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Validation of the Learner Engagement Instrument for Continuing Professional Development. 持续专业发展学习者参与工具的验证。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-07-29 DOI: 10.1097/ACM.0000000000005749
David A Cook, Christopher R Stephenson

Purpose: Learner engagement is the energy learners exert to remain focused and motivated to learn. The Learner Engagement Instrument (LEI) was developed to measure learner engagement in a short continuing professional development (CPD) activity. The authors validated LEI scores using validity evidence of internal structure and relationships with other variables.

Method: Participants attended 1 of 4 CPD courses (1 in-person, 2 online livestreamed, and 1 either in-person or livestreamed) in 2018, 2020, 2021, and 2022. Confirmatory factor analysis was used to examine model fit for several alternative structural models, separately for each course. The authors also conducted a generalizability study to estimate score reliability. Associations were evaluated between LEI scores and Continuing Medical Education Teaching Effectiveness (CMETE) scores and participant demographics. Statistical methods accounted for repeated measures by participants.

Results: Four hundred fifteen unique participants attended 203 different CPD presentations and completed the LEI 11,567 times. The originally hypothesized 4-domain model of learner engagement (domains: emotional, behavioral, cognitive in-class, cognitive out-of-class) demonstrated best model fit in all 4 courses, with comparative fit index ≥ 0.99, standardized root mean square residual ≤ 0.031, and root mean square error of approximation ≤ 0.047. The reliability for overall scores and domain scores were all acceptable (50-rater G-coefficient ≥ 0.74) except for the cognitive in-class domain (50-rater G-coefficient of 0.55 to 0.66). Findings were similar for both in-person and online delivery modalities. Correlation of LEI scores with teaching effectiveness was confirmed (rho=0.58), and a small correlation was found with participant age (rho=0.19); other associations were small and not statistically significant. Using these findings, we generated a shortened 4-item instrument, the LEI Short Form.

Conclusions: This study confirms a 4-domain model of learner engagement and provides validity evidence that supports using LEI scores to measure learner engagement in both in-person and livestreamed CPD activities.

目的:学习者投入度是指学习者为保持学习的专注性和积极性而付出的精力。学习者参与度工具(LEI)是为了测量学习者在短期持续专业发展(CPD)活动中的参与度而开发的。作者利用内部结构的有效性证据以及与其他变量的关系对 LEI 分数进行了验证:参与者参加了 2018 年、2020 年、2021 年和 2022 年的 4 门 CPD 课程(1 门面授课程、2 门在线直播课程和 1 门面授或在线课程)中的 1 门。作者分别对每门课程进行了确认性因子分析,以检验几种可供选择的结构模型的模型拟合度。作者还进行了一项可推广性研究,以估算分数的可靠性。还评估了 LEI 分数与继续医学教育教学效果 (CMETE) 分数和学员人口统计学之间的关联。所有统计方法都考虑了参与者的重复测量:415名参与者参加了203场不同的继续医学教育讲座,完成了11,567次LEI。最初假设的学习者参与度 4 领域模型(领域:情感、行为、课内认知、课外认知)在所有 4 门课程中均表现出最佳模型拟合度,比较拟合指数≥0.99,标准化均方根残差≤0.031,均方根近似误差≤0.047。除课堂认知领域(50 人 G 系数为 0.55 至 0.66)外,总分和领域分的信度均可接受(50 人 G 系数≥ 0.74)。所有结果在面授和在线授课模式下都相似。LEI 分数与教学效果的相关性得到了证实(rho 0.58),与参与者年龄的相关性较小(rho 0.19);其他相关性较小,且无统计学意义。根据这些研究结果,我们制作了一个简短的 4 个项目的工具,即 LEI 简表:本研究证实了学习者参与度的 4 领域模型,并提供了有效性证据,支持使用 LEI 分数来衡量学习者在现场和直播 CPD 活动中的参与度。
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引用次数: 0
Engaging Learners With the Utility of Electronic Medical Record Templates in Patient Note Writing. 让学习者了解电子病历模板在病人笔记书写中的实用性。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 10.1097/ACM.0000000000005787
Gabriella Schmuter, Robert A Beale
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引用次数: 0
Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship. 探索医学生在儿科实习期间的直接观察经验。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-05-01 DOI: 10.1097/ACM.0000000000005747
Capri P Alex, H Barrett Fromme, Larrie Greenberg, Michael S Ryan, Sarah Gustafson, Maya K Neeley, Shaughn Nunez, Molly E Rideout, Jessica VanNostrand, Nicola M Orlov

Purpose: Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions.

