Academic Medicine最新文献

Purpose: Clerkship grades are important in the residency selection process but can be influenced by individual bias and grading tendencies. Although clinical competency committees are standard in graduate medical education, in undergraduate medical education, they have not gained widespread traction. This study describes structures and processes of grading committees in internal medicine (IM) clerkships and strategies used to mitigate grading bias.

Method: From September to December 2022, the Clerkship Directors in Internal Medicine conducted its annual survey of IM core clerkship directors at 140 U.S. and U.S. territory-based medical schools. This study was based on 23 questions about grading committees in IM clerkships.

Results: The survey response rate was 80% (n = 112/140). Forty-seven respondents (42%) reported using grading committees in their IM clerkship (median committee size, 7; range, 3-20) (primarily clerkship leadership and faculty). Responsibilities included determining grades for all students (31 [66%]) and students at borderline of failing (30 [64%]), adjudicating on students with professionalism concerns (25 [53%]), and reconciling discordant clinical evaluations (24 [51%]). To mitigate deliberation bias, committees most frequently used multisource assessments (38 [81%]) and adoption of a shared mental model (36 [77%]). Approximately one-third of grading committees "rarely" discussed gender (14 [30%]) and race or ethnicity (15 [32%]), and 7 committees (15%) "never" discussed gender and race or ethnicity. Clerkship directors perceived developing a shared mental model (60 [92%]), promoting consistency (59 [91%]) and transparency (57 [88%]) in the process, mitigating assessment bias (58 [89%]), improving student satisfaction (54 [83%]), and sharing grading responsibility (44 [68%]) as potential benefits.

Conclusions: This study found that grading committees in IM clerkships are not widely used and that existing committees vary in structure and process. These findings highlight an opportunity for medical schools to consider using grading committees to improve grade assignment and address grading inconsistencies.

Purpose: The MeToo movement forced a social reckoning, spurring women in medicine to engage in the #MeTooMedicine online discourse. Given the risks of reporting sexual violence, discrimination, or harassment, it is important to understand how women in medicine use platforms like Twitter to publicly discuss their experiences. With such knowledge, the profession can use the public documentation of women in medicine for transformative change.

Method: Using reflexive thematic analysis, 7,983 tweets (posted between November 2017-January 2020) associated with #WomenInMedicine, #MeTooMedicine, and #TimesUpHC were systematically analyzed in 2020-2022, iteratively moving from describing their content, to identifying thematic patterns, to conceptualizing the purpose the tweets appeared to serve.

Results: The Twitter engagement of women in medicine was likened to "holding beacons of light to shine in the corners [harassers] are hoping to keep dark," both reinforcing the message that "gender bias is alive and well" and calling for a "complete transformation in how we approach" the problem. The tweets of women in medicine primarily seemed aimed at disrupting complacency; encouraging bystanders to become allies; challenging stereotypes about women in medicine; championing individual women leaders, peers, and trainees; and advocating for reporting mechanisms and policies to ensure safety and accountability across medical workplaces.

Conclusions: Women in medicine appeared to use Twitter for a host of reasons: for amplification, peer support, advocacy, and seeking accountability. By sharing their experiences publicly, women in medicine seemed to make a persuasive argument that time is up, providing would-be allies with supporting evidence of sexual violence, discrimination, and harassment. Their tweets suggest a roadmap for what is needed to achieve gender equity, ensure that lack of awareness is no longer an excuse, and ask bystanders to grapple with why women's accounts continue to be overlooked, ignored, or dismissed and how they will support women moving forward.

Purpose: The Arab experience is understudied because Arabs are categorized as White on the U.S. Census, leading to diminished documentation of their personal experiences. There is also little understanding of the Arab experience and its intersectionality with gender, being an international medical graduate (IMG), and working in academia. The authors studied the experience of Arab women IMGs working in the U.S. academic system.

Method: This qualitative study used interpretative phenomenological analysis to analyze in-depth interview data from 20 first-generation U.S. immigrant Arab women who were IMGs. Interpretative phenomenological analysis involved data familiarization, immersion, and coding. Codes were grouped into potential themes on the participants' experience. The authors explored connections between the themes and engaged in reflexive practice through memo writing and team meetings. The study was performed from November 2022 to May 2023.

Results: The experiences of the 20 first-generation U.S. immigrant Arab women IMGs were as diverse as the Arab identity itself but congruent with some documented IMG experiences. Political turmoil, desire for new opportunities, and career goals were all reasons that led them to emigrate, but cultural differences, isolation from their home countries, and missing family were central to their experiences. Muslim women wearing the hijab or those with heavy accents faced more microaggressions and xenophobia in academic clinical settings. Those in environments that embraced their differences and supported them described less discrimination. They all, however, felt that they benefited from training in the United States. However, they noted room for improving cultural humility in residencies and the need for a more inclusive workplace.

Conclusions: This study highlights the visible and invisible challenges that affect Arab women IMGs' experience in the United States. Program directors and department leaders should try to learn about the backgrounds of IMGs and current geopolitical events that might affect IMGs and extend support.

