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Matchett CL, Usher EL, Ratelle JT, Suarez DA, Leep Hunderfund AN, Aragon Sierra AM, Sawatsky AP. Physician Humility: A Review and Call to Revive Virtue in Medicine. Ann Intern Med 2024. [PMID: 39074373 DOI: 10.7326/m24-0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Physician virtues, including humility, are crucial for shaping a physician's identity and practice. The health care literature offers varied views on humility, and the rising call for discussing virtues as a framing for professional identity formation underscores the need for a clearer understanding of physician humility. This review aimed to develop a cohesive conceptualization of physician humility and to define how it functions in medical practice. To achieve this, a comprehensive search was done across PubMed, Ovid MEDLINE, Web of Science, Embase, ERIC, and PsycInfo, covering all records up to 30 October 2023. Articles were included if they discussed physician humility and excluded if they were unrelated to physician humility, focused on nonphysician health professionals, lacked conceptual depth, or focused solely on cultural humility. An applied thematic analysis was conducted. The results provide a synthesized conceptualization of physician humility across stances toward self, others, and the profession. The included articles identified the pivotal role of physician humility within the following 5 domains of medical practice: learning and professional growth, navigating error, uncertainty tolerance, trust and entrustment, and teamwork and communication. The authors highlight some of the intrapersonal, interpersonal, and sociocontextual challenges to cultivating and practicing physician humility. These findings highlight the importance of promoting humility in shaping physicians' actions, thoughts, and relationships with patients, colleagues, and their profession. Integrating such virtues as humility into medical education is essential for upholding the ideals of the medical profession and cultivating moral agents who engage in self-reflection and embody the principles of exemplary physicians.
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Affiliation(s)
- Caroline L Matchett
- Mayo Clinic, Rochester, Minnesota (C.L.M., E.L.U., J.T.R., D.A.S., A.N.L.H., A.P.S.)
| | - Ellen L Usher
- Mayo Clinic, Rochester, Minnesota (C.L.M., E.L.U., J.T.R., D.A.S., A.N.L.H., A.P.S.)
| | - John T Ratelle
- Mayo Clinic, Rochester, Minnesota (C.L.M., E.L.U., J.T.R., D.A.S., A.N.L.H., A.P.S.)
| | - Diego A Suarez
- Mayo Clinic, Rochester, Minnesota (C.L.M., E.L.U., J.T.R., D.A.S., A.N.L.H., A.P.S.)
| | | | | | - Adam P Sawatsky
- Mayo Clinic, Rochester, Minnesota (C.L.M., E.L.U., J.T.R., D.A.S., A.N.L.H., A.P.S.)
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Caretta-Weyer HA, Smirnova A, Barone MA, Frank JR, Hernandez-Boussard T, Levinson D, Lombarts KMJMH, Lomis KD, Martini A, Schumacher DJ, Turner DA, Schuh A. The Next Era of Assessment: Building a Trustworthy Assessment System. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:12-23. [PMID: 38274558 PMCID: PMC10809864 DOI: 10.5334/pme.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Assessment in medical education has evolved through a sequence of eras each centering on distinct views and values. These eras include measurement (e.g., knowledge exams, objective structured clinical examinations), then judgments (e.g., workplace-based assessments, entrustable professional activities), and most recently systems or programmatic assessment, where over time multiple types and sources of data are collected and combined by competency committees to ensure individual learners are ready to progress to the next stage in their training. Significantly less attention has been paid to the social context of assessment, which has led to an overall erosion of trust in assessment by a variety of stakeholders including learners and frontline assessors. To meaningfully move forward, the authors assert that the reestablishment of trust should be foundational to the next era of assessment. In our actions and interventions, it is imperative that medical education leaders address and build trust in assessment at a systems level. To that end, the authors first review tenets on the social contextualization of assessment and its linkage to trust and discuss consequences should the current state of low trust continue. The authors then posit that trusting and trustworthy relationships can exist at individual as well as organizational and systems levels. Finally, the authors propose a framework to build trust at multiple levels in a future assessment system; one that invites and supports professional and human growth and has the potential to position assessment as a fundamental component of renegotiating the social contract between medical education and the health of the public.
