Academic Medicine最新文献

Research in health professions education (HPE) is often executed by teams-groups of individuals working together to solve a problem, reconceptualize an issue, or conduct a study. Teams frequently involve individuals from different disciplinary backgrounds or professions1,2 who work collaboratively to accomplish specific scholarly goals. Matching team composition to research goals is critical for ensuring the team has the skills and perspectives necessary to generate, integrate, and mobilize the desired knowledge. Drawing on literature,3,4 we describe the who, what, how, and when of 4 types of research teams.

Purpose: State medical boards are charged through their medical practice acts to regulate physician practice and, when necessary, discipline physicians for incompetent or inappropriate behavior. Boards often authorize remedial continuing medical education (CME) as part of a disciplinary action; however, it is unclear how effective remedial CME is in reducing the likelihood of physicians receiving additional discipline. This study examined the relationship between physicians who were required to complete remedial CME as part of their first discipline by state medical boards and the likelihood of additional discipline.

Method: The national-level sample included 4,061 MD-physicians whose first discipline included license restrictions, probation, or other conditions imposed by state medical boards between 2011 and 2015. A multivariate logistic regression model examined whether physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by boards within 5 years.

Results: Of the 4,061 physicians, 36% (n = 1,449) were required to complete remedial CME as part of their first discipline, and 35% (n = 1,426) received additional discipline within 5 years. After accounting for other factors, physicians who were required to complete remedial CME as part of their first discipline by boards were less likely to receive additional discipline (odds ratio, 0.597; 95% confidence interval, 0.513-0.696; P < .001) within 5 years compared to physicians who were not required to complete remedial CME.

Conclusions: Findings support remedial CME as a means to help reduce physician disciplinary recidivism in certain circumstances. Physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by state medical boards within 5 years.

Purpose: Little is known about the clinical knowledge and skills that are acquired by physicians through teaching, how such learning occurs, or the factors that influence this process. This study explored how physicians acquire clinical knowledge and skills through clinical teaching and examined the contextual elements that influence this learning.

Method: Two theoretical frameworks informed this interpretive description study: situated learning and cognitive apprenticeship. From March to November 2021, semistructured interviews and follow-up discussions were conducted at McGill University with clinician-teachers who regularly supervise internal medicine residents. Participants were asked to describe how they learned clinical medicine through spontaneous clinical teaching, guided by questions relating to what they learned, memorable teaching moments, and factors influencing this learning. Data were analyzed iteratively, using both a deductive and inductive approach.

Results: Of the 87 contacted physicians, 45 responded, expressing interest (n = 22) or declining participation (n = 23), and 42 did not respond. All 22 clinicians who responded positively were interviewed, with 7 follow-up discussions. Results suggested that clinician-teachers encountered myriad opportunities to learn clinical medicine during spontaneous interactions with trainees. These interactions, embedded in authentic patient care, were influenced by clinician-teacher characteristics, trainee characteristics, and contextual affordances. Clinician-teachers were stimulated to learn by trainee presence and through discrete interactions with trainees. These stimuli often led to feelings of "performative pressure" to role model and teach effectively or "slowing down" in thinking, prompting clinician-teachers to engage in learning processes (e.g., reflection, collaboration, and articulation), which resulted in knowledge acquisition, reinforcement, and refinement.

Conclusions: Learning through teaching is an underappreciated strategy that can help clinician-teachers improve their clinical knowledge and skills. This study uncovered some of the processes through which clinicians learn during spontaneous clinical teaching and the factors that modulate this learning.

Problem: High-stakes multiple-choice question (MCQ) exams in medical education typically focus on assessment of learning at a single point without providing feedback for improvement. Educators can achieve a more balanced approach to MCQ exams by combining efficient assessment of learning with the feedback and improvement opportunities of assessment for learning.

