Academic Medicine最新文献

Abstract: Medical education is a complex field involving interacting contexts of settings, individuals, and institutional culture. Understanding how contexts interact is important for the applicability of research findings. In this article, the authors describe contexts highlighted in this year's Research in Medical Education articles related to being and belonging, the definition of medical education, assessment and feedback, and learning and climate. The authors summarize the various contexts and examine implications for the medical education research community.

Purpose: Accelerated 3-year programs (A3YPs) at medical schools were developed to address student debt and mitigate workforce shortage issues. This study investigated whether medical school length (3 vs 4 years) was associated with early residency performance. The primary research question was as follows: Are the Accreditation Council for Graduate Medical Education Milestones (MS) attained by A3YP graduates comparable to graduates of traditional 4-year programs (T4YPs) at 6 and 12 months into internship?

Method: The MS data from students entering U.S. medical schools in 2021 and 2022 from the 6 largest specialties were used: emergency medicine, family medicine, internal medicine, general surgery, psychiatry, and pediatrics. Three-year and 4-year graduates were matched for analysis (2,899 matched learners: 182 in A3YPs and 2,717 in T4YPs). The study used a noninferiority study design to examine data trends between the study cohort (A3YP) and control cohort (T4YP). To account for medical school and residency program effects, the authors used cross-classified random-effects regression to account for clustering and estimate group differences.

Results: The mean Harmonized MS ratings for the midyear and end-year reporting periods showed no significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = 0.01 [0.02], P = .77). Mean MS ratings across internal medicine MS for the midyear and end-year reporting periods showed no significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = -0.03 [0.03], P = .31). Similarly, for family medicine, there were no statistically significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = 0.01 [0.02], P = .96).

Conclusions: For the specialties studied, there were no significant differences in MS performance between 3-year and 4-year graduates at 6 and 12 months into internship. These results support comparable efficacy of A3YPs in preparing medical students for residency.

Abstract: Despite predictions that the United States will experience a growing physician shortage in the coming decades, there remains a population of would-be clinicians who are barred from becoming licensed physicians because of their immigration status. Undocumented medical students who do not have DACA have to overcome many barriers to gain admittance to medical school, but because they lack work authorization in the United States, they are unable to enter residency training. In this article, the authors highlight the implications of this dilemma for academic medicine. After detailing the experiences of an undocumented medical student, they examine the historical and policy background of this barrier to licensure and board certification. The authors consider the most immediate option available to academic medical institutions: to create a viable training program that is an alternative to residency. Such an alternative training program would need to be equivalent in quality to an accredited residency program and enable its trainees to become board-certified but not be a form of employment. Finally, the authors conclude with a call for academic medicine to engage in advocacy in support of legislative solutions for undocumented young people.

Abstract: During and following the COVID-19 pandemic, the world experienced a significant increase in the prevalence of mental health problems along with a concomitant increase in mental health service utilization rates. Even though the stigma associated with mental health problems has been decreasing and service utilization rates have increased, these have not been seen in all segments of the population; for instance, some religious beliefs have been associated with less frequent and lower rates of mental health service use. In this commentary, the authors, an academic psychiatrist and a community-based pastor, describe how their informal academic-community collaboration led to a series of speaking opportunities to help an international group of clergy members develop a better understanding of mental health and how mental health problems may intersect with faith. They reflect on lessons learned from these opportunities and their professions, discuss opportunities for academic faculty to apply these lessons in their daily practices, and encourage academic faculty to consider a "common ground" approach in their own community outreach efforts. The authors underscore the importance of building connections with people who might have beliefs, views, or understandings of medical concepts that differ from academic medicine's and of teaching trainees how to build these connections. They challenge individual clinicians and academic faculty to identify spheres of influence that they have in their own lives through which they can create a positive impact for medicine and public health by finding shared experiences and common ground, clarifying misunderstandings, educating where needed, and serving as role models to encourage trainees to do the same.

Purpose: High-ranking educational leaders in academic medicine oversee multiple clinical programs. This requires them to prioritize dozens of emergent tasks and responsibilities daily, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Identifying their key responsibilities and frequently used skills and competencies may clarify the educational needs of senior educational leaders and facilitate targeted professional development to promote effective and efficient performance.

Method: In August 2022 researchers interviewed 12 designated education officers (DEOs) from U.S. Department of Veterans Affairs (VA) Veterans Health Administration medical centers about their daily work and most challenging responsibilities. Content analysis of interview transcripts identified key responsibilities and activities identified by participants and prioritization of the perceived skills needed to complete them.

Results: Participants emphasized 4 key areas of responsibility: fiscal, administrative, affiliate partnership, and educational duties. They identified 12 skills as baseline requirements for effective performance for which additional professional development would be useful and suggested that both new and more established educational leaders receive targeted professional development and mentoring to foster these capacities.