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Affiliation(s)
- Holly A. Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Alina Smirnova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A. Barone
- NBME, Philadelphia, Pennsylvania, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jason R. Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, CA
| | | | - Dana Levinson
- Josiah Macy Jr Foundation, Philadelphia, Pennsylvania, USA
| | - Kiki M. J. M. H. Lombarts
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, NL
- Amsterdam Public Health research institute, Amsterdam, NL
| | - Kimberly D. Lomis
- Undergraduate Medical Education Innovations, American Medical Association, Chicago, Illinois, USA
| | - Abigail Martini
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel J. Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David A. Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Abigail Schuh
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Carrillo-Avalos BA, Leenen I, Trejo-Mejía JA, Sánchez-Mendiola M. Bridging Validity Frameworks in Assessment: Beyond Traditional Approaches in Health Professions Education. TEACHING AND LEARNING IN MEDICINE 2023:1-10. [PMID: 38108266 DOI: 10.1080/10401334.2023.2293871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Construct: High-stakes assessments measure several constructs, such as knowledge, competencies, and skills. In this case, validity evidence for test scores' uses and interpretations is of utmost importance, because of the consequences for everyone involved in their development and implementation. Background: Educational assessment requires an appropriate understanding and use of validity frameworks; however, health professions educators still struggle with the conceptual challenges of validity, and frequently validity analyses have a narrow focus. Important obstacles are the plurality of validity frameworks and the difficulty of grounding these abstract concepts in practice. Approach: We reviewed the validity frameworks literature to identify the main elements of frequently used models (Messick and Kane's) and proposed linking frameworks including Russell's recent overarching proposal. Examples are provided with commonly used assessment instruments in health professions education. Findings: Several elements in these frameworks can be integrated into a common approach, matching and aligning Messick's sources of validity with Kane's four inference types. Conclusions: This proposal to contribute evidence for assessment inferences may provide guidance to understanding the use of validity evidence in applied settings. The evolving field of validity research provides opportunities for its integration and practical use in health professions education.
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Affiliation(s)
| | - Iwin Leenen
- Faculty of Psychology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | | | - Melchor Sánchez-Mendiola
- Faculty of Medicine, UNAM, Mexico City, Mexico
- Educational Innovation and Distance Education, UNAM, Coordination of Open University, Mexico City, Mexico
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Spicer JO, Ujunwa KC, Witt LS, Meka J, Gooding HC. Using instructor-developed study resources to increase evidence-based learning strategies among medical students: A mixed-methods study. MEDICAL TEACHER 2023; 45:1380-1386. [PMID: 37270765 PMCID: PMC11002966 DOI: 10.1080/0142159x.2023.2218537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Applying effective learning strategies to address knowledge gaps is a critical skill for lifelong learning, yet prior studies demonstrate that medical students use ineffective study habits. METHODS To address this issue, the authors created and integrated study resources aligned with evidence-based learning strategies into a medical school course. Pre-/post-course surveys measured changes in students' knowledge and use of evidence-based learning strategies. Eleven in-depth interviews subsequently explored the impact of the learning resources on students' study habits. RESULTS Of 139 students, 43 and 66 completed the pre- and post-course surveys, respectively. Students' knowledge of evidence-based learning strategies was unchanged; however, median time spent using flashcards (15% to 50%, p < .001) and questions (10% to 20%, p = .0067) increased while time spent creating lecture notes (20% to 0%, p = .003) and re-reading notes (10% to 0%, p = .009) decreased. In interviews, students described four ways their habits changed: increased use of active learning techniques, decreased time spent creating learning resources, reviewing content multiple times throughout the course, and increased use of study techniques synthesizing course content. CONCLUSION Incorporating evidence-based study resources into the course increased students' use of effective learning techniques, suggesting this may be more effective than simply teaching about evidence-based learning.
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Affiliation(s)
- Jennifer O. Spicer
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Katherine C. Ujunwa
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucy S. Witt
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer Meka
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Holly C. Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Smith JF, Piemonte NM. The Problematic Persistence of Tiered Grading in Medical School. TEACHING AND LEARNING IN MEDICINE 2023; 35:467-476. [PMID: 35619232 DOI: 10.1080/10401334.2022.2074423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Issue: The evaluation of medical students is a critical, complex, and controversial process. It is tightly woven into the medical school curriculum, beginning at the inception of the medical student's professional journey. In this respect, medical student evaluation is among the first in a series of ongoing, lifelong assessments that influence the interpersonal, ethical, and socioeconomic dimensions necessary for an effective physician workforce. Yet, tiered grading has a questionable historic pedagogic basis in American medical education, and evidence suggests that tiered grading itself is a source of student burnout, anxiety, depression, increased competitiveness, reduced group cohesion, and racial biases. Evidence: In its most basic form, medical student evaluation is an assessment of the initial cognitive and technical competencies ultimately needed for the safe and effective practice of contemporary medicine. At many American medical schools, such evaluation relies largely on norm-based comparisons, such as tiered grading. Yet, tiered grading can cause student distress, is considered unfair by most students, is associated with biases against under-represented minorities, and demonstrates inconsistent correlation with residency performance. While arguments that tiered grading motivates student performance have enjoyed historic precedence in academia, such arguments are not supported by robust data or theories of motivation. Implications: Given the evolving recognition of the deleterious effects on medical student mental health, cohesiveness, and diversity, the use of tiered grading in medical schools to measure or stimulate academic performance, or by residency program directors to distinguish residency applicants, remains questionable. Examination of tiered grading in its historical, psychometric, psychosocial, and moral dimensions and the various arguments used to maintain it reveals a need for investigation of, if not transition to, alternative and non-tiered assessments of our medical students.
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Affiliation(s)
- James F Smith
- Departments of Medical Education and Medical Humanities, Creighton University, Omaha, Nebraska, USA
| | - Nicole M Piemonte
- Departments of Medical Humanities and Student Affairs, Creighton University, Phoenix, Arizona, USA
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TAYLOR LAURENA, NONG PAIGE, PLATT JODYN. Fifty Years of Trust Research in Health Care: A Synthetic Review. Milbank Q 2023; 101:126-178. [PMID: 36689251 PMCID: PMC10037697 DOI: 10.1111/1468-0009.12598] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023] Open
Abstract
Policy Points First, policymakers can create conditions that will facilitate public trust in health care organizations by making creating and enforcing health policies that make exploitative behavior costly. Second, policymakers can bolster the trustworthiness of health care markets and organizations by using their regulatory authority to address and mitigate harm from conflicts-of-interest and regulatory capture. Third, policymakers and government agencies can further safeguard the public's trust by being transparent and effective about their role in the provision of health services to the public. CONTEXT Trust plays a critical role in facilitating health care delivery and calls for rebuilding trust in health care are increasingly commonplace. This article serves as a primer on the trust literature for health policymakers, organizational leaders, clinicians, and researchers based on the long history of engagement with the topic among health policy and services researchers. METHODS We conducted a synthetic review of the health services and health policy literatures on trust since 1970. We organize our findings by trustor-trustee dyads, highlighting areas of convergence, tensions and contradictions, and methodological considerations. We close by commenting on the challenges facing the study of trust in health care, the potential value in borrowing from other disciplines, and imperatives for the future. FINDINGS We identified 725 articles for review. Most focused on patients' trust in clinicians (n = 499), but others explored clinicians' trust in patients (n = 11), clinicians' trust in clinicians (n = 69), and clinician/patient trust in organizations (n = 19) and systems (n = 127). Across these five subliteratures, there was lack of consensus about definitions, dimensions, and key attributes of trust. Researchers leaned heavily on cross-sectional survey designs, with limited methodological attention to the relational or contextual realities of trust. Trust has most commonly been treated as an independent variable related to attitudinal and behavioral outcomes. We suggest two challenges have limited progress for the field: (1) conceptual murkiness in terms and theories, and (2) limited observability of the phenomena. Insights from philosophy, sociology, economics, and psychology offer insights for how to advance both the theoretical and empirical study of health-related trust. CONCLUSION Conceptual clarity and methodological creativity are critical to advancing health-related trust research. Although rigorous research in this area is challenging, the essential role of trust in population health necessitates continued grappling with the topic.
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Affiliation(s)
| | - PAIGE NONG
- University of Michigan School of Public HealthAnn ArborUSA
| | - JODYN PLATT
- University of Michigan Medical SchoolAnn ArborUSA
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7
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Geraghty JR, Russel SM, Renaldy H, Thompson TM, Hirshfield LE. One test to rule them all: A qualitative study of formal, informal, and hidden curricula as drivers of USMLE "exam mania". PLoS One 2023; 18:e0279911. [PMID: 36735699 PMCID: PMC9897523 DOI: 10.1371/journal.pone.0279911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/18/2022] [Indexed: 02/04/2023] Open
Abstract
High-stakes examinations are an integral part of medical education. To practice in the United States (U.S.), students must pass the U.S. Medical Licensing Examinations (USMLE). With the transition of USMLE Step 1 to pass/fail scoring on January 26, 2022, a worldwide debate regarding how residency program directors will view the Step 2 Clinical Knowledge (CK) exam emerged. Here, the authors explore the role of formal, informal, and hidden curricula related to USMLE, with broader implications for high-stakes examinations. Six focus groups of fourth-year students who recently took Step 2 CK and a supplemental curricular content analysis were conducted to explore students' decision-making and emotions regarding the exam, including how the formal, informal, and hidden curricula influence their perspectives. Participants highlighted how informal and hidden curricula drive the belief that high-stakes examinations are the single most important factor in medical school. Prior experience with Step 1 drives behaviors and attitudes when preparing for Step 2 CK. Pressures from these examinations have unintended consequences on burnout, professional identity, specialty choice, and interpersonal interactions. Both interpersonal interactions within medical education as well as subconscious, unintended messaging can influence medical student approaches to and perspectives about high-stakes examinations. Within the context of U.S. medical training, with the transition to a new era of a pass/fail Step 1 examination, careful consideration to prevent shifting the current "Step 1 mania" to a "Step 2 CK mania" is warranted. More broadly, medical educators must examine the unintended yet potentially damaging pressures institutions generate in their medical trainees in relation to high-stakes examinations.
