Academic Medicine最新文献

Purpose: Timing is crucial to effective feedback delivery. Optimizing feedback timing can enhance learner satisfaction, promote engagement, and improve feedback uptake. Despite widespread adoption of entrustable professional activity (EPA) assessment forms, little research has examined the impact of timing on residents' perceptions of these formative workplace-based assessments. The current study sought to examine the effect of timing on residents' perceptions of EPA-based feedback.

Method: The authors conducted fifteen semi-structured interviews with Internal Medicine residents from the University of Toronto between July to December 2023. Using constructivist grounded theory, data collection occurred alongside comparative analysis to identify core themes.

Results: Residents valued EPAs that were specific, actionable, and opportune. Timing significantly influenced residents' perception of, and engagement with, EPA-based feedback. Early EPAs forms completed days following an educational encounter were perceived to possess higher quality feedback, accompany greater opportunities for feedback uptake, and foster a stronger student-teacher relationship. Residents importantly distinguished between early and immediate EPA form completion, noting that the latter may be impractical and fraught with challenging emotions. While late feedback was least preferred, residents acknowledged their tendency to batch and request EPA forms belatedly. Underlying this practice were barriers to feedback-seeking, which residents perceived to be onerous and difficult. Reported concerns included worries over burdening staff and a fear of hidden image and relationship costs. Finally, verbal feedback was highly valued, cultivating a sense of timeliness that was otherwise lost in its absence.

Conclusions: Optimizing the timing of EPA forms as a means of workplace-based assessment, necessitates a balanced approach with considerations for a learner's readiness for feedback and pragmatism in the face of competing workplace responsibilities. As EPA forms continue to gain traction as important tools for assessment and feedback, addressing these complexities may alleviate ongoing reports of resident dissatisfaction and facilitate feedback provision within medical education.

Purpose: This study compares the cost-effectiveness and educational utility of a 3-dimensional (3D)-printed hand model with a commercial model used in first-year medical student education.

Method: The 3D model was derived from a virtual rendering of a patient's hand and printed using polylactic acid filament on a 3D printer, with excess filament removed and neurovasculature wires added in postprocessing. On February 6, 2024, first-year University of Virginia School of Medicine medical students were randomized to study the 3D-printed model or a comparable commercial model during a 30-minute guided session. Students then completed a 19-question practical examination on anatomical knowledge using Bloom's taxonomy. Examination questions covered muscles, tendons, neurovasculature, osteology, ligaments, and clinical scenarios. Students provided qualitative feedback on their experience with the models. Costs were calculated.

Results: Eighty students completed the anatomical knowledge examination, with 41 randomized to the 3D-printed model group and 39 to the commercial model group. Production of raw materials cost $24.58 per unit with an estimated cost if student volunteers were unavailable of $99.56 per unit, representing an average cost reduction of 94.4% compared with the commercial model's retail price ($1,098). Both models had comparable mean (SD) examination scores (61.6% [3.3%] in the 3D group vs 62.6% [3.0%] in the commercial group; P = .59). Qualitative feedback highlighted the anatomical accuracy of the 3D model but noted a preference for the labeling and disassembly features of the commercial model.

Conclusions: The study demonstrated that the locally constructed 3D-printed hand model was noninferior to the commercial model for teaching anatomy in a single-site pilot study in a first-year medical school anatomy class. The findings suggest that this 3D-printed model could serve as a cost-effective alternative in medical education, particularly in resource-limited settings. Future improvements in design, such as incorporating modular components, could optimize their educational value.