Approach: As part of a curriculum renewal at Baylor College of Medicine's MD program, the Two-Phase Individual Assessment (TPIA) model was launched within a 4-week preclinical Foundations of Medicine course in August 2023. The TPIA model featured weekly assessments, each consisting of 2 MCQ exams given on the same day with a 4-hour study period in between. Exams were paired, consisting of an equal number of items that addressed the same learning objectives. After the initial exam, students received an individualized feedback report indicating correctly and incorrectly answered objectives. Students applied individualized feedback reports to self-identify and remediate deficiencies in preparation for the second-chance exam. Only the highest score counted toward the final grade.

Outcomes: Among 230 medical student participants, significant performance improvements between morning and afternoon exams were observed across the first 3 weekly TPIAs, with mean score increases of 4.93, 5.06, and 10.86. Mean change in performance in week 4 was not significant. Student end-of-course survey responses indicated a strong preference for the TPIA format. Responses highlighted the value of offering individualized feedback, unstructured time to address knowledge gaps, and a corresponding opportunity for improvement.

Next steps: Future research will extend TPIA's implementation in more clinical-oriented courses to validate TPIA's effectiveness and explore its effect on long-term knowledge retention through more cumulative examinations. Integrating TPIA-based approaches may advance educational systems toward developing a culture of feedback literacy and embracing second chances to support learning and professional growth.

Purpose: Competency-based time-variable (CBTV) graduate medical education (GME) has been implemented in Canada, Europe, and the United States, yet its perceived value has not been explored. Promotion in Place (PIP) is a CBTV GME program in which residents graduating early advance to attending status with "sheltered independence" until the standard graduation date. This study describes perceived value of CBTV GME and PIP at Mass General Brigham by capturing diverse stakeholder perspectives.

Method: In this stakeholder analysis using semistructured interviews (June 2022-August 2023), 49 participants were invited (44 representative members and 5 external stakeholders) from 11 GME programs: PIP eligible residents, program directors (PDs), chairs, service chiefs, and external national medical education organization leaders. Authors' understanding of value was informed by Harvey and Green's conceptualization of quality in higher education as "fit for purpose," "standards monitoring," "transformation," and "value for the money." Deductive codes and inductive subcodes captured diverse perspectives of value.

Results: Of the 49 invited stakeholders, 34 (69%) were interviewed across 5 stakeholder groups. Nearly all groups cited aspects of PIP that are "fit for purpose" as evidence of value; PIP supported "workforce readiness" and provided "sheltered independence" as intended. External stakeholders, PDs, service chiefs, hospital leadership, and faculty cited value aligning with "standards monitoring" (e.g., PIP must maintain or improve patient and resident outcomes). Nearly all groups cited aspects of PIP aligning with "transformation" as evidence of value. PIP promoted "independent decision-making" and enhanced trainee confidence. Chairs cited aspects of PIP aligning with "value for the money" (e.g., "cost neutral" as optimal for sustainability and avoidance of "hidden costs" such as assessment burden).

Conclusions: Understanding perceptions of PIP and CBTV GME value is critical to engaging diverse stakeholders and extending CBTV GME to more programs and specialties. PIP's transformative nature underscores the added value of CBTV GME.

Purpose: Internal medicine (IM) residency programs with clinician educator tracks (CETs) have increased during the past decade; however, no standardized list of learning domains and competencies exist. The authors use a modified Delphi approach to determine a consensus set of teaching skills for IM CET residents.

Method: A CET teaching skills list was developed from June to August 2023 via a PubMed search through July 31, 2023, by University of Pittsburgh faculty physicians. Seventy-seven potential participants were identified through professional society listservs and publications. Between January and February 2024, participants (current or former CET directors within an IM residency program) iteratively ranked teaching skills based on importance for IM CET residents from 1 (less important) to 4 (most important) for 2 online surveys. Consensus was defined a priori as 80% agreement or higher that a skill is important or most important. Participants identified the most appropriate training level for each skill and the most critical teaching skills for CET residents.

