Academic Medicine最新文献

Purpose: Residency selection processes have become increasingly time intensive and complex. This study examined current processes and barriers to the creation and composition of internal medicine clerkship narrative assessments to inform potential improvement opportunities.

Method: Internal medicine clerkship directors (CDs) at US Liaison Committee on Medical Education-accredited medical schools with membership in an academic medicine professional association completed a multithemed annual survey between September 7 and December 6, 2022. The survey explored faculty development for composing narrative assessments, translation of assessments to the Medical Student Performance Evaluation (MSPE) narrative, and practices for editing MSPE evaluations.

Results: Of the 140 CDs sent the survey, 112 responded (response rate, 80.0%). Two CDs who did not complete the entire survey completed this study's section (section response rate, 81.4%). The frameworks reported to assess clinical performance included Accreditation Council for Graduate Medical Education core competencies (84 [73.7%]), Reporter-Interpreter-Manager-Educator (51 [44.7%]), and Entrustable Professional Activities (49 [43.0%]). Fifty-seven CDs (50.0%) review and interpret preceptor comments, 65 (57.1%) select portions of faculty assessments or representative comments, and 24 (21.1%) copy and paste all faculty narrative comments. Most respondents reported that narrative comments described clinical skills to a moderate (60 [52.6%]) or great (52 [45.6%]) extent. Clerkship directors identified assessments that primarily describe teamwork and personal attributes or use code words and global adjectives instead of providing descriptions of observable clinical skills. No associations with school size or grading scheme were identified in a subgroup analysis.

Conclusions: Although responsibility for the end-of-clerkship narrative evaluation belongs mostly to CDs, the processes for creating range from synthesis to administrative copy-paste. Although largely reliant on faculty narrative assessments, CDs reconfirmed inconsistent quality and continued to perceive barriers to faculty development for improvement. Understanding these process similarities, differences, and stressors will help identify opportunities and needs for future improvement efforts.

Purpose: This study explores the relationship between medical students' sense of belonging and perceived learning climate in clerkships, how these perceptions vary across clinical departments, and how students describe the interplay between belonging and learning climate.

Method: A mixed-methods approach with an explanatory sequential design was used among medical students at Maastricht University. Quantitative data from 6,434 program evaluation questionnaires completed between December 2014 and January 2020 were retrospectively analyzed to assess the relationship between belongingness and learning climate. Thematic analysis of narrative questionnaire responses and one focus group provided further insights into students' experiences. Data were integrated at the analytic and interpretation stages toward a conceptual model.

Results: The mean (SD) belongingness score was 3.90 (1.13). The mean (SD) learning climate score was 7.62 (1.72). A positive correlation between belongingness and learning climate was found (r = 0.693, P < .001). Significant differences were observed among clinical departments, with the family medicine department scoring highest on both measures. Having a meaningful role enabled by various stakeholders, such as residents, nurses, and consultants, was identified as key to enhancing both belongingness and learning climate. Students conceptualized a meaningful role as being allowed active participation in patient care and having genuine interest shown in them.

Conclusions: Students' sense of belonging and perceived learning climate are closely intertwined and shaped by the degree to which students are given meaningful roles in clinical practice. This underscores the importance of intentional engagement strategies by the broader health care team and educational administrators to foster an inclusive educational environment and promote active student participation. Roster planning can support this by scheduling learning opportunities. Faculty development should focus on supporting student learning, fostering personal engagement and open dialogue, and providing meaningful feedback. Students themselves are encouraged to actively seek meaningful ways to contribute in clinical settings.

