Academic Medicine最新文献

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.

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.

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.

Purpose: This study synthesizes and characterizes pregnancy outcomes and complications among US female physician trainees.

Method: In this systematic review, the PubMed, Embase, Scopus, Web of Science, and Cochrane databases were searched in May 2024 and May 2025 for peer-reviewed, English-language articles published from January 2000 to May 2025 reporting pregnancy outcomes in US female residents or fellows. Medical Subject Headings and keywords for pregnancy complications, pregnancy outcomes, and women or female physicians were used. Cross-sectional, retrospective, prospective, and case-control studies were included. Opinion articles, editorials, systematic or scoping reviews, and other non-peer-reviewed articles were excluded. Abstracts and full-text articles were screened by 3 investigators. Extracted data were documented in standardized forms. Risk of bias was assessed regarding study population and outcome reporting and summarized using standardized quality assessment tools.

Results: Of 792 titles and abstracts screened, 10 articles involving 4,891 trainees were included. Eight of these 10 studies described pregnancy outcomes specifically in surgical trainees; all were cross-sectional surveys. The numbers of trainees experiencing pregnancy complications ranged from 38.9% to 56.0%. The most frequently described complication was preterm labor (9 of 10 studies), affecting 5.3% to 22.9% of surveyed trainees. The most cited fetal complication was miscarriage (5 of 10 studies), affecting 20.0% to 28.0% of trainee pregnancies. Other commonly reported complications included preeclampsia or eclampsia, hyperemesis gravidarum, and gestational hypertension.

Conclusions: Although pregnancy complications appear to be common among female physician trainees, current data on obstetric outcomes in this population remain limited. Most studies focus specifically on surgical trainees and rely on self-reported data, limiting generalizability. Residency programs may consider findings from this review to enhance support for childbearing trainees, although prospective studies are needed to better discern the impact of medical training on maternal and fetal outcomes.

Problem: Reflective practice is associated with personal and professional development, including enhanced well-being and improved quality of patient care. Although medical education typically relies on narrative or text-based exercises for reflection, the visual arts are well suited to fostering reflective practice in ambiguous learning environments, such as medical school. Incorporating the visual arts with written reflections can enhance creativity and observation while engaging metacognitive skills, such as perspective-taking and self-awareness of biases. The authors describe an innovative reflection tool that integrates photographs with brief written reflections on meaningful learning from early clinical encounters in undergraduate medical education.

Approach: The authors developed a health humanities reflection tool-the Photo/Tiny Story (PTS)-that combines taking a photograph with writing a corresponding 55-word story. Introduced in a first-year course at the University of Rochester School of Medicine and Dentistry, the tool facilitates students to critically reflect on their experiential learning from one meaningful clinical encounter and represent this in a PTS. Students subsequently discussed their assignments in facilitated small groups. Assignment evaluations from May of the academic year 2021 to 2022 were examined, and the PTSs were thematically analyzed using an inductive approach.

Outcomes: Seventy-six of 102 students (75%) reported that the PTS was a valuable tool for reflection, with 72 (71%) reporting that it helped them examine assumptions and biases. Additionally, 91 (89%) acknowledged its effectiveness in facilitating reflection on the affective elements of their patient encounter. Qualitative analysis of the PTSs identified 4 key themes: clinical challenge of biopsychosocial practice, awareness of uncertainty, recognizing discrepancies between clinical expectations and reality, and skills application.

Next steps: Results indicate that the PTS is an effective, resource-efficient tool for reflecting on experience and complex skills acquisition in emotionally charged clinical environments. Next steps include analyzing PTS assignments across all 4 years of undergraduate medical education.