Academic Medicine最新文献

Purpose: Competency committees serve as a holistic mechanism for determining whether learners have reached thresholds for advancement. In the United States, standards for competency committee operations are mandated throughout graduate medical education (GME) programs. Although similar committees have become increasingly prevalent in undergraduate medical education (UME), there is no external standard for their operations, and research is limited. This study aimed to address gaps in understanding the purpose, structure, and function of UME competency committees in US medical schools.

Method: This study was part of a larger focused ethnography conducted across 7 US MD-granting programs. Data were collected between April 2023 and November 2024 from site-specific documents (n = 21) and semistructured interviews with chairs (n = 7), an administrator (n = 1), and founders (n = 7) of the respective competency committees. Interviews were recorded and transcribed verbatim. The authors incorporated an interpretative approach to analyze data: generating and refining codes, developing institutional case summaries, and identifying emergent analytic ideas.

Results: Participants developed competency committees to serve as a critical component toward the aim of realizing a true competency-based education model. Despite the similar purpose, outcomes were variable, ranging from feedback and coaching to advancement and remediation. Competency was defined and operationalized locally; some identified numerical thresholds, whereas others favored individual judgment. Workload was commonly distributed between subgroups or subcommittees to navigate the large learner volume. Other critical considerations included the relationship between the competency committee and advancement committees, roles and responsibilities of members, and mitigation of conflicts.

Conclusions: Although significant variability existed, participants encountered similar decision points, which illustrate key considerations for competency committee implementation in UME. This work provides a detailed description of competency committees in US medical schools, with important contrasts to GME, laying the groundwork for future research and best practices.

Personal statements for medical school and residency are often viewed as authentic accounts of an applicant's fit and interest within a specific medical context. Yet these narratives remain an inconsistent predictor of academic performance, and generative artificial intelligence (AI) may undermine their authenticity. Now is the time for admissions committees to convene stakeholders and reassess the value and purpose of personal statements for both admissions and applicants. While some may be tempted to do away with personal statements entirely, these statements can provide meaningful opportunities for reflection and growth. This Scholarly Perspective recommends that programs focus on the humanity of the writing process by: (1) viewing the personal statement as a learning opportunity for the applicant, (2) fostering community and collaboration in the writing process, (3) crafting more specific prompts, and (4) intentionally incorporating interview questions referencing the applicant's statement. By doing so, personal statements can humanize the admissions process, even in an era of AI.

Purpose: This study assesses independent variables associated with recent US MD-granting medical school graduates' intention, at graduation, to practice in underserved areas (underserved practice intention [UPI]).

Method: This retrospective cohort study used national deidentified graduate-respondent data from the Association of American Medical Colleges' Graduation Questionnaire (among other sources) from 2018-2019 through 2021-2022 to perform bivariate analysis and multilevel (graduates nested by school) logistic regression, examining independent associations between demographic characteristics, early-career intentions, medical school exposures and setting, and postgraduation professional plans and whether respondents had UPI at graduation.

Results: Among 56,484 respondents from 142 schools, 15,889 (28%) reported UPI (median, 26%; range, 11%-69%; P < .001). In multilevel logistic regression, UPI likelihood was higher among graduates from low vs high socioeconomic backgrounds (adjusted odds ratio [AOR], 1.21; 95% CI, 1.15-1.28), from rural vs nonrural backgrounds (AOR, 1.60; 95% CI, 1.47-1.75), with vs without UPI at matriculation (AOR, 7.87; 95% CI, 7.07-8.76), who reported participation in 2 or more vs 0 preparatory electives for working with underserved communities (2 electives: AOR, 1.26; 95% CI, 1.11-1.42; 6 electives: AOR, 3.02; 95% CI, 2.63-3.48), and planning general primary care (AOR, 3.40; 95% CI, 3.15-3.67) or emergency medicine (AOR, 2.25; 95% CI, 2.07-2.44) specialties, each vs internal medicine with a subspecialty. UPI likelihood was lower among graduates planning non-general surgical (AOR, 0.54; 95% CI, 0.49-0.60) and all other (nonsurgical) specialties (AOR, 0.58; 95% CI, 0.54-0.63).

Conclusions: This study identified demographic characteristics, early-career intentions, medical school exposures, and postgraduation professional plans associated with increased odds of UPI at graduation. These findings highlight multiple points in the medical education continuum where UPI might be fostered or sustained among students with varied backgrounds, exposures, and career plans, supporting medical school efforts that contribute to physician workforce needs in underserved areas.

The accelerating integration of artificial intelligence (AI) into clinical practice presents a profound challenge to conventional medical education and assessment. Legacy assessment methods, focused on individual knowledge recall, fail to evaluate the competencies required for effective human-AI partnership. While numerous AI competency frameworks have emerged, they often overlook the synergistic wisdom needed for true collaboration. To address this gap, this article introduces and defines collaborative intelligence (CI), a dyad-centric construct focusing on the emergent capabilities of the human-AI team. CI represents the capability to critically appraise, ethically integrate, and judiciously act upon AI-derived insights. Its 5 core components are delineated: critical AI appraisal, information synthesis, adaptive judgment, ethical reasoning, and effective human-AI interaction. Subsequently, it proposes a novel assessment framework that discards rigid, time-based training stages in favor of a 4-stage competency spiral (novice to expert). This programmatic approach systematically maps assessment methods-including workplace-based assessments, high-fidelity simulations, and script concordance testing-to each CI component across the developmental spiral. Reengineering assessment to effectively measure CI is presented not merely as a technical adjustment but as a strategic imperative for cultivating physicians who possess the wisdom to harness algorithmic power while upholding the humanistic core of medicine, thereby ensuring safe and equitable care in the coming century.

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: This study aimed to assess the capacity of the Clinician Educator Milestones to distinguish between those who place less career emphasis on clinical education and those who have been recognized by their peers for their teaching abilities.

Method: The authors conducted a survey (January-April 2024) of clinician educators at Johns Hopkins University School of Medicine who were nominated by their peers for an institutional educator award between 2012 and 2023. Award nominees who responded were asked to identify 2 colleagues of similar academic rank who would not identify educator as their lead identity (control respondents). Respondents from both groups self-assessed from level 1 (novice) to 5 (expert) across the 20 subcompetencies of the Clinician Educator Milestones. The authors tested for differences between award nominees and the comparison group and for differences based on demographic characteristics. Statistical significance was set at P < .0025 to account for multiple comparisons.

Results: Of the 85 award nominees contacted, 71 (84%) completed the survey, compared to 91 (66%) of the 138 individuals in the control group. Award nominees rated themselves higher on 18 of the 20 subcompetencies compared to the control group. No statistically significant differences were found for commitment to professional responsibilities or leadership skills (P = .107 and .064, respectively). No subcompetencies reached the adjusted significance threshold when comparing across demographic groups.

Conclusions: The findings of this study suggest that the Clinician Educator Milestones can effectively differentiate between educators nominated by their peers for an institutional education award and other educators and showed few differences based on demographic characteristics. These findings support the milestones' potential utility for self-assessment and educator development. Further study of the milestones would add valuable information with which to compare these findings.