The success of early-career faculty at R1 research-intensive institutions depends on institutions' ability to establish an independent, grant-funded research program in a highly competitive funding environment in which only 2,174 of 11,463 National Institutes of Health (NIH) applications (19%) submitted by early-stage investigators were funded in 2023. This report summarizes outcomes of early-career faculty enrolled in the University of California San Diego Health Sciences Grant Writing Course (GWC), which provided a structured, step-by-step, multicomponent experience focused on preparing a competitive grant proposal. The program evaluation includes effects on grant submission and funding rates and grant-writing self-efficacy after 2 years of follow-up. Eighty-five early-career faculty members were enrolled in the GWC from 2017 to 2021, including 48 (56%) MD and MD-PhD physicians, 37 (44%) PhD faculty, 45 (53%) women, and 15 (18%) self-identifying as being from underrepresented racial or ethnic backgrounds. Data from 82 participants (98%) at 12 or 24 months were used for grant outcomes, and 75 participants (88%) with 12- and 24-month data were used in the self-efficacy analysis. Seventy-one participants (87%) submitted their course proposal, and 79 (96%) submitted at least one grant application by the 2-year follow-up. Thirty-three GWC proposals (40%) were funded, and 65 participants (79%) received at least one grant as principal investigator or multiple principal investigator since taking the course. Success rates were equal for men (26 [79%]) and women (34 [79%]) and highest (12 [86%]) for underrepresented faculty. Of the funded proposals, 49 (30%) were NIH R01, R01-equivalent, or R21 awards. Underrepresented participants had the highest (19 [48%]) success rate. Participants' confidence in the 19 grant-writing skills inventory increased overall. The GWC is a highly effective and innovative program for improving grant-writing success of early-career, women, and underrepresented faculty in academic medicine.

Purpose: Scholarship on psychological safety (PS) in medicine has focused on improving patient safety on interprofessional teams. In medical education, PS literature has focused on the role of PS in simulation and on undergraduate medical education learners. However, less is written about the role of PS in shaping the learning of graduate medical education (GME) trainees. As a step toward better understanding the relationship between PS and the GME clinical learning environment (CLE), the authors conducted a scoping review exploring the phenomenon of PS in the CLE for GME learners.

Method: The authors used Arksey and O'Malley's 5-step framework: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting results. The authors included Levac's sixth step-consulting with key informants. The authors searched PubMed, Scopus, Web of Science, Embase, and PsychInfo in November 2022 and again in February 2025 for peer-reviewed English-language articles published from database inception to the search date using broad search terms designed to include all works discussing PS in the CLE. They developed an extraction tool to catalog search results and used thematic analysis to code and thematically cluster findings.

Results: After screening 1,234 articles, 44 articles published from 2014 to 2025 met criteria for inclusion, of which 28 were original research. Findings clustered around 3 roles for PS: (1) a foundational component of trainee well-being and learning, (2) a proxy for residents' satisfaction with their CLE, and (3) a hallmark of successful teaching or supervisory behaviors.

Conclusions: Works in this review correlate the presence of PS with trainee well-being, resident learning, and supervisory behaviors; however, significant gaps remain in the literature regarding the specifics of how PS can and should be created for GME trainees, particularly for marginalized individuals.

Purpose: Knowledge about death, dying, loss, grief, and end-of-life care is an essential skill for physicians. However, end-of-life education is often incorporated into medical school curricula in the United States as electives. This scoping review explores the current empirical literature on how death and dying is taught in U.S. medical schools to identify evidence-based teaching practices and areas of opportunities to enhance death and dying education for future physicians.

Method: The authors conducted a systematic scoping review in PubMed and EMBASE, using PRISMA-ScR guidelines, of articles focused on death and dying education conducted in a U.S. MD-granting medical school setting between January 2010 and April 2025. Successive reviews of the titles, abstracts, and full texts were performed, as well as forward and backward citation searches. The initial search yielded 4,959 records; ultimately, the analytic sample for this review was 43 articles.

Results: Overall, the 43 included articles described significant variation in how death and dying is taught in medical schools. Twenty-one studies used quantitative methodologies, 13 used qualitative methodologies, and 9 used mixed or multiple methods. In line with competency-based medical education standards, the authors organize the findings around the knowledge, skills, and abilities model. Over half of the articles (n = 25) emphasized knowledge acquisition, 22 integrated skills-based components, and 28 addressed the assessment of abilities. Simulation training was common within skills-based interventions.

Conclusions: There remains a sizeable gap in evidence-based medical education related to knowledge, skills, and abilities pertaining to end-of-life care. The authors offer next steps for developing, implementing, and measuring evidence-based interventions to improve end-of-life care competency. The authors advocate for continued implementation of evidence-based educational interventions, regardless of anticipated specialty area, throughout all preclinical and clinical years.