Method: This multimethod study was performed at 6 U.S.-based institutions from March to October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses.

Results: Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]).

Conclusions: This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.

目的:直接观察(DO)可以评估临床技能等重要能力。尽管国家要求医学生在每次实习期间都要进行直接观察,但这些观察的频率、时间长度、质量和背景并没有得到很好的确定。本研究考察了多所院校在儿科实习期间获得的实习指导的质量、数量和特点:本研究采用多种方法,于 2022 年 3 月至 10 月在美国 6 所院校进行。在定性研究阶段,作者在儿科实习结束后对三年级医学生进行了焦点小组和/或半结构式访谈。在定量阶段,作者在焦点小组讨论或访谈后使用了内部开发的工具。定性数据采用主题分析法进行分析,定量数据采用匿名调查法进行分析:73名医学生参加了20个焦点小组,71人(97.3%)完成了调查。作者确定了 7 个主题,并将其归纳为关键原则:实习前、实习中和实习后。大多数学生表示,在住院环境中,他们的DO主要由住院医师(62人[87.3%])而非主治医师(6人[8.4%])进行。学员们报告说,主治医师每天都会观察他们的临床推理能力(38 [53.5%])、沟通能力(39 [54.9%])和表达能力(58 [81.7%])。三分之一的学生称他们从未被住院主治医师观察过病史采集(23 [32.4%]),四分之一的学生称他们从未被观察过体格检查(18 [25.4%]):这项研究表明,主治医师对学生在住院环境中执行重要临床技能的评估并不像以前认为的那样频繁。当观察者设定期望值、创造安全的学习环境并跟进可操作的反馈时,医学生会认为这种经历很有价值;然而,目前的DO经历并不理想。因此,有必要为医学生提供高质量、以能力为基础的临床教育,通过培养有能力的医生队伍来直接推动未来的患者护理工作。
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引用次数: 0
Disparities in Medical School Clerkship Grades Associated With Sex, Race, and Ethnicity: A Person-Centered Approach. 与性别、种族和民族有关的医学院实习成绩差异:以人为本的方法》。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-03-14 DOI: 10.1097/ACM.0000000000005690
Paulina Perez Mejias, Gustavo Lara, Alex Duran, Rashelle Musci, Nancy A Hueppchen, Roy C Ziegelstein, Pamela A Lipsett

Purpose: To determine whether students' self-reported race/ethnicity and sex were associated with grades earned in 7 core clerkships. A person-centered approach was used to group students based on observed clerkship grade patterns. Predictors of group membership and predictive bias by race/ethnicity and sex were investigated.

Method: Using data from 6 medical student cohorts at Johns Hopkins University School of Medicine (JHUSOM), latent class analysis was used to classify students based on clerkship grades. Multinomial logistic regression was employed to investigate if preclerkship measures and student demographic characteristics predicted clerkship performance-level groups. Marginal effects for United States Medical Licensing Exam (USMLE) Step 1 scores were obtained to assess the predictive validity of the test on group membership by race/ethnicity and sex. Predictive bias was examined by comparing multinomial logistic regression prediction errors across racial/ethnic groups.

Results: Three clerkship performance-level groups emerged from the data: low, middle, and high. Significant predictors of group membership were race/ethnicity, sex, and USMLE Step 1 scores. Black or African American students were more likely (odds ratio [OR] = 4.26) to be low performers than White students. Black or African American (OR = 0.08) and Asian students (OR = 0.41) were less likely to be high performers than White students. Female students (OR = 2.51) were more likely to be high performers than male students. Patterns of prediction errors observed across racial/ethnic groups showed predictive bias when using USMLE Step 1 scores to predict clerkship performance-level groups.

Conclusions: Disparities in clerkship grades associated with race/ethnicity were found among JHUSOM students, which persisted after controlling for USMLE Step 1 scores, sex, and other preclerkship performance measures. Differential predictive validity of USMLE Step 1 exam scores and systematic error predictions by race/ethnicity show predictive bias when using USMLE Step 1 scores to predict clerkship performance across racial/ethnic groups.