Results: Forty-one experts participated, with 31 (76%) completing both surveys. Of the 29 teaching skills in round 1, 12 achieved consensus as important. In round 2 (24 teaching skills), 5 additional teaching skills achieved consensus as important. Panelists ranked the most critical teaching skills for CET residents: teaching in different settings, communicating feedback, fostering a conducive learning climate, teaching across different learner levels, creating learning goals and objectives, and developing and delivering effective chalk talks.

Conclusions: This study offers national consensus on a prioritized list of teaching skills for IM CET residents. Consensus skills were foundational and intentional, important for all deliberate educators, and aligned with 2 CE milestone subcompetencies (universal pillars and educational theory and practice). Nonconsensus skills were generally more advanced. Current and aspiring CET leadership can leverage these recommendations to develop and critically appraise CET curricula.

Purpose: Near-peer teaching is a vital teaching resource in most medical schools, but little is known about the comparative benefits of near-peers and faculty teaching or the learning mechanisms that underlie them. This study explored near-peers' and students' perceptions of differences between the way near-peers and faculty teach practical skills.

Method: Using qualitative methods, the authors conducted 4 focus groups with near-peers (n = 22) and 4 focus groups with students (n = 26, years 3-6) at the University of Bern, Bern, Switzerland, between September and December 2022. All participants recently participated in near-peer skills training. Vignettes of typical teaching situations guided the focus group discussions. The reflexive thematic analysis was both inductive and deductive; cognitive apprenticeship teaching methods informed the deductive analysis.

Results: Three major areas of difference were identified in near-peers and faculty skills teaching methods: (1) learning climate, (2) teaching orientation, and (3) reaction to identified competence gaps and students' questions. Near-peers were perceived to establish a safer learning climate than faculty, lowering the threshold to ask questions. Near-peer teaching was oriented toward the formal curriculum and students' learning needs, resulting in more tailored explanations focused on examination-relevant content. Faculty oriented their teaching toward clinical practice, which helped students transition to clinical practice but could overwhelm novice students. Faculty better stimulated students to think critically about unanswered questions and how to fill their competence gaps.

Conclusions: Skills teaching by near-peers and faculty differed in teaching climate and orientation. Near-peers saw students as learners, focused on the learning climate and on students' needs. Faculty saw students as future physicians and facilitated the transition from curricular learning to clinical practice. Curricular design should capitalize on the complementary benefits of near-peer and faculty skills instructors and seek to get the best of both worlds.

Purpose: Undergraduate medical education (UME) to graduate medical education (GME) transition gaps may limit opportunities for learner improvement along each individual's learning trajectory. Additional information regarding learner perspectives on skill-based learning goals in preparation for the residency transition is needed. The authors hypothesized that fourth-year medical student (MS4) learning plans may provide information to fill the gap in understanding learner perspectives on the knowledge, skills, and opportunities they consider important in supporting their residency readiness.

Method: Directed thematic analysis informed by a constructivist analytical approach was used to review readiness for residency reflections as part of a portfolio assessment system at a large, urban, research-intensive medical school during academic years 2021 and 2022. The authors identified student-selected Accreditation Council for Graduate Medical Education (ACGME) competencies and subcompetencies, iteratively identified non-subcompetency-based themes, refined the codes, and achieved consensus. They then analyzed the frequency of competencies and subcompetencies within learner reflections and explored additional themes.

Results: In the final set of 291 reflections, the ACGME competencies selected for MS4 learning plans were patient care (227 learning plans), medical knowledge (144 learning plans), interpersonal and communication skills (94 learning plans), practice-based learning and improvement (79 learning plans), system-based practice (67 learning plans), and professionalism (63 learning plans). The top 3 ACGME subcompetencies identified as growth areas by MS4s were practice-based learning and improvement: evidence-based and informed practice, patient care: clinical reasoning, and interpersonal and communication skills: interprofessional and team communication. Teaching was the most common learning goal outside the ACGME subcompetencies.

Conclusions: The MS4 readiness for residency reflections offered important insight into student perspectives on UME to GME transition preparation. Learners' reflections yielded a diverse set of learning goals for the fourth year of medical school, highlighting the importance of individualized approaches in addition to standardized curricula at the time of transition.