Academic Medicine最新文献

Purpose: Researchers extensively studied burnout in the medical profession; however, findings on gender differences have remained inconsistent. Understanding well-being disparities between male and female resident physicians is essential for providing appropriate support and fostering a sustainable medical workforce. This study examined gender differences in burnout, depression, job stress, and job satisfaction among Japanese resident physicians in their first and second postgraduate years.

Method: The authors conducted a nationwide, cross-sectional study using data from the 2022 General Medicine In-Training Examination (GM-ITE). The analysis included resident physicians who completed the GM-ITE; it assessed burnout, job stress, and job satisfaction using single items from the Mini-Z 2.0 on a five-point Likert scale, and measured depression using the Japanese version of the Patient Health Questionnaire-2. This study categorized gender as male or female and estimated prevalence ratios (PRs) for well-being outcomes using clustered log-linear modified Poisson regression models.

Results: The final analysis included 5812 residents, of whom 31.8% were female. Compared with male residents, female residents were younger, less likely to pursue high-workload specialties, and reported fewer working hours, emergency duties, and self-study time. Well-being outcomes revealed that 17.9% experienced burnout, 29.5% reported depressive symptoms, 39.0% experienced high job stress, and 66.6% reported job satisfaction. Multivariable analysis indicated that female residents were significantly less likely to experience burnout (PR = 0.74; 95% CI, 0.65-0.84) and more likely to report job satisfaction (PR = 1.10; 95% CI, 1.05-1.13). Gender differences in depressive symptoms and high job stress were not significant.

Conclusions: Female residents in Japan experienced lower burnout rates and higher job satisfaction than their male counterparts. These findings challenged assumptions that female gender universally correlates with poor occupational well-being outcomes in the medical field and underscored the need for gender-sensitive support strategies.

Problem: Professional and graduate students face unique challenges predisposing them to food insecurity, which impacts health and wellness. Lack of research and data on the barriers to food accessibility, availability, utilization, and stability impedes developing and implementing effective initiatives addressing student food insecurity.

Approach: A medical student champion at the Perelman School of Medicine, University of Pennsylvania, partnered with a community organization in Philadelphia to run 18 weekly produce pop-ups in the 2023 to 2024 academic year to target student food insecurity. The weekly events decreased food waste and repurposed surplus food to increase the availability of fresh fruits and vegetables to students. This medical student-driven initiative depended on student volunteers to advertise the events, pick up the produce, and set up and clean up the produce pop-ups. Produce pop-up attendees completed an anonymous survey containing discrete and open-ended questions, with more than 1000 survey responses. The student champion worked with faculty to evaluate the questionnaire responses and analyze the feedback on the events to understand the challenges students may face.

Outcomes: Analysis of 1080 responses revealed that professional and graduate students attending produce pop-ups face significant barriers to food accessibility, availability, utilization, and stability. Produce pop-ups increase access to fresh fruits and vegetables, improve student physical and mental health, and decrease food waste. By offering fresh fruits and vegetables to students, produce pop-ups facilitated at-home cooking and healthy eating, empowered students to try new and varied recipes, and increased sharing and socialization. Students reported tangible improvements in wellness from attending produce pop-ups.

Next steps: Produce pop-ups offer an innovative solution to provide fresh food to students and improve student health and wellness. Academic institutions should consider tracking the prevalence of food insecurity among their students and partnering with community organizations to repurpose excess produce to combat food insecurity.

Problem: Substance use disorders (SUDs) are widespread, yet few individuals receive treatment. Internal medicine (IM) residents need clinical training on how to provide SUD treatment.

Approach: In 2023, the authors used a structured approach to develop an addiction clinic integrated into the University of Cincinnati IM resident primary care practice to provide SUD treatment. A formative logic model with output measures to evaluate the short-term outcome of the first 15 weeks of clinic was used. Output measures included no-show rates, number of patient visits, and primary SUD diagnosis. Short-term outcomes of residents' experiences were evaluated using a retrospective pre-post survey and the McNemar paired test to assess their confidence in performing addiction-related clinical tasks before vs after their rotation.

