received. Respondents rated themselves highest in commitment to professional responsibilities (mean [SD], 4.30 [0.68]), teaching and facilitating learning (mean [SD], 3.96 [0.74]), and professionalism (mean [SD], 3.93 [0.73]) and lowest in medical education scholarship (mean [SD], 3.11 [1.15]), program evaluation (mean [SD], 3.33 [1.03]), and the science of learning (mean [SD], 3.43 [1.10]). Statistically significant group differences were found by years of posttraining clinical experience (F2,413 = 16.87, P < .001, η2 = .076), years of teaching experience (F2,433 = 20.87, P < .001, η2 = .088), and academic rank (F2,403 = 13.96, P < .001, η2 = .065).

Conclusions: This study identifies key trends in self-perceived strengths and needs among clinician educators and highlights the limited awareness of the CEM framework. As institutions aim to build effective educator development systems, the CEMs can serve as a useful structure for tailoring support to individuals and identifying institutional needs.

Purpose: Workplace violence is prevalent in settings where health care practitioners are responsible for managing agitated patients and visitors. First-line management of agitation within health care is verbal deescalation. However, formal training in verbal deescalation is not standardized across health professions education (HPE), and consensus about best practices is lacking. This systematic review examines the characteristics of existing curricula within HPE that teach deescalation skills, assesses the research quality and strength of evidence of these studies, and outlines consequent best practices for teaching the skill of deescalation to health professionals.

Method: PubMed, EMBASE, ERIC (EBSCOhost), and Google Scholar were searched using terms related to HPE, aggression, and deescalation for work published from database inception to July 22, 2025. Studies on empirical outcomes from curricula designed to teach deescalation to health professionals were included. Included studies were assigned scores on the Medical Education Research Study Quality Instrument (MERSQI) and an adapted version of the Best Evidence Medical Education (BEME) strength of evidence scale. A narrative synthesis approach was adopted.

Results: Of 4,312 unique records identified, 56 studies met the inclusion criteria. Twelve had BEME scores of 4 or 5, indicating strong evidence. MERSQI scores ranged from 5.5 to 16.0, with a mean (SD) of 10.4 (2.5). Learning interventions were targeted to nurses, physicians, students, and hospital staff. The interventions with strong evidence all incorporated both didactic education as well as role-play and/or simulation for active practice. The Ten Domains of De-escalation by the American Association for Emergency Psychiatry and the De-escalating Violence in Healthcare Settings curriculum by the International Committee of the Red Cross were referenced by multiple studies.

Conclusions: Available literature suggests that the most evidence-supported way to teach deescalation within HPE is through a combination of didactic lessons and active skills practice.

Purpose: Compassion is crucial for effective, patient-centered care, but its development in medical education is challenging due to its complexity, with explicit and implicit teaching approaches. A qualitative synthesis is needed to explore nuances and foster sustainable compassion in medical students. This review aims to investigate perceptions and experiences of the flows of compassion (from others, for others, and self-compassion) in medical education.

Method: For this qualitative systematic review and meta-aggregation, systematic searches were conducted using 7 major databases for studies published before July 5, 2024 (search date). Studies reporting qualitative data on the perceptions and experiences of medical students, educators, clinicians, or other relevant knowledge users with compassion in medical education were considered eligible. Two independent reviewers performed all screening as well as quality appraisal, data extraction, and certainty of evidence assessments for included studies with multiple relevant results. Meta-aggregation was guided by the Joanna Briggs Institute approach, forming categories from extracted results and synthesized findings overall.

Results: In total, 151 studies were included, from which extracted qualitative results were grouped into 30 categories, making 12 synthesized findings. Structured training and positive role modeling enhance compassionate care, whereas barriers such as burnout, negative role models, and restrictive clinical cultures hinder compassion.

Conclusions: Formal and hidden curricula must integrate longitudinal compassion education, from assessments and clerkship instruction to faculty development, to foster compassion in medical education. Integrating both cultural and structural changes in medical education may enhance the flows of compassion.

Problem: Academic medical institutions face longstanding challenges in recruiting and retaining historically excluded, midcareer research faculty. Although progress in recruiting has been documented, retention has focused on individuals rather than a system-level approach.

Approach: The University of California San Francisco (UCSF) Mid-Career Development Program was launched in 2020 to advance and retain historically excluded research faculty (scholars) and their historically excluded mentees via a novel program that provided faculty discretionary funding of $150,000 per person over 2 years, a structured career development curriculum, networking with executive campus leaders, personalized and peer group mentorship, and sponsorship. A formative evaluation in 2024 collected baseline and follow-up data on scholars' and mentees' academic output and leadership attainment.

Outcomes: Between 2020 and 2024, 7 midcareer scholars and 35 mentees have benefited from the program. The first 2 cohorts of scholars documented academic rank and step advancements; scholarly outcomes, including 119 articles and $2.3 million new National Institutes of Health (NIH) career awards; and key campus and national leadership roles. These changes reflected not only standard accumulated academic experience but also increased leadership opportunities previously unavailable to participants. Multiplier effects were documented among the scholars' primary mentees, who were awarded $2 million in NIH career awards and published 194 peer-reviewed manuscripts, for an overall program total of 313 articles. This model program showed a return on its initial $1.05 million investment: for every dollar spent, the program generated $3.10 in NIH funding-a 310% return on investment.

Next steps: Program leaders and UCSF executive leadership are working to promote program sustainability. Additionally, collection of comparison data for program outcomes among participants and comparable faculty applicants for the program, who met criteria and were not enrolled due to space limitation, is being planned to enhance the pilot program results and, if successful, scale to other sites.

Purpose: Clinical teachers must continuously learn new skills to support evolving needs of learners in complex clinical environments. The Clinician Educator Milestones published by the Accreditation Council on Graduate Medical Education delineate the skills needed, yet guidance for how to develop skills is lacking. The Master Adaptive Learner (MAL) framework outlines a process for expertise development, but whether clinical teachers apply this to their own teaching skills development is unclear. The authors explored, through the MAL lens, how master clinical teachers develop their skills and what factors drive changes in their teaching.

Method: The authors conducted a multisite, interview-based, qualitative study of master clinical teachers, using a cocreated definition to inform selection of participants. They developed and refined a semi-structured interview guide and collected demographics through an online survey between February and June 2024. Two authors analyzed the data using thematic analysis through an iterative process.

Results: Twenty-nine clinical teachers participated, representing 11 specialties. The authors identified 4 main themes: (1) master clinical teachers intentionally change and improve their teaching over time; (2) internal and external factors drive change, including learner feedback, reflection, and humility; (3) formal and informal mechanisms enable teachers to change and improve, including faculty development, role modeling, and practice; and (4) changes encompass what and how they teach, with increasing emphasis on learner-centered approaches. The data suggest a master adaptive approach to teacher development-identifying gaps in knowledge through reflection and seeking professional development opportunities (planning), engaging with such opportunities (learning), analyzing feedback after experimenting (assessing), and adopting successful approaches (adapting).

Conclusions: Master clinical teachers describe an active, intentional process to development of teaching skills that maps on the MAL framework. Institutions should support the expansion of faculty development efforts to explicitly promote this approach and address barriers to professional development of clinical teachers.