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Affiliation(s)
- Joseph R. Geraghty
- Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois, United States of America
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Sarah M. Russel
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Hilary Renaldy
- Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Trevonne M. Thompson
- Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois, United States of America
- Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Laura E. Hirshfield
- Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois, United States of America
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Hafferty FW. Future proofing medical education: The case for a confrontationally oriented and hidden curriculum informed restructuring of professional preparation. CLINICAL TEACHER 2022. [DOI: 10.1111/tct.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Frederic W. Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values Mayo Clinic Rochester Minnesota USA
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9
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Underman K, Kochunilathil M, McLean L, Vinson AH. Online student culture as site for negotiating assessment in medical education. Soc Sci Med 2022; 310:115270. [PMID: 36030626 DOI: 10.1016/j.socscimed.2022.115270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Classic studies of medical education have examined how professional socialization reproduces the prevailing professional culture, as well as how students actively negotiate their place in educational processes. However, sociological research has not re-examined student culture in light of structural transformations in medical education, such as the introduction of new assessment types and their use as modes of commensuration. In this paper, we examine data from two studies of online forums where medical trainees and applicants to medical school discuss their experiences preparing for tests of professional skills, including judgment, empathy, and communication. Examining how medical students talk about these tests on such forums allows us to understand the meaning-making processes at work as students negotiate the commensuration processes such tests enable. We examine how these negotiations take place in online forums, where participants confront common challenges, form common perspectives, and share common solutions, all hallmarks of student culture. Through qualitative analysis, we find that online communities are spaces where students grapple with these new forms of commensuration, interrogate the standards and quantifications that underlie them, and collectively negotiate how to approach these assessments. Using the case of online forum communities, our findings advance past work on student culture in medical sociology by theorizing student culture as an extra-organizational phenomenon that spans multiple career stages. In so doing, we highlight the importance of online forum data for studying social processes.
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Affiliation(s)
| | | | - Lauren McLean
- Central Michigan University College of Medicine, USA
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10
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Zaidi Z. Teaching: The expression of freedom? MEDICAL EDUCATION 2022; 56:787-790. [PMID: 35670766 DOI: 10.1111/medu.14849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Zareen Zaidi
- Division of General Internal Medicine, George Washington School of Medicine & Health Sciences, Washington, District of Columbia, USA
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11
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Chan TM, Dowling S, Tastad K, Chin A, Thoma B. Integrating training, practice, and reflection within a new model for Canadian medical licensure: a concept paper prepared for the Medical Council of Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:68-81. [PMID: 36091730 PMCID: PMC9441128 DOI: 10.36834/cmej.73717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In 2020 the Medical Council of Canada created a task force to make recommendations on the modernization of its practices for granting licensure to medical trainees. This task force solicited papers on this topic from subject matter experts. As outlined within this Concept Paper, our proposal would shift licensure away from the traditional focus on high-stakes summative exams in a way that integrates training, clinical practice, and reflection. Specifically, we propose a model of graduated licensure that would have three stages including: a trainee license for trainees that have demonstrated adequate medical knowledge to begin training as a closely supervised resident, a transition to practice license for trainees that have compiled a reflective educational portfolio demonstrating the clinical competence required to begin independent practice with limitations and support, and a fully independent license for unsupervised practice for attendings that have demonstrated competence through a reflective portfolio of clinical analytics. This proposal was reviewed by a diverse group of 30 trainees, practitioners, and administrators in medical education. Their feedback was analyzed and summarized to provide an overview of the likely reception that this proposal would receive from the medical education community.
