Academic Medicine最新文献

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.

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.

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.

Purpose: Morning report (MR), a tradition in internal medicine residency programs, is widely used across the United States and increasingly used by other specialties. However, limited data exist regarding learner-level-specific considerations. The authors conducted a scoping review to characterize current knowledge regarding learner-level MR content, structure, gaps, and outcomes.

Method: The authors searched 3 databases on June 17, 2025, for English-language peer-reviewed articles that described MR in graduate medical education. Included studies featured case-based educational activities that enhanced trainees' clinical skills from history-taking to management, targeted resident learners, and mentioned the participants' composition (ie, interns or first-year residents only or senior residents [second year and beyond] only). Data were extracted and analyzed using content analysis.

Results: Of 2,287 articles identified, 36 met the inclusion criteria. Twenty-three articles (64%) addressed first-year-related sessions, whereas 32 (89%) covered senior resident-related sessions. Common study objectives included intern (7 [19%]) or senior (11 [31%]) perception or attitudes toward MR. Structural themes included intern (11 [31%]) or senior (13 [36%]) session time limits. Few studies evaluated outcomes incorporating theoretical models or validated tools. Literature differed where intern sessions gravitated toward fundamental history-gathering, differential diagnosis generation, and adapting to the rapidly changing responsibilities of intern year, whereas senior-only sessions focused on more advanced cases and evidence-based medicine. Key gaps included limited incorporation of adult learning theory, minimal facilitator development, ways to evaluate sessions, and content or structural redesign.

Conclusions: Despite its fundamental and widespread use, MR's educational design has remained largely unchanged during the past 3 decades and remains poorly aligned with adult learning theory or rigorous evaluation. This review highlights the need for more studies to reevaluate MR through learner-specific design, incorporation of modern learning theories, and validated outcomes to ensure it continues to meet the evolving needs of trainees.

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.

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.

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: 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.