目的:确定学生自报的种族/民族和性别是否与 7 个核心实习的成绩有关。根据观察到的实习成绩模式,采用以人为本的方法对学生进行分组。研究了分组成员的预测因素以及种族/民族和性别的预测偏差:利用约翰霍普金斯大学医学院(JHUSOM)6个医学生组群的数据,采用潜类分析法根据实习成绩对学生进行分类。采用多项式逻辑回归法来研究实习前的衡量标准和学生的人口统计学特征是否能预测实习成绩水平组别。美国医学执业资格考试(USMLE)第 1 步分数的边际效应用于评估该测试对不同种族/族裔和性别群体成员的预测有效性。通过比较不同种族/族裔群体的多叉逻辑回归预测误差,对预测偏差进行了检验:结果:从数据中得出了三个实习表现水平组别:低、中、高。种族/人种、性别和 USMLE 第 1 步分数是预测组别成员的重要因素。与白人学生相比,黑人或非裔美国人学生更有可能成为成绩较差的学生(几率比 [OR] = 4.26)。黑人或非裔美国人(OR = 0.08)和亚裔学生(OR = 0.41)比白人学生更不可能成为成绩优秀的学生。女生(OR = 2.51)比男生更有可能成为成绩优秀的学生。在使用 USMLE 第 1 步分数预测实习成绩水平组别时,不同种族/族裔组别的预测误差模式显示出预测偏差:结论:在 JHUSOM 学生中发现了与种族/族裔相关的实习成绩差异,在控制了 USMLE 第 1 步分数、性别和其他实习前成绩衡量标准后,这种差异依然存在。USMLE 第 1 步考试分数和系统误差预测的种族/人种差异预测有效性表明,使用 USMLE 第 1 步考试分数预测不同种族/人种群体的实习成绩存在预测偏差。
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引用次数: 0
The Need for Greater Transparency in Journal Submissions That Report Novel Machine Learning Models in Health Professions Education. 需要提高期刊投稿的透明度,以报道卫生职业教育中的新型机器学习模型。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI: 10.1097/ACM.0000000000005793
Gustavo A Patino, Laura Weiss Roberts
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引用次数: 0
To the Fig Tree on 9th and Christian. 去第九大道和克里斯蒂安路口的无花果树餐厅
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2023-05-25 DOI: 10.1097/ACM.0000000000005280
Ross Gay
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引用次数: 0
Protecting and Learning From LGBTQ Students. 保护 LGBTQ 学生并向他们学习。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 10.1097/ACM.0000000000005785
Nam S Danny Hoang
{"title":"Protecting and Learning From LGBTQ Students.","authors":"Nam S Danny Hoang","doi":"10.1097/ACM.0000000000005785","DOIUrl":"10.1097/ACM.0000000000005785","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Significance of Adding a Separate Racial Checkbox for Middle Eastern and North African Patients. 为中东和北非患者添加单独种族复选框的意义。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1097/ACM.0000000000005791
Ghida El Banna, Sophia Neman, John Trinidad
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引用次数: 0
Racial and Ethnic Bias in Letters of Recommendation in Academic Medicine: A Systematic Review. 学术医学推荐信中的种族和民族偏见:系统综述。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-03-08 DOI: 10.1097/ACM.0000000000005688
Saarang R Deshpande, Gina Lepore, Lily Wieland, Jennifer R Kogan

Purpose: Letters of recommendations (LORs) are key components of academic medicine applications. Given that bias against students and trainees underrepresented in medicine (UIM) has been demonstrated across assessment, achievement, and advancement domains, the authors reviewed studies on LORs to assess racial, ethnic, and UIM differences in LORs. Standardized LORs (SLORs), an increasingly common form of LORs, were also assessed for racial and ethnic differences.

Method: A systematic review was conducted for English-language studies that assessed racial or ethnic differences in LORs in academic medicine published from database inception to July 16, 2023. Studies evaluating SLORs underwent data abstraction to evaluate their impact on the given race or ethnicity comparison and outcome variables.

