Academic Medicine最新文献

In light of increasing legislation aimed at prohibiting diversity, equity, and inclusion (DEI) efforts at publicly funded universities in the United States, women-only leadership programs (WOLPs) have come under increasing pressure, which could undermine gender equity advancements, particularly in academic medicine. Women-only leadership programs have traditionally offered a unique advantage for women over mixed-gender leadership programs by fostering psychologically safe spaces to share experiences, teaching leadership competencies while using a gender equity lens in areas where it makes sense, and providing essential support in the form of mentorship and sponsorship. Women-only leadership program participation is also -associated with increased promotion rates, retention rates, and leadership roles. Given the current political environment, this is a pivotal moment-and a key opportunity-to elevate the work of WOLPs by expanding their reach to include all individuals who can benefit from their programming and help build a more inclusive and equitable field. To this end, WOLPs must reimagine, reframe, and rebrand their work to continue cultivating the future generation of health care leaders, focusing on a central tenet of WOLPs: different people have different experiences and are treated differently. As the national focus on DEI work evolves, it is imperative that WOLPs evolve and expand spaces for leadership development for all talented individuals to ensure that there continues to be progress in gender representation and leadership advancement. Amid growing legislative threats to diversity, equity, and inclusion, women-only leadership programs (WOLPs) too have faced scrutiny. WOLPs must reimagine, reframe, and rebrand their work to continue cultivating the future generation of healthcare leaders. As part of this evolution, the progeny of WOLPs should maintain that different people have different experiences and are treated differently.

Problem: Physician trainees receive limited formal education in high-value care (HVC) despite care costs being a high priority for patients. The authors evaluated the impact of a supplemental HVC curriculum, which exposed students to real health care costs for patients under their care, on understanding of health care cost determination, interest in HVC, and self-efficacy in advocating for patients.

Approach: Internal medicine clerkship students at the Perelman School of Medicine at the University of Pennsylvania were randomized between April 2023 and March 2024 to an intervention or control group. The intervention group obtained a postdischarge hospital bill for one patient and participated in a facilitated debrief session on billing and financial assistance resources. Students in the control group could opt to receive a bill but not the debrief. All students who obtained bills were asked to reflect on their findings. After clerkship completion, students were surveyed on their attitudes and planned behavior.

Outcomes: A total of 161 medical students completed the clerkship during the study, with 74 (46%) in the intervention group and 87 (54%) in the control group. All students agreed it was important for physicians to understand costs of care. Intervention group students were more likely to endorse improved understanding of how out-of-pocket costs were determined (47 of 53 [89%] vs 21 of 37 [57%], P < .001), confidence discussing costs on rounds (32 of 53 [60%] vs 14 of 37 [38%], P = .004), and plans to incorporate cost awareness into future practice (46 of 53 [87%] vs 23 of 37 [62%], P = .003).

Next steps: This approach was the first to evaluate the use of patient bills in teaching medical students the financial ramifications of clinical behavior. Future work should explore how exposure to patient costs affects trainees' behaviors as they progress through training. Teaser text: In this study, educators at the Perelman School of Medicine of the University of Pennsylvania piloted a hands-on high-value care curriculum in which internal medicine clerkship students reviewed real hospital bills from their own patients and participated in a guided debrief. Compared with peers receiving standard HVC instruction alone, participating students demonstrated greater understanding of how costs are determined, improved comfort discussing expenses with patients, and stronger intentions to incorporate cost-conscious decision-making into clinical practice. Reflection analysis revealed themes of surprise regarding costs, enhanced awareness of system inefficiencies, and increased motivation for patient financial advocacy and resource stewardship. This scalable intervention highlights how exposing trainees to actual patient costs can meaningfully shape attitudes, enhance resource stewardship, and bridge a critical gap in medical education.

Succession planning facilitates leadership transitions that allow for the continuation of mission-critical processes with minimal disruption. This AM Last Page contains tips to improve succession planning at academic medicine institutions to support candidates and maintain organizational efficiency.

Purpose: This study explores how new residents experienced the transition to residency, examines factors that made the transition process more or less difficult, and identifies potentially modifiable program features that enhanced or would have enhanced transition experiences.

Method: The authors conducted a qualitative interview study of postgraduate year (PGY) 1 residents in emergency medicine, family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatric and adolescent medicine, and psychiatry at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin between December 2020 and March 2021. Open-ended questions explored residents' transition experiences. Interviews were audio-recorded, transcribed, coded inductively, and analyzed iteratively using general thematic analysis from an epistemologically constructivist perspective.

Results: Forty-five residents (25 women, 20 men) from 12 programs, 7 specialties, and 4 states participated. PGY-1 residents experienced the transition to residency as a confluence of overlapping and interconnected transitions that unfolded over time, spanned multiple life domains, and generated numerous personal and professional demands. Residents appraised demands based on their effects on patient care, professional growth, and personal well-being and struggled when coincident demands forced tradeoffs among these concerns. Residents who experienced many difficulties during the transition to residency reported high demands (eg, due to transition-related discontinuities, depleted resources from prior transitions or a difficult match experience, structural and systemic barriers, coincident personal or situational stressors) and/or fewer resources (eg, insufficient residency or life skills, limited social support, financial strain). Preparedness and supportive relationships eased the transition process. Residency program features that enhanced or would have enhanced the transition experience included monitoring and limiting overall demands, minimizing unhelpful and harmful demands, calibrating constructive demands, and increasing holistic support.

Conclusions: Study findings illuminate transition experiences of PGY-1 residents, reveal person-centered considerations to inform ongoing improvement efforts, and identify potentially actionable steps programs can take to improve resident transition experiences.

Problem: Health equity cannot be achieved without transformative leaders, yet there is little social sector investment dedicated to leadership development. Educational curricula may highlight the tremendous burden of health inequities, but usually without providing learners the skills to address them.

Approach: The Atlantic Fellows for Health Equity (AFHE), based at the Fitzhugh Mullan Institute for Health Workforce Equity at The George Washington University in Washington, DC, brings together emerging international leaders across diverse disciplines to learn, develop, and share innovative approaches to eliminating health disparities. Established in 2017, the AFHE is a 1-year, nonresidential program with recruitment starting in the spring, selection occurring in August, and commencement starting the following January of each year. Between 2017 and 2024, 122 fellows from 31 countries completed the program. The program blends in-person and online learning. Alternating and intertwining concepts of health equity and leadership, fellows are engaged in both topical learning and skills development in biweekly sessions throughout the year. Graduates of the program are supported with further opportunities for skills development, networking, and amplification of their work.

Outcomes: The 2023 Senior Fellows Survey, a 26-item electronically administered survey, was sent to 88 fellows, with 51 fellows (58%) responding. The survey responses demonstrated that fellows continue to use the leadership and equity skills gained from the fellowship in their daily work, including in expanding access to care, supporting vulnerable populations, and influencing change at their institutions.

Next steps: Next steps include broadening the fellowship's content and delivery to include new international initiatives and diverse approaches to advancing health equity-based fellow-directed projects and deepening of partnerships with values-aligned global organizations. The AFHE is highly adaptable and scalable. The fellowship principles have already been replicated in other formal programs, including in the United States and Argentina.

Teaser text: This article describes the Atlantic Fellows for Health Equity, which brings together emerging leaders across diverse disciplines to learn, develop, and share innovative approaches to eliminating health disparities.

Premedical or admissions competencies define a standard set of expectations for medical school candidates to guide their preparation for and application to medical school. These competencies also support medical school admissions committees in advancing fair and efficient application review. In their article updating the 2011 premedical competencies with a revised model consisting of 17 competencies that span professional, science, and thinking and reasoning domains, Wasserman and colleagues have attempted to characterize a qualified medical school applicant poised for success. While these competencies constitute a laudable effort, additional refinement may be needed over time to address emerging areas in medical education and health care. These include incorporating qualitative reasoning, fostering artificial intelligence literacy, emphasizing feedback literacy, and articulating the skills required to reconcile competing needs, ultimately reframing professionalism as a complex, adaptive challenge of developing professional identity within a demanding environment. To operationalize these competencies, a robust toolkit with resources, assessment tools, and training materials will be needed. To understand how well the updated competencies capture the enduring and evolving expectations for incoming medical students, medical educators must ask what problems these competencies are trying to solve. In this commentary, the authors propose 3 problems that admissions competencies could solve: (1) linking education to health outcomes, (2) promoting fairness in admissions, and (3) cultivating physicians skilled in relationship building and team functioning. For the competencies to address these problems, medical schools must continue to commit to holistic review processes that evaluate applicants within their unique contexts and opportunities. Focusing the admissions competency framework on behavior-based guidance, rather than on prescriptive experiences, creates a more accessible pathway to medical education that honors applicants' backgrounds, while identifying qualified candidates with the potential to become compassionate, adaptable physicians prepared for the ever-evolving health care landscape. Teaser text: This commentary reflects on updated premedical competencies that characterize a qualified medical school applicant. Forward looking premedical student competencies should incorporate qualitative reasoning, fostering artificial intelligence literacy, emphasizing feedback literacy, and articulating the skills required to reconcile competing needs, ultimately reframing professionalism as a complex, adaptive challenge of developing professional identity within a demanding environment. Used well, premedical competencies can facilitate linking education to health outcomes, promote fairness in admissions, and cultivate physicians' skills in relationship building and team functioning.