Outcomes: Eighteen learners were sent a survey from December 2023 to March 2024, with 11 responding (61%). Short-term outcomes included resident-reported confidence as moderate, quite, or extremely confident in the listed tasks before vs after their clinic experiences: making an SUD diagnosis (4 [36%] vs. 10 [91%], P = .03), interpreting urine drug screen results (4 [36%] vs. 10 [91%], P = .03), starting buprenorphine for opioid use disorder (OUD) (1 [9%] vs. 8 [73%], P = .02), titrating buprenorphine for OUD (0 [0%] vs. 8 [73%], P = .01), starting medications for alcohol use disorder (4 [36%] vs. 7 [64%], P = .36), and harm reduction counseling (4 [36%] vs. 9 [82%], P = .06). In the first 15 weeks of this clinic, there were 73 patient visits. Primary SUD diagnoses were OUD (37 [51%]), alcohol use disorder (18 [25%]), other (7 [9%]), stimulant use disorder (6 [8%]), and nicotine (5 [7%]).

Next steps: Next steps include further evaluation of the clinic rotation's impact on resident clinical behaviors, attitudes on SUD, and patient SUD outcomes.

Numerous studies have shown that medical learners experience poorer wellbeing than their counterparts in the general population. Over the last decade, medical learner wellbeing has become front-of-mind for educators and administrators, which has helped drive systematic improvements in learning and working environments. However, as awareness has grown on the importance of learner wellbeing, a parallel narrative has emerged that questions whether these initiatives are impacting the development of medical competency. In this article, the authors argue that the false dichotomy of wellbeing vs competency stems from a historical medical culture that prized self-sacrifice and "toughness" as markers of competence. There is no doubt that professional growth in medicine requires elements of discomfort and uncertainty. However, the line between productive stress and harm has historically been blurred and pushed by medical training. This culture of "toughness" consequently reinforces a harmful hidden curriculum that dissuades learners from raising appropriate concerns about excessive workloads and mistreatment. However, the evidence is clear that enhanced learner wellbeing promotes competency and patient safety, rather than detracts from it. The authors, therefore, propose a set of actionable steps to support both the personal health and professional development of learners. This includes distinguishing between necessary and unnecessary discomfort, integrating wellbeing into continuous quality improvement, fostering open and safe dialogue between learners and faculty, as well as committing to a cultural shift in medical education that embeds wellbeing into structural systems and policies. Through recognizing wellbeing as an integral part of competency, learners can be supported to become highly skilled, resilient, and compassionate members of the health workforce. Teaser: Medical learner wellbeing is no longer a fringe concern-it is central to how we train competent, safe physicians. Yet as wellbeing initiatives have expanded, a worry has emerged: are we coddling learners at the expense of rigor? This article challenges that framing by arguing that the perceived trade-off between wellbeing and competency is a false dichotomy rooted in a culture that equates self-sacrifice and "toughness" with excellence. While growth in medicine inevitably involves discomfort and uncertainty, the boundary between productive challenge and preventable harm has historically been blurred, fueling a hidden curriculum that normalizes excessive workloads, silences learners, and undermines safety. Drawing on growing evidence, the authors show that supporting learner wellbeing strengthens-not weakens-competency and patient care. They propose concrete, actionable strategies to align wellbeing with professional development. Reframing wellbeing as foundational to competency is essential to developing skilled, resilient, and compassionate clinicians.

Purpose: Clinician burnout is a health care crisis, especially for medical trainees, with few evidence-based curricula on durable resiliency skills. The researchers hypothesize that a curriculum fostering uncertainty tolerance, self-compassion, and adaptive thinking can enhance medical students' resilience. Applied improvisation, derived from the principles of unscripted, collaborative theater, has been used to strengthen clinicians' interpersonal and communication skills. This study investigates the potential impact of improvisation-based training on medical students' capacity to tolerate uncertainty, cultivate self-awareness, and build resilience.