Results: Twenty-three studies describing 19,012 applicants and 41,925 LORs were included. Nineteen studies (82.6%) assessed LORs for residency, 4 (17.4%) assessed LORs for fellowship, and none evaluated employment or promotion. Fifteen of 17 studies (88.2%) assessing linguistic differences reported a significant difference in a particular race or ethnicity comparison. Of the 7 studies assessing agentic language (e.g., "strong," "confident"), 1 study found fewer agentic terms used for Black and Latinx applicants, and 1 study reported higher agency scores for Asian applicants and applicants of races other than White. There were mixed results for the use of communal and grindstone language in UIM and non-UIM comparisons. Among 6 studies, 4 (66.7%) reported that standout language (e.g., "exceptional," "outstanding") was less likely to be ascribed to UIM applicants. Doubt-raising language was more frequently used for UIM trainees. When SLORs and unstructured LORs were compared, fewer linguistic differences were found in SLORs.

Conclusions: There is a moderate bias against UIM candidates in the domains of linguistic differences, doubt-raising language, and topics discussed in LORs, which has implications for perceptions of competence and ability in the high-stakes residency and fellowship application process.

目的:推荐信(LOR)是学术医学申请的关键组成部分。鉴于在评估、成绩和晋升等方面存在对医学领域代表性不足的学生和受训人员(UIM)的偏见,作者回顾了有关推荐信的研究,以评估推荐信中的种族、民族和 UIM 差异。标准化 LORs(SLORs)是一种越来越常见的 LORs 形式,作者也对其种族和民族差异进行了评估:方法:我们对从数据库建立到 2023 年 7 月 16 日发表的评估学术医学中 LORs 的种族或民族差异的英文研究进行了系统回顾。对评估SLORs的研究进行了数据抽取,以评估其对特定种族或民族比较和结果变量的影响:结果:共纳入 23 项研究,描述了 19,012 名申请人和 41,925 份 LOR。19项研究(82.6%)对住院医师资格的LOR进行了评估,4项研究(17.4%)对研究员资格的LOR进行了评估,没有研究对就业或晋升进行评估。在 17 项评估语言差异的研究中,有 15 项(88.2%)报告在特定种族或民族比较中存在显著差异。在 7 项评估代理语言(如 "强势"、"自信")的研究中,1 项研究发现黑人和拉丁裔申请人使用的代理术语较少,1 项研究报告称亚裔申请人和非白人申请人的代理得分较高。在 UIM 与非 UIM 的比较中,使用公共语言和磨刀石语言的结果不一。在 6 项研究中,有 4 项(66.7%)报告说,杰出的语言(如 "卓越的"、"杰出的 "等)较少被归因于统一入学申请者。对未参加统一入学考试的受训者使用的质疑性语言更多。在比较 SLOR 和非结构化 LOR 时,发现 SLOR 的语言差异较小:结论:在语言差异、质疑性语言和LOR中讨论的主题方面,对UIM候选人存在一定程度的偏见,这对申请住院医师和研究员资格的高风险过程中对能力和才干的认识有影响。
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引用次数: 0
Bibliometric Networks for Researchers in Health Professions Education. 卫生职业教育研究人员的文献计量网络。
IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-01 Epub Date: 2024-03-13 DOI: 10.1097/ACM.0000000000005700
Anton Boudreau Ninkov, Jason R Frank, Joseph A Costello, Anthony R Artino, Lauren A Maggio

Bibliometric network analysis is an analytical approach that enables researchers to visualize the relationships between a set of research items (e.g., journal articles, books). There are 3 types of bibliometric network analyses, and multiple tools to conduct the analysis and visualize results (e.g., VOSviewer , 1Gephi2 ). For health professions educators, bibliometric network analysis is valuable for discovering the field's emerging trends, popular topics, and multidisciplinary relationships. 3,4.

文献计量学网络分析是一种分析方法,可使研究人员直观地看到一组研究项目(如期刊论文、书籍)之间的关系。文献计量学网络分析有 3 种类型,有多种工具可以进行分析并将结果可视化(如 VOSviewer、1Gephi2 等)。对于卫生专业教育工作者来说,文献计量学网络分析对于发现该领域的新兴趋势、热门话题和多学科关系非常有价值。3,4.
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引用次数: 0
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Academic Medicine
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