Purpose: The medical education community is pursuing reforms addressing unsustainable growth in the number of residency applications per applicant and application costs. Little research has examined the prevalence or contributions of parallel applications (application to residency in multiple specialties) to this growth.

Method: A retrospective analysis of Electronic Residency Application Service® data provided by the Association of American Medical Colleges was conducted. The percentage of applicants applying to ≥1 specialty, mean number of specialties applied, number of submitted applications, and percentage of applicants to each specialty who were parallel applying were determined. MD, DO, and international (U.S. international medical graduate [IMG] and IMG) applicants were included.

Results: The sample contained 586,246 applicant records from 459,704 unique applicants. The percentage of applicants who parallel applied decreased from 41.3% to 35.4% between 2009 and 2021. DO applicants were the only group for whom the percentage parallel applying increased (30.6% vs. 32.1%). IMG (60.4% vs. 49.1%) or USIMG applicants (69.6% vs. 63.1%) were groups with the greatest percentage of applicants parallel applying each year (2009-2021). The mean number of specialties applied to when parallel applying also decreased from 2.96 in 2009 to 2.79 in 2021, overall. Between 2009 and 2021, mean number of applications increased for all applicant types amongst both single-specialty applicant and parallel-applying applicants. Among applicants who were single-specialty applying, mean number of applications grew from 38.6 in 2009 to 74.6 in 2021 and from 95.2 to 149.8 for parallel-applying applicants.

Conclusions: All applicant groups experienced decreases in percentages parallel applying except for DO applicants. Parallel application appears to be common and slowly declining, and does not appear to significantly contribute to increasing numbers of applications per candidate. Efforts to control the growth of applications per applicant should continue to focus on applicants' numbers of applications submitted to each specialty.

Problem: Trauma-informed care (TIC) provides a medical framework for addressing and mitigating the negative consequences of trauma. In response to student and faculty advocacy, medical schools are developing trauma-informed curricular content. However, medical education literature does not present a comprehensive assessment rubric to evaluate medical students' acquisition of trauma-informed clinical skills.

Approach: A committee of medical students, trainees, and faculty developed a longitudinal TIC curricular theme at Harvard Medical School (HMS). Guided by the National Collaborative on Trauma-Informed Health Care Education and Research competencies, the committee created a set of medical student TIC competencies from July to December 2019. From November 2021 to November 2022, 3 committee subgroups generated new TIC descriptors for each HMS entrustable professional activity (EPA), then circulated these to other subgroups, external experts, and stakeholders for review and feedback. From April to June 2023, the committee iteratively reviewed the materials until reaching consensus for content and pedagogy. The committee integrated TIC content into HMS's existing EPAs expected of students, provided anchoring descriptions of each level, and achieved consensus using a process of iterative review with TIC content experts.

Outcomes: The committee identified 10 TIC competencies and revised all 13 general HMS EPAs to include specific items based on these competencies. The committee incorporated at least 1 trauma-informed competency into each HMS EPA.

Next steps: This novel set of HMS EPAs provides a framework for assessment of TIC clinical skills. Faculty will be trained to correctly and reliably incorporate TIC competencies into patient care and to use the TIC-inclusive EPAs for student assessment, ensuring that TIC is standard medical practice at HMS. This work may facilitate the adoption of trauma-inclusive EPAs by other institutions to educate the next generation of physicians to practice TIC and thus promote a more accessible, safe, and equitable health care system.

Purpose: Medical education journal editors work to improve scholarly rigor and expand access to scholarship. How editors conceptualize these dual roles is unknown and holds implications for the kinds of scholarship that are valued and made visible through publication. The authors applied the concept of capacity building to examine how medical education journal editors conceptualize and operationalize capacity building and to identify the contextual factors that support or constrain these efforts.

Method: Using a reflexive thematic approach, the authors interviewed 13 editors of 11 medical education journals between February 2022 and March 2023. Data collection and analyses were performed iteratively. Interview transcripts were coded by 2 authors to generate initial codes, which were then refined by the research team until final themes were created.

Results: Editors viewed capacity building "making space" for people and perspectives. Making space for people included efforts to support editors and reviewers, offer feedback to authors, and engage with readers. Making space for perspectives included efforts to promote discussion on diversity and inclusion and to introduce ideas perceived to advance the field. How editors made space was shaped by a journal's ecosystem, including local features unique to each journal (e.g., aims, scope, readership) and system-level factors that influenced all journals (e.g., English as the language of science, academic promotion and tenure).

Conclusions: Although medical education journal editors' capacity-building work will inevitably guide future scholars and scholarship, their work should be considered in the context of a larger ecosystem, including such features as institutional academies for scholarship and promotion and tenure policies. Improving rigor and expanding access will require clarifying how editors' approach and understand capacity building to advance as a field. Future work should clarify how individual journals' capacity-building efforts can be facilitated and how journals can collectively reimagine spaces for knowledge-building conversations.

Purpose: Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts.

Method: Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis.

Results: Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intraprofessionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate.

Conclusions: The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur interprofessionally but occurs intraprofessionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations.