MedEdPublish (2016)最新文献

Background: Clinical reasoning processes involve gathering and interpreting information, creating differential diagnoses and testing hypotheses to inform and guide patient management. Effective clinical reasoning is an essential graduate outcome for medical students to ensure safe and efficient care of patients. In the clinical setting, a large proportion of hospital-related adverse events are attributed to errors in cognitive processes rather than knowledge, including diagnostic reasoning and decision-making. Teaching clinical reasoning is challenging due to its implicit nature, typically relying on internal thinking processes, pattern recognition and the use of prior clinical experiences. Current conventional teaching relies on student-driven application of clinical reasoning during their rotations as part of a hidden curriculum, which can be highly variable, unstructured, non-standardised, with limited oversight from faculty and with few opportunities for feedback. Furthermore, current barriers exist, including difficulties in teaching and assessing clinical reasoning. Due to this, many educators and faculty agree upon the significance of embedding explicit teaching and assessment of clinical reasoning into the curriculum, however the best approach remains poorly characterised.

Methods: A narrative synthesis was undertaken from the current literature and the authors' collective experience. The synthesis distils this information into ten practical tips to guide design, integration and innovation of clinical reasoning teaching in medical education.

Results: Ten tips were identified to support educators' efforts in embedding clinical reasoning into curriculum design and teaching. Together, these ten tips promote explicit, reflective and contextual clinical reasoning learning within the contemporary medical curriculum.

Conclusions: Clinical reasoning requires deliberate, longitudinal and student-centred approaches that are integrated within authentic situated learning experiences. The ten tips provide avenues for more evidence-based adoption of effective learning environments that focus on clinical reasoning skills development.

Purpose: The purpose of this study was to explore whether there were lasting effects of brief implicit bias education on clinicians' teaching and practice one year after taking the course and whether implicit and explicit bias was associated with self-reported impact of the course.

Method: This was a mixed-method study. We followed up with a sample of 119 academic clinicians who completed the baseline study December 2019. Recruitment for the current study was conducted between December 2020 and March 2021. Participants responded online to survey questions about whether the course had an impact on their teaching and practice. We categorized qualitative responses to these questions using Prochaska & DiClemente's Stages of Change Model of Behavior Change. Implicit and explicit race and gender bias data were collected at baseline.

Results: Response rate was 47.1% (N=56). Participants were 64.3% female, 66.1% White, 67.9% were Medical Doctors (MD) and 82.1% work in an academic healthcare system. Overall, we found slight implicit pro-White bias (mean= 0.27, SD 0.45, p=<0.001) and male-career gender bias (mean= 0.33, SD 0.31, p=<0.001). Across all four questions 42 unique participants (75.0%) responded to at least one question reporting, " yes", the course had an impact on their teaching/mentoring and or practice. Thirty-five (62.5%) participants reported that the course had an impact on their teaching and 23 (41.4%) reported an impact on their clinical practice. Participants reported 35 instances of increased bias awareness and 47 instances of actions taken due to the course. Those who reported no impact of the course on teaching held no implicit race bias, while those who reported actions taken held moderate implicit Pro-White bias.

Conclusions: This study found that the majority of study participants reported lasting effects of the course on their teaching and/or practice. Brief implicit bias education can impact clinicians' teaching and practice. .

Background: Discharge summary (DS) is an essential clinical document for hospitalized patients. Writing effective DS is a core competency of intern doctors upon entering clinical practice. However, this skill is often underdeveloped due to its exclusion from most medical school curricula, resulting in suboptimal DS quality and communication breakdowns.

Methods: We conducted a one-day, in-person DS writing workshop in June 2025 for 58 final year medical students prior to hospital internship. The workshop comprised of pre-workshop assessments, didactic lectures on DS writing skills, small-group appraisals, and post-workshop assessments with tutor feedback. Pre- and post-workshop surveys assessed participants' perceptions of DS writing and workshop effectiveness using a 5-point Likert scale. DS samples from pre- and post-workshop assessments were graded by three blinded specialist doctors using a 10-component rubric (maximum score: 30, 3 in each component).

Results: 98.2% of participants agreed that the workshop improved their DS writing skills and would recommend it to others. Survey reponses showed significant post-workshop improvements in understanding purposes and structure of DS (p<0.001), the requirements for an effective DS (p<0.001), confidence in writing an effective DS (p<0.001), and completing it within 10 minutes (p=0.002). Objective assessment scores also improved significantly across most DS key components and for the total score (20.53 ± 2.86 vs 15.54 ± 3.86, p<0.001).

Conclusions: This is the first report in the literature describing a DS writing educational intervention for orthopedics, as previous reports focused mainly on internal medicine and were not tailored to the specifics of an orthopedic or surgical admission such as procedures, complications, and post-operative instructions. This pilot program improved students' performance and confidence in DS writing. It highlights the importance in incorporating competency-based, hands-on DS training as a routine component in medical education to better prepare interns for inpatient clinical practice.

Background: As the incidence of skin cancer is growing and access to specialty care is becoming more limited in most settings, family physicians must take on an increasing role in detecting and managing skin cancer. Unfortunately, most family physicians are not adequately trained to perform the skin biopsies or excisions needed to do this.

Aims and methods: Drawing on their own experience and the available literature, the authors present practical tips for clinical educators to teach skin procedures more effectively. Some of the tips are best applied in an academic centre with multiple learners; others are applicable to all settings.

Conclusions: Family medicine training programs have a responsibility to ensure that their learners gain adequate expertise to diagnose skin cancers. This includes the ability to perform skin biopsies. These tips will help educators and institutions training family medicine residents design more effective ways to teach skin procedures.

Introduction: Generative AI (GenAI) tools are transforming health professions education, offering opportunities to enhance faculty development (FD). Faculty developers are uniquely positioned to integrate GenAI into practice to address resource constraints, improve accessibility, and foster equity across diverse educational contexts. This Applied Insights article offers a perspective on how GenAI can be leveraged as a co-developer in FD by drawing on emerging literature and discussion points from a workshop at the 8th International Faculty Development Conference in the Health Professions.

Applied insights: The applied insights are structured around key phases of FD: planning, content creation, delivery, and evaluation. They include actionable strategies for using GenAI in needs assessment, multilingual and culturally relevant resource creation, personalized learning plans, and when providing feedback and mentorship. Each insight is rooted in pedagogical rationale, evidence, and strategies to address ethical and practical challenges, with an emphasis on human oversight, contextual relevance, and continuous evaluation of GenAI's impact.

Conclusions: By considering these insights, faculty developers can harness GenAI to co-design educational materials, extend their reach through innovative formats, and maintain ethical and equity-driven educational practices. This article highlights the transformative potential of GenAI in FD when thoughtfully integrated. GenAI can empower faculty developers to enhance the quality and inclusivity of HPE while safeguarding educational standards.

Background: Academic faculty development varies in scope and utility. Timely, specialty-specific faculty development helps support junior faculty and should be incorporated early in their academic careers. Junior faculty likely have the most to gain from faculty development but are rarely included in its creation. This study aimed to create and deploy an effective faculty development curriculum for junior emergency medicine (EM) faculty through experiential learning by using junior faculty as primary authors.

Methods: Eight senior faculty developed a list of high-yield topics. Seven junior faculty were assigned as primary authors for each of the topics according to interest. A senior faculty considered an expert in the area was assigned as a mentor. Topics were presented at a peer review session with all participants present. Following the session, participants took an electronic survey consisting primarily of 5 point Likert scale questions with an 86% response rate.

Results: Survey responses highlight faculty development as an academic gap and strongly support the curriculum's importance and effectiveness. All responding junior faculty and the majority of senior faculty strongly agreed that creation of the modules and participation in the peer review process improved their knowledge (median of 5 for both questions). All respondents strongly agreed the topics covered were important and should be mandatory for all new academic faculty.

Conclusions: Using junior faculty as primary authors to create a specialty and institutional specific faculty development curriculum is an effective approach to create and deliver a curriculum. This method is cost-effective, well-received and sustainable as it builds on and strengthens pre-existing resources and relationships. This method also succeeded in creating a community of practice dedicated to sharing knowledge and skills around medical education. Given its generalizable framework, this model of curriculum development could likely be deployed in any graduate medical program regardless of specialty.

Background: Physician burnout remains a defining challenge in medical education, driven by excessive demands and fragmented wellness initiatives. While calls for systemic reform grow louder, many efforts lack a unifying framework capable of addressing both distress and the cultivation of professional fulfillment.

Methods: This guide applies a dual-theory lens-Self-Determination Theory (SDT) and the Job Demands-Resources (JD-R) model-to propose a systems-based approach to motivation and wellness. Drawing on empirical evidence and applied experience, it presents twelve actionable strategies across three ecological domains: the built environment, policy frameworks, and interpersonal dynamics. The first six strategies target hindrance demands that frustrate psychological needs and contribute to burnout; the next six strengthen resources that satisfy those needs and foster engagement, resilience, and well-being.

Results: The strategies offer flexible, theoretically grounded entry points for reform. Rather than prescribing rigid solutions, they aim to support institutions in cultivating sustainable, human-centered learning environments where wellness is embedded-not bolted on. Examples include prioritizing formative over high-stakes assessments, making justice and safety integral to institutional design, and balancing clinical responsibility with developmental support.

Conclusions: Integrating SDT and JD-R provides a rigorous, coherent, and scalable foundation for systems-level wellness initiatives. It reframes well-being not as the absence of burnout but as the presence of thriving-offering a shared language, validated metrics, and a roadmap for lasting cultural and structural transformation in medical education.

Clinical pharmacists are responsible for safe medication use in hospitals. Most clinical pharmacists are perfectionists. However, in their decision-making process, they have to embrace uncertainty, while interpreting available data, and integrating knowledge and clinical experience. In clinical practice, how to teach and master clinical pharmaceutical reasoning is unclear. We developed the DRIP framework including different aspects on drug, indication and patient and a stepwise approach to support clinical pharmaceutical reasoning by students, residents in hospital pharmacy and clinical pharmacists. The DRIP framework was first introduced during the daily report with residents and faculty of the clinical pharmacy. The framework was implemented in daily clinical practice to handle drug safety alerts, and to optimise drug therapy during ward rounds, multidisciplinary consultations, and in entrustmentbased discussions with residents. Pharmacists using the DRIP framework felt more confident that relevant aspects of a complex pharmaceutical problem had been considered, they learned to anticipate on the issues behind an apparently simple pharmaceutical question, and to explain their reasoning. Several CANMEDS roles can be simultaneously trained by using our approach. We are developing a course for residents in clinical pharmacy and pharmacology to teach the competency of clinical pharmaceutical reasoning using the DRIP framework.

Introduction: Strong skills in teaching for residents contribute to increased satisfaction and improved student interest. Few opportunities in medical education are offered at the junior resident level. We aim to evaluate the needs of residents in teaching at Université de Montréal (UdeM).

Methods: A 19-question survey created after a literature review was sent to all 769 current PGY1 to PGY3 residents at UdeM to assess their interest and needs in various aspects of clinical teaching. Descriptive statistics were analyzed through themes to make recommendations for improvements in medical education training.

Results: We received 65 completed surveys (8.5% response rate), mostly in family and internal medicine. Eighty percent of participants were interested in further training in teaching and 58% were interested in a medical education elective. Main skills to be improved are indirect supervision and adapting feedback to different learners. Lack of time was considered by most responders (89%) as the main factor limiting participation in further training. Narrative comments noted the lack of information on medical education resources and lack of recognition by faculty compared to clinical performance or research, particularly in family medicine.

Conclusion: Protected time for varied medical education activities is needed, including better offers for an elective rotation. Information on currently available resources should be more widely circulated. Promoting and recognizing teaching and reserving time for direct supervision by faculty of teaching by junior residents should be encouraged.

Background: Cognitive simulation where individuals deliberately rehearse procedural tasks using the mind without physical action has been demonstrated to improve technical skills across various disciplines such as aviation and elite sport. These practices however are used variably in medical education. Therefore, the efficacy and value of cognitive simulation in improving procedural skills of medical students remains unknown.

Methods: Medline, Embase, CINAHL, Emcare and the World Health Organisation (WHO) International Clinical Trials Registry Platform databases were searched for articles that explored cognitive simulation approaches for the procedural skills development of medical students. Outcomes of interest included improvements in technical skill and proficiency, non-technical skills such as confidence and stress management and intervention-related outcomes such as practicality and cost.

Results: 14 studies reporting results from randomised-controlled trials were included in this systematic review. Overall, studies demonstrated mixed results in technical and non-technical skill development across a variety of procedures. However, cognitive simulation offers a practical and cost-effective learning tool that is adaptable to a variety of procedural skills programs in contemporary medical curriculum.

Conclusion: This systematic review highlights the emerging potential for cognitive simulation to be adapted and integrated into standard procedural skills learning programs for medical students. However, the current evidence lacks robust insights into the efficacy of these programs due to heterogeneity of study design, specifics of the cognitive simulation program and approaches to assessment. Further research is necessary to explore the efficacy of standardised cognitive simulation programs to validate these findings.