Conclusions: The key skills participants identified by area of perceived responsibility are relevant to VA DEOs, designated institutional officers, and senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. Structured orientation programs and ongoing professional development for senior educational leaders could emphasize these areas of responsibility, potentially enriching DEOs' performance and reducing burnout.

Purpose: Medical training institutions worldwide must be prepared to remediate struggling learners, but there is little empirical evidence around learners' perspectives on remediation efforts. Research shows that emotion has a significant effect on learning, but it has not been well studied in remediation in medical education. Given the high stakes of remediation, understanding more about learners' emotional experience could lead to improvements in remediation programs. This study aimed to explore medical students' emotional experience of failure and remediation to offer opportunities to improve remediation.

Method: This study is a thematic analysis of data collected from July to September 2022 from one-to-one interviews with students from 4 institutions (2 in the United States and 2 in the Netherlands) who had not met expectations on 1 or more medical school assessment(s). Interview questions explored students' experiences with learning of and responding to a performance that was below expected standards, with probes around any mentions of emotions.

Results: Fourteen students participated: 9 from schools in the United States and 5 from schools in the Netherlands. The students perceived the failure and remediation event to be highly significant, reflecting negatively on their suitability for a career as a physician. We identified 5 themes: (1) shame was pervasive and only retrospectively perceived as unwarranted; (2) self-doubt was common and weighty; (3) resentment, blame, and other external-facing emotions were present but softened over time; (4) worry and stress related to perceived career effect differed across countries; and (5) students had mixed emotional reactions to the remediation process.

Conclusions: Medical students have strong emotional responses to failure and remediation. Expecting and considering emotions such as shame, self-doubt, and anger could help educators design better remediation programs. Differences across countries may be at least partially explained by different degrees of time variability and flexibility within the curricula.

Purpose: Medical education initiatives incorporate arts and humanities (AHs) to foster physician competence and professionalism. However, the full potential of these initiatives is unclear. A recent conceptual framework attempts to clarify this potential but was constructed primarily from undergraduate medical education studies. To explore AHs instruction in graduate medical education, the authors asked: What is the potential of a longitudinal curriculum incorporating AHs for the personal and professional development of internal medicine interns throughout the intern year?

Method: From September 2021 to June 2022, 14 internal medicine interns at a large internal medical residency program participated in a longitudinal qualitative study, recording longitudinal audio-diaries (LADs) and participating in semistructured interviews. The LAD response rate was 91%, and the interview completion rate was 96%. The authors identified 3 themes that reflected shared meaning on the transformative potential of AHs: reclaiming personal sense of self, building community, and surfacing empathy. They constructed stories from 2 interns whose trajectories resonated most with AHs instruction's potential for personal and professional development.

Results: Interns valued the abstract over the concrete benefits of AHs. Interns detailed valuable abstract benefits, with reclaiming sense of self, building community, and surfacing empathy apparent across time, pointing to long-term effects of AHs interventions. The intern stories revealed a steady appreciation for AHs and difficulty with the practical utility of AHs midyear before a return to recognition of its value by year's end.

Conclusions: Despite varying AHs experience levels, interns consistently appreciated AHs instruction. These findings extend a prior conceptual model to a graduate medical education population by highlighting AHs instruction's potential for reclaiming interns' senses of self, building community, and surfacing empathy. Future curricula can leverage this ability to create meaningful connections with one's purpose, peers, and patients to maximize the potential of AHs instruction for graduate medical education learners.

Purpose: Students with disabilities have inequitable access to medical education, despite widespread attention to their inclusion. Although systemic barriers and their adverse effects on medical student performance are well documented, few studies include disabled students' first-person accounts. Existing first-person accounts are limited by their focus predominantly on students who used accommodations. This study bridged these gaps by analyzing a national dataset of medical students with disabilities to understand their perceptions of disability inclusion in U.S. medical education.

Method: The authors analyzed 674 open-text responses by students with disabilities from the 2019 and 2020 Association of American Medical Colleges Year Two Questionnaire responding to the prompt, "Use the space below if you would like to share anything about your experiences regarding disability and medical school." Following reflexive thematic analysis principles, the authors coded the data using an inductive semantic approach to develop and refine themes. The authors used the political-relational model of disability to interpret themes.

Results: Student responses were wide-ranging in experience. The authors identified key dimensions of the medical education system that influenced student experiences: program structure, processes, people, and culture. These dimensions informed the changes students perceived as possible to support their access to education and whether pursuing such change would be acceptable. In turn, students took action to navigate the system, using administrative, social, and internal mechanisms to manage disability.

Conclusions: Key dimensions of medical school affect student experiences of and interactions with disability inclusion, demonstrating the political-relational production of disability. Findings confirm earlier studies on disability inclusion that suggest systemic change is necessary, while adding depth to understand how and why students do not pursue accommodations. On the basis of student accounts, the authors identify existing resources to help medical schools remedy deficits in their systems to improve their disability inclusion practice.