The demand for high-quality faculty development in medical education is more acute than ever. Faculty developers' responsibilities are growing exponentially as they are called upon to help medical faculty maintain expertise in an evolving array of content domains, curricular and assessment strategies, education technologies, and active learning methods. Faculty development has a long history of supporting medical education colleagues in times of change. More recently expectations for faculty developers are expanding due to (1) increasing enrollment of learners, (2) emphasis on learner-centered teaching practices and competency-based assessment methods, and (3) heightened accreditation standards for training faculty. Yet, faculty development in medical education lacks the conventional structures of a profession, such as an adopted set of competencies. In 2023, a series of sessions at regional, national, and international medical education conferences were held to generate ideas and collect examples of faculty developer competencies from over 100 stakeholders. More than 500 responses were gathered from prompts such as "What are the competencies faculty developers need?" and "What is one of the most valuable faculty developer competencies today?" This perspective offers both a rationale for establishing faculty development in medical education as a profession and a path forward through the provision and broad promotion of clearly defined core competencies. The competencies outlined are intended to help inform those entering or currently working in the profession, recruiters of faculty developers, medical education leaders, institutional partners, those conducting performance appraisals of faculty developers, and the broader medical education community. The aim of this work is to generate discussion among vested medical education and faculty development stakeholders who seek to provide structure, clarify roles, and further define medical education faculty development as a profession.

Academic health centers (AHCs) face unique challenges regarding freedom of expression, a topic that recently has caused considerable public controversy at universities across the United States. Little has been published on institutional responses to these controversies. To inspire conversation, reflection, and policy development at other AHCs, in this article, the authors outline steps taken by the Medical College of Wisconsin (MCW) in 2023 and 2024 to respond to an immediate challenge to freedom of expression and to develop a long-term response that will support the institution's commitment to freedom of expression as an essential element of education, patient care, and scientific inquiry. The authors describe the work of the MCW Committee on Freedom of Expression, including its formation, the steps it took to develop guiding principles, and the reaction of faculty, staff, and particularly medical students to initial educational programming around applying the newly developed principles. As a private institution, MCW has greater legal latitude than public AHCs, which allowed the committee to engage leaders and stakeholders in a reflective process, asking questions about the institution's position as a "public square," how to best address the needs of institutional and clinical partners, and the impact of power and inequity on broad protections of freedom of expression. To date, among stakeholders, students have been the most hesitant to embrace the new principles and consistently have shared concerns. Feedback from students has demonstrated that self-censorship is widespread, social justice concerns are a high priority, and structured programming can support and scaffold constructive conversations. The authors conclude that providing opportunities for engagement with institutional freedom of expression principles, especially when uncomfortable, is an essential step in integrating them into educational and clinical practices.

Purpose: The number of medical degree candidates who obtain a second advanced degree via combined degree or dual--degree programs is increasing. This scoping review examines existing literature on dual-degree programs in undergraduate medical education to summarize findings and identify research gaps to help guide future academic pursuits.

Method: Publications on dual degrees in medicine were searched in MEDLINE, ERIC, CINAHL, Scopus, and Web of Science on April 2, 2025. Two investigators independently reviewed and extracted data from eligible studies. Inclusion criteria were doctor of medicine (MD) or doctor of osteopathic medicine (DO) as one of the dual degrees, both degrees earned concomitantly at institutions in the United States, and published in 1964 or later. A qualitative content analysis was conducted.

Results: A total of 3501 studies were identified. After removing duplicates and irrelevant articles, 69 articles were included. Of the 69 articles, 43 discussed doctor of medicine (MD)/doctor of philosophy (PhD) programs, 23 discussed MD/master of public health programs, 18 addressed MD/master of business administration programs, 13 examined MD/master of science programs (including 1 combined MD and master of engineering), 3 analyzed MD/juris doctor programs, 3 examined MD/doctor of dental surgery programs, and 2 discussed osteopathic medicine/PhD programs. Across all dual-degree types, 35 articles discussed student perceptions, 24 examined curricular challenges, 19 addressed match outcomes, and 23 explored career choices and outcomes compared with standard medical school programs.

Conclusions: This scoping review synthesizes the dual-degree program literature and identifies common themes addressed in these articles. Furthermore, this scoping review identifies areas for further research in medical education regarding dual-degree -programs, including longitudinal outcomes of dual-degree graduates, perceptions of prospective and current students in such programs, evaluation of curricular challenges, and challenges of academic progress faced by students while completing 2 graduate degrees.