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Affiliation(s)
- Teresa M Chan
- Division of Emergency Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University
- Division of Education & Innovation, Department of Medicine
- Faculty of Health Sciences, McMaster University; McMaster Education Research, Innovation, and Theory (MERIT) program
- Office of Continuing Professional Development; Faculty of Health Sciences, McMaster University
| | - Shawn Dowling
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary
| | - Kara Tastad
- Royal College Emergency Medicine Training Program, University of Toronto
| | - Alvin Chin
- Division of Emergency Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan
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Tackett S, Jeyaraju M, Moore J, Hudder A, Yingling S, Park YS, Grichanik M. Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams. BMC MEDICAL EDUCATION 2022; 22:16. [PMID: 34983481 PMCID: PMC8728922 DOI: 10.1186/s12909-021-03055-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/17/2021] [Indexed: 05/15/2023]
Abstract
BACKGROUND Nearly all U.S. medical students engage in a 4-8 week period of intense preparation for their first-level licensure exams, termed a "dedicated preparation period" (DPP). It is widely assumed that student well-being is harmed during DPPs, but evidence is limited. This study characterized students' physical, intellectual, emotional, and social well-being during DPPs. METHODS This was a cross-sectional survey sent electronically to all second-year students at four U.S. medical schools after each school's respective DPP for USMLE Step 1 or COMLEX Level 1 in 2019. Survey items assessed DPP characteristics, cost of resources, and perceived financial strain as predictors for 18 outcomes measured by items with Likert-type response options. Open-ended responses on DPPs' influence underwent thematic analysis. RESULTS A total of 314/750 (42%) students completed surveys. DPPs lasted a median of 7 weeks (IQR 6-8 weeks), and students spent 70 h/week (IQR 56-80 h/week) studying. A total of 62 (20%) reported experiencing a significant life event that impacted their ability to study during their DPPs. Most reported 2 outcomes improved: medical knowledge base (95%) and confidence in ability to care for patients (56%). Most reported 9 outcomes worsened, including overall quality of life (72%), feeling burned out (77%), and personal anxiety (81%). A total of 25% reported paying for preparation materials strained their finances. Greater perceived financial strain was associated with worsening 11 outcomes, with reported amount spent associated with worsening 2 outcomes. Themes from student descriptions of how DPPs for first-level exams influenced them included (1) opportunity for synthesis of medical knowledge, (2) exercise of endurance and self-discipline required for professional practice, (3) dissonance among exam preparation resource content, formal curriculum, and professional values, (4) isolation, deprivation, and anguish from competing for the highest possible score, and (5) effects on well-being after DPPs. CONCLUSIONS DPPs are currently experienced by many students as a period of personal and social deprivation, which may be worsened by perceived financial stress more than the amount of money they spend on preparation materials. DPPs should be considered as a target for reform as medical educators attempt to prevent student suffering and enhance their well-being.
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Affiliation(s)
- Sean Tackett
- Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL Center Tower Suite 2300, Baltimore, MD 21224 USA
| | | | - Jesse Moore
- Larner College of Medicine at the University of Vermont, Burlington, USA
| | - Alice Hudder
- Lake Erie, College of Osteopathic Medicine, Erie, USA
| | | | - Yoon Soo Park
- Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - Mark Grichanik
- David Geffen School of Medicine at UCLA, Los Angeles, USA
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13
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Affiliation(s)
- Joseph H Wu
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Philip A Gruppuso
- Departmentof Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eli Y Adashi
- Medical Science, Medicine, and Biological Sciences, Brown University, Providence, Rhode Island
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de Carvalho Filho MA, Hafferty FW, Pawlina W. Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19. ANATOMICAL SCIENCES EDUCATION 2021; 14:528-535. [PMID: 34363339 PMCID: PMC9135058 DOI: 10.1002/ase.2130] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 05/07/2023]
Abstract
The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.
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Affiliation(s)
- Marco Antonio de Carvalho Filho
- Life and Health Sciences Research InstituteSchool of MedicineUniversity of MinhoBragaPortugal
- Center for Education Development and Research in Health Professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University Medical Centre GroningenGroningenThe Netherlands
| | - Frederic W. Hafferty
- Division of General Internal MedicineDepartment of MedicineMayo Clinic College of Medicine and ScienceMayo ClinicRochesterMinnesotaUSA
- Program in Professionalism and ValuesMayo ClinicRochesterMinnesotaUSA
| | - Wojciech Pawlina
- Department of Clinical AnatomyMayo Clinic College of Medicine and ScienceMayo ClinicRochesterMinnesotaUSA
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15
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Michalec B. MCAT Testing During the COVID-19 Pandemic. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1292-1293. [PMID: 32483014 PMCID: PMC7288772 DOI: 10.1097/acm.0000000000003526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Barret Michalec
- Associate dean of interprofessional education, College of Health Sciences, University of Delaware, Newark, Delaware;
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Roberts LW. High Road, Low Road: Professionalism, Trust, and Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:817-818. [PMID: 32452849 DOI: 10.1097/acm.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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