In the context of the increasing number of health care mergers, bridging institutional cultures is critical to successful outcomes. Using the Massachusetts General Hospital (MGH) and Brigham and Women's Hospital (BWH) as a case study, this article discusses cultural challenges during a 30-year history from an initial merger that only combined corporate and administrative functions (Partners HealthCare) to one that is currently mandating comprehensive clinical integration (renamed Mass General Brigham [MGB]). Although the ultimate success of this strategy will take years to evaluate, the cultures of the old MGH and BWH have not yet been effectively bridged to the new MGB. A thoughtful, sustained investment in bridging these cultural divides could still strengthen alignment and help realize the long-term goals of merging these 2 academic medical centers.

Problem: California faces a physician workforce crisis: an aging physician population that lacks representation from socioeconomically disadvantaged and underrepresented racial and ethnic communities. Given physician practice patterns, this discrepancy severely impacts millions of Californians. In response, the California Future Health Workforce Commission issued recommendations to enhance workforce diversity, emphasizing the importance of expanding access to educational pathways in order to build a workforce more representative of the state and its needs.

Approach: In 2021, Senate Bill 40, proposed by Sen. Melissa Hurtado, D-14, paved the way for the establishment of the California Medicine Scholars Program (CMSP). CMSP takes a pioneering approach by focusing on community colleges as critical entry points for aspiring medical professionals. This strategic initiative involves forming Regional Hubs of Healthcare Opportunity (RHHO) that connect medical schools, community colleges, 4-year universities, and health systems to facilitate student mentorship, academic advising, and early exposure to health care environments. The program aims to create a scalable, systematic pathway for community college students, leveraging their unique educational experiences to better serve California's diverse populations.

Outcomes: Initial outcomes indicate promising engagement and interest, with 399 scholars enrolled across 4 RHHO regions since the 2022-2023 academic year, including significant representation from underrepresented groups and first-generation college students. As of the 2023-2024 academic year, 150 scholars have successfully been admitted to a 4-year university-the first major academic milestone on the pathway to medical school. However, challenges remain, such as limited partnerships with community colleges and funding to expand to additional regions.

Next steps: Future steps include targeted outreach to additional community colleges and ongoing evaluations of educational outcomes and student experiences to refine and enhance program effectiveness. By addressing these gaps, CMSP aims to create a more equitable pathway into medicine that aligns with California's health care needs and workforce diversity goals.

Mission-aligned selection and retention (formerly holistic review) offers an approach to selection that considers applicants' academic metrics, attributes, and experiences to assess job-related competencies and mission-aligned characteristics. Despite residency programs' interest in mission-aligned review, the current application context presents barriers. Designed when applicants submitted more manageable numbers of applications, the Electronic Residency Application Service (ERAS) application was not designed to support mission-aligned review amid high application volumes. It lacked sufficient structure to guide applicants to provide relevant, valuable information, leaving programs to over-rely on academic metrics rather than broader evaluations of applicants' qualifications. It also did not provide a formal process for applicants to indicate genuine interest in a program or location, unintentionally leading programs to draw inferences and rely on informal communications, introducing inequities into the application process. To address these challenges, in 2021, the Association of American Medical Colleges (AAMC) sought to streamline and restructure the ERAS application to guide applicants to provide meaningful content and support programs' mission-aligned review. The AAMC also leveraged the application to provide a formal, standardized process for applicants to indicate genuine interest and for programs to identify applicants interested in their programs and communities. The AAMC updated the experiences section (limited experiences to 10 and added structured experience information), added an optional impactful experiences essay question, and added geographic preferences and program signaling. Evaluation results from the 2022-2023 and 2023-2024 cycles show these changes may improve programs' ability to conduct effective and efficient mission-aligned review and may improve fairness in the selection process. This article discusses how changes to the ERAS application seek to promote mission-aligned review and fairness in residency selection, helping programs identify capable, mission-aligned applicants. It also discusses opportunities for further research and calls for ongoing evaluation of the ERAS application by the AAMC to support continuous improvement.