Academic Medicine最新文献

Abstract: Although physicians with disabilities are underrepresented in medicine, their lived experiences of disability can increase empathy for patients, enrich the learning environment, and improve working conditions. However, they face barriers related to procedures, policies, clinical accommodations, disability and wellness support services, and physical environments as well as cultural barriers that affect their meaningful inclusion and ability to work at their full capacity. Despite national Canadian physician organizations recommending accommodations and inclusive policies and practices, an environmental scan of the top 10 ranked Canadian hospital institutions in April-May 2020 did not identify any existing accommodations policies.The Medical Advisory Committee and senior management team at The Ottawa Hospital (TOH) formally endorsed the first position statement in Canada supporting physicians with disabilities in 2021, which led to the establishment of a process to develop and implement an accessibility and accommodations policy for the Department of Medicine (DOM) at TOH. After careful review and an iterative development process, the DOM approved a formal Accessibility and Accommodations Policy in June 2022. The policy ensures physicians are accommodated during the recruitment, interview, and appointment phases. It outlines a process for the development of an accommodation plan, addresses funding for accommodations, protects physicians returning to work following absences due to a disability, and requires exploration of opportunities for physicians to make a meaningful contribution if they cannot practice clinically due to their disability.In this article, the authors discuss the process of developing and implementing the DOM Accessibility and Accommodations Policy, outline the key elements of the policy, discuss broader implementation of the policy, and how they are monitoring its impact. They also discuss the importance and benefits of collecting data on physicians who self-identify as having a disability and, through confidential surveys, focus groups, and interviews, monitoring the impact of accessibility and accommodations policies.

Purpose: Point-of-care ultrasonography (PoCUS) has improved the diagnostic capacity of medical conditions; however, integrating it into medical curricula is constrained by cost, time, accessibility, and teaching style variability. This study examines whether simulator-based self-learning for cardiac PoCUS is noninferior to instructor-guided teaching.

Method: This randomized controlled trial, conducted at Ben-Gurion University of the Negev, enrolled 116 medical students as part of the medical school's PoCUS curriculum. Participants were randomly assigned to a simulator-based self-learning or conventional instructor-guided teaching group. After training, which took place January 29 to February 22, 2023, participants completed exams on February 23, 2023, assessing their abilities to obtain specific cardiac views, capture images of quality, and correctly identify common cardiac pathologies.

Results: Of 116 participants, 57 (49.1%) were categorized into the instructor-guided group and 59 (50.9%) the self-learning group. Participants in the self-learning group had higher total test scores compared with the instructor-guided group (81.6% vs 77.2%, P = .30), with only the apical 2-chamber view reaching statistical significance in favor of the self-learning group (81.3% vs 68.3%, P = .04). The self-learning group also scored higher on image quality, but the difference was not statistically significant (59.5% vs 55.6%, P = .26). There was no significant difference in total scores for cardiac pathology identification (93.5% in the self-learning group vs 94.7% in the instructor-guided group, P = .81). A multivariable logistic regression presented no significant difference in achieving an above median score when adjusted for gender, chest anatomy academic grade, and prior PoCUS training (adjusted odds ratio, 1.55; 95% CI, 0.69-3.53; P = .30).

Conclusions: This study suggests that the self-learning approach is noninferior to instructor-guided teaching for cardiac ultrasonography training. Incorporating these programs into medical curricula may enhance the quantity and proficiency of PoCUS operators, improving diagnostic capabilities and treatment outcomes across medical specialties.

Abstract: The Accreditation Council for Graduate Medical Education's mandate for quality improvement (QI) training in residency programs has generated discussion in the literature of QI best practices and curriculum models. Despite this requirement, residents continue to report limited exposure to domains like available QI expertise, access to data collection, QI knowledge, and ability to complete all project stages.While the barriers to successful QI project implementation are numerous, the lack of experienced QI educators is also a major limitation. Educators new to QI education may not know how to approach common project pitfalls residents face, namely their tendency to jump to the "do" phase in a Plan-Do-Study-Act (PDSA) cycle without prior framing of the problem through process evaluation and identification of timely measures. These pitfalls can lead to many unintended consequences, including diminished physician engagement in QI work.To focus residents on learning about health systems, the authors draw on their collective experiences as learners and educators to propose a practical approach for new QI educators, consisting of 4 objectives: (1) illustrate and evaluate the process; (2) obtain meaningful and timely measures; (3) propose an intervention and obtain feedback from high-level stakeholders; and (4) reflect on lessons learned throughout the endeavor. The authors assert that by prioritizing these objectives before embarking on a PDSA cycle, residents will learn more about systems of care, gain competency in analyzing these systems, and continue QI efforts successfully in their future careers.

Problem: The opioid overdose crisis had progressed broadly in the United States, with an 21% increase from 2016 to 2017, and specifically in Massachusetts, with a peak rate of 1,374 deaths in 2016. In 2016, students and faculty at Harvard Medical School (HMS) established the Substance Use and Pain Curriculum Committee (SUPCC) to expand substance use and pain education. However, faculty capacity, financial resources, and administrative support were insufficient to implement changes across all phases of the medical school curriculum.

Approach: The HMS SUPCC restructured in 2021 to put students at the forefront of curricular development. This restructuring was done through 3 main innovations: (1) establishment of a student-centered committee structure, ensuring that curricular changes are centered on student interests and needs; (2) student-led curricular development and implementation, reducing faculty workload; and (3) focus on clinically relevant teaching and opportunities to practice learned skill sets.

Outcomes: This student-centered structure facilitated the expansion of the addiction and pain medicine curriculum to more than 30 hours of teaching by 2024. Examples of student-driven initiatives include development of an opioid use disorder management practicum equivalent to the Drug Enforcement Agency X-waiver, increased medical student access to naloxone through a hospital partnership, and integration of case-based opioid use disorder and pain medicine didactics into the clerkship year.

Next steps: Although this work has established a longitudinal curriculum across all medical training stages, more must be done in clerkship rotations to help students apply their substance use and pain education in the clinical setting. The HMS SUPCC is working to incorporate teaching on nonopioid substances, such as alcohol, cannabis, and ketamine, provide longitudinal clinical experiences so students learn to care for patients with substance use disorder and chronic pain from short-term intervention to long-term recovery, and develop surveys to quantitatively and qualitatively measure curriculum outcomes.