Method: All first-year medical students at The University of Arizona College of Medicine-Phoenix attended four 3-hour mandatory applied improvisation training sessions during 15 months (2022-2024). A mixed-methods approach was used to expand knowledge of the educational process, content, and impacts. Quantitative data included 3 validated scales: Intolerance of Uncertainty Scale 12 (IUS-12), Self-Compassion Scale (SCS), and the Connor-Davidson Resilience Scale (CD-RISC). Qualitative data included brief text responses to a set of question prompts, anonymous feedback collected in the live postsession debrief, and a reflective writing assignment analyzed for key themes and various aspects of the improvisational training.

Results: Of the 118 students, 108 (92%) consented to participate in this study, and 84 (76%) completed all quantitative and qualitative instruments. The quantitative data showed statistically significant improvement in the SCS over time (mean [95% CI] change in score from session 1: -0.01 [-0.11 to 0.09] for session 2, 0.05 [-0.05 to 0.15] for session 3, and 0.12 [0.02-0.22] for session 4; P = .04), with no significant improvement on the IUS-12 or CD-RISC. The qualitative data indicated that most participants experienced an overall positive impact, with a few reporting disliking the content and nature of improvisation training.

Conclusions: These findings carry potential implications for curricular design in filling a crucial gap of teaching uncertainty tolerance, self-compassion, and resiliency to medical students.

Problem: Undergraduate medical education (UME) often lacks detailed data on student learning in the clinical learning environment, instead relying on self-reported and observational assessments of student involvement in patient care. This reliance on subjective data can lead to inconsistencies and gaps in understanding student experiences during clinical encounters. The electronic health record (EHR) contains a wealth of data that could address these limitations but is underused in UME, limiting objective analysis of student encounters and hindering the ability to monitor and ensure consistent experiences across different clinical sites.

Approach: In 2020, a multidisciplinary team at the Kaiser Permanente Bernard J. Tyson School of Medicine used business intelligence software to develop dashboards that enhance analysis of student experiences in the clinical learning environment. Student encounters were identified using a unique EHR profile that enabled the capture of encounter-level data, which were then exported to a centralized dataset, facilitating creation of dashboards for comprehensive visualization and analysis of student experiences.

Outcomes: By 2024, 17 dashboards were created that included visit- and patient-specific data. The EHR-linked dashboards featured encounter-specific details (specialty, preceptor, visit type and specialty, chief concern, diagnoses) and patient-specific details (age, race, sex, language, interpreter use). This allowed the capture of student experiences and facilitated analysis of student quality and patient-reported experience metrics. The dashboards also served as feedback tools to ensure comparability between students and cohorts across clinical sites.

Next steps: The dissemination of individualized student dashboards enables insights into clinical experiences and identifies student contributions to patient care. By sharing rich data, students can pinpoint learning opportunities and faculty can better support curricular goals, advancing precision medical education strategies. This approach can serve as a model for empirical studies on how clinical learning environments shape student development and marks a necessary step toward personalized learning systems in UME.

Problem: Medical students have high needs for mental health care. Traditional models of campus-based health care have limitations in meeting medical students' unique needs, including hours of accessibility, diversity of practitioners, and geographic limitations in a distributed educational model. Internal surveys performed before and after a Liaison Committee on Medical Education accreditation survey showed that students had low rates of satisfaction with access to mental health services.

Approach: A working group was formed at the Drexel University College of Medicine in fall 2022 to analyze student feedback on access to mental health care 2 years before (2020 and 2022) and 1 year after (2024) 1 telehealth intervention. On the basis of the student feedback desiring after-hours care and diverse practitioners and within the context of a distributive medical education model, telehealth was considered a promising way to meet students' needs. On the basis of student priorities, a telehealth company with multiple service offerings (scheduled counseling, on-demand therapy available 24/7, psychiatry visits, and health coaching) was vetted and ultimately chosen to begin in the 2023 to 2024 academic year.

Outcomes: Students readily adopted the use of telehealth services for their mental health needs. Approximately 15 months after implementation, nearly half of medical students in this study are registered for the telehealth service. Internal surveys after widespread use of the mobile app for 8 months showed improvements in students' satisfaction with available mental health resources.

Next steps: Telehealth mental health services can augment traditional, institutionally based practitioners. Moreover, students readily use telehealth services to meet their needs and perceive benefits from doing so. Next steps include evaluating whether students' engagement and satisfaction with telehealth services are sustained throughout medical school and reassessing the current fiscal model to ensure the service's long-term sustainability.

Purpose: United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) scores have been predictive of performance on in-training examinations in various fields, including internal medicine and surgery. As of 2022, USMLE Step 1, a basic science examination that has been studied as a strong predictor of Step 2 CK scores, has transitioned to pass/fail grading. This study aims to identify factors that predict performance on the Step 2 exam, focusing on comparisons with prior standardized test scores.

Method: In this single-institution cross-sectional study, data from 600 medical students at the University of California San Francisco who matriculated between 2016 and 2019 were analyzed. Scores on the Medical College Admission Test (MCAT), Comprehensive Basic Sciences Examination (CBSE), Open-Ended Question (OEQ) in-house block exams, and National Board of Medical Examiners (NBME) subject examinations were collected. There were 12 OEQ exams taken during the preclinical foundational science blocks. Multivariable regression models were used to examine MCAT, CBSE, OEQ, and NBME subject exam score predictability of Step 2 CK score. Data were analyzed in February 2023.

Results: A model containing the MCAT combined percentile, CBSE 1, CBSE 2, NBME subject exams for neurology, psychiatry, and surgery, and in-house block examinations for five different blocks accounted for 45% of variability in Step 2 score. The surgery NBME subject exams had the largest β coefficient (β = 0.212, P < .001). This study found that neurology, psychiatry, and surgery NBME exam scores are the strongest predictors of Step 2 performance.

Conclusions: In students who may be underperforming, these findings promote earlier interventions to optimize standardized test scores, which, with a well-rounded curriculum vitae, maximize chances of successful residency match.

Problem: Effective postexamination psychometric analysis plays an important role in supporting medical education assessments and is critical for ensuring reliability, dependability, validity, and fairness, which ultimately contribute to patient safety. However, many medical educational settings face significant barriers to achieving this, including expensive or complex software, limited psychometric expertise or programming skills, and increasing budgetary constraints regarding the need for rapid score release and quality control. This report describes a free, user-friendly tool that enables health education professions to conduct rapid and accurate postexamination analysis using classical test theory (CTT), generalizability theory (GT), and the Rasch model (RM).

Approach: The web-based tool, developed and tested in 2025 at the University of Nottingham, removes the need for complex postexamination data processing and provides real-time item performance metrics, reliability coefficients, and diagnostic reports, enabling educators to rapidly compare 3 measurement theories simultaneously for a comprehensive postexamination review.

Outcomes: A dataset from a high-stakes final medical assessment (489 students, 200 items) was uploaded. The tool rapidly produced CTT measures, GT variance components, and a decision study, including G-coefficient and phi-coefficient, as well as the absolute standard error of measurement and RM calibrations. Under CTT, the tool also outputs individual outcomes, histograms of marks, the true score and 68% or 95% bounds, rank scores, z scores, percentiles, and deciles. The tool also identified misfit items and persons, item-person maps, separation coefficients, and Rasch reliability. Additionally, the tool produced item characteristics curves, test characteristic curves, and test information function.

Next steps: Future work includes expanding the tool by adding categorical responses to fully evaluate the quality of single-best-answer questions or multiple-choice question distractors. This aim will be achieved by analyzing plausible and implausible options and displaying the correlation between the total scores and the occurrence of each answer option for each question.