Coaching is considered the next generation of professional development in academic medicine, building on the historically important roles of advisor, mentor, and sponsor. A growing number of organizations are exploring or currently utilizing coaching to support their employees and/or learners. Positive impressions of coaching have contributed to its ubiquitous use. However, to avoid confusion about the aim, approach, and outcomes of coaching, a thorough stakeholder analysis, an intentional organizational design, and a sustainable execution plan are necessary. Faculty and workforce coaching programs are distinct from learner coaching. Workplace coaching has pivoted from a disciplinary, problem-based reaction to a proactive investment in top performers. Coaching has also broadened beyond the C-suite, as a meaningful investment across all workforce layers. A coaching relationship helps high-achieving faculty elevate or sustain performance by having a thinking partner to reflect on situations, values, or vision; analyze and build awareness of needs or gaps; investigate impact factors of actions or inactions; strategize goals, priorities, and timelines; and evaluate decisions and options. Offering coaching as part of contemporary benefits packages signals career-long organizational interest in supporting talent. Coaching for faculty is a versatile and personalized approach to professional development and can be achieved through individualized, group, online, and in-person interactions. Key considerations for planning, launching, redesigning or evaluating a faculty coaching program are outlined, including expected faculty consumers, stakeholder concerns, access, benefits, goals, and outcomes of coaching within an academic medicine environment.

Problem: High-stakes licensing exams such as the USMLE play a critical role in medical education, influencing both trainee progression and patient outcomes. Access to high-quality board preparation resources is uneven and often cost-prohibitive, disproportionately affecting students from underrepresented or financially disadvantaged backgrounds.

Approach: An AI-driven system to generate USMLE-style practice questions aligned with NBME item-writing guidelines using a Large Language Model (LLM) enhanced with retrieval augmented generation (RAG), chain-of-thought and few-shot prompting, and JSON schema validation was developed and piloted at the University of Cincinnati College of Medicine between November and December 2023. Five lectures from a preclinical hematology course were selected, and 565 questions were generated for 177 first-year medical students. A human-in-the-loop process, led by a faculty course director, ensured content validity and adherence to educational standards. Validated questions were deployed via a mobile app, allowing students to practice, receive performance feedback, and access an AI tutor.

Outcomes: Of the 565 questions, 490 (87%) were deemed accurate and NBME-compliant. Eighty students used the question bank, completing up to 220 questions each. Although not statistically significant, increased use trended toward improved performance on related exam questions. Qualitative feedback highlighted enthusiasm for AI-assisted study tools, with calls for broader content coverage.

Next steps: This pilot demonstrates that LLMs can generate high-quality, guideline-aligned practice questions. To improve scalability and reduce faculty workload, future iterations will incorporate AI-based review agents for pre-screening content. The platform is intended to be expanded to additional courses, training phases, and health professions. Ongoing refinement will focus on improving content specificity and maintaining accuracy, especially in advanced and subspecialty education.

Purpose: In 2020, the University of Colorado School of Medicine launched the Community Hospice and Palliative Medicine (CHPM) Fellowship, a part-time, innovative, online fellowship for midcareer physicians. The 3- to 4-year specialty training program, which includes completing a master of science in palliative care, was created to address the increasing need for palliative care physicians in communities with underdeveloped hospice and palliative medicine resources. This model enables fellows to remain in their communities and clinical practices while completing training leading to board certification. Guided by the Kirkpatrick Model, this program evaluation examined the fellows' perceptions of the program's effectiveness as a training model.

Method: In 2023, 10 CHPM Fellowship graduates from the first 2 cohorts were invited to participate in recorded video interviews. Using a deductive rapid qualitative approach informed by the Kirkpatrick Model, investigators analyzed interview data across 4 levels of educational impact: satisfaction, learning, behavior, and results.

Results: Ten graduates were interviewed. Feedback was relevant to all 4 Kirkpatrick Model levels, including program impacts on system changes, typically a challenging level to document. Four major themes emerged: developing self, being in community, feeling confident and competent, and facing challenges. Subthemes highlighted graduates' perceptions of being a palliative care role model and leader, experiencing personal and professional transformation, establishing supportive relationships, feeling supported by interdisciplinary faculty, and mastering diverse palliative care skills. Participants commented on the program's rigor and offered suggestions for including interdisciplinary faculty members in seminars, increasing business and program leadership content, and increasing administrative support.

Conclusions: The CHPM Fellowship demonstrates a promising model for addressing the national palliative care workforce shortage by providing accessible, community-based training for midcareer physicians. As more physicians complete the program and are board eligible, continued evaluation will be important to update content, guide programmatic changes, and improve the online model.