Application of continuous quality improvement to medical education

Research and Practice in Quality Improvement and Implementation Science: The Synergy for Change Model

BACKGROUND

Nurses play an essential role in the achievement of quality depicted by the Quintuple Aim to improve clinical outcomes, patient experience, equity, provider well-being, and reduction of costs. When quality gaps occur, practice change is required and is facilitated by quality improvement (QI) and implementation science (IS) methods. QI and IS research are required to advance our understanding of the mechanisms that explain how evidence is implemented and improvements are made.

PROBLEM

Despite past efforts of the evidence-based practice and QI movements, challenges persist in sustaining practice improvements and translating research findings to direct patient care.

APPROACH

The purpose of this article is to describe the Synergy for Change Model that proposes that both QI and IS research and practice be used to accelerate improvements in health care quality.

CONCLUSIONS

Recognizing the synergy of QI and IS practice and research will accelerate nursing's contributions to high-quality and safe care.

Bridging Gaps: A Quality Improvement Project for the Continuing Medical Education on Stick (CMES) Program

BACKGROUND

Aimed at bridging the gap in continuing medical education (CME) resource availability in low- and middle-income countries (LMICs), the "Continuing Medical Education on Stick" (CMES) program introduces two technological solutions: a universal serial bus (USB) drive and the CMES-Pi computer facilitating access to monthly updated CME content without data cost. Feedback from users suggests a lack of content on tropical infectious diseases (IDs) and content from a Western perspective, which may be less relevant in LMIC settings.

METHODS

This quality improvement project was intended to identify areas for improvement of the CMES database to better meet the educational needs of users. We compared the CMES content with the American Board of Emergency Medicine (ABEM) Exam content outline to identify gaps. The curriculum map of the CMES library, encompassing content from 2019 to 2024, was reviewed. An anonymous survey was conducted among 47 global users to gather feedback on unmet educational needs and suggestions for content improvements. All healthcare workers who were members of the CMES WhatsApp group were eligible to participate in the survey.

RESULTS

The curriculum map included 2,572 items categorized into 23 areas. The comparison with the ABEM outline identified gaps in several clinical areas, including procedures, traumatic disorders, and geriatrics, which were represented -5%, -5%, and -4% in the CMES library compared with the ABEM outline, respectively. Free responses from users highlighted a lack of content on practical skills, such as electrocardiogram (ECG) interpretation and management of tropical diseases. Respondents identified emergency medical services (EMS)/prehospital care (81%), diagnostic imaging (62%), and toxicology/pharmacology (40%) as the most beneficial areas for clinical practice. In response to feedback from users, new content was added to the CMES platform on the management of sickle cell disease and dermatologic conditions in darkly pigmented skin. Furthermore, a targeted podcast series called "ID for Users of the CMES Program (ID4U)" has been launched, focusing on tropical and locally relevant ID, with episodes now being integrated into the CMES platform.

CONCLUSIONS

The project pinpointed critical gaps in emergency medicine (EM) content pertinent to LMICs and led to targeted enhancements in the CMES library. Ongoing updates will focus on including more prehospital medicine, diagnostic imaging, and toxicology content. Further engagement with users and education on utilizing the CMES platform will be implemented to maximize its educational impact. Future adaptations will consider local relevance over the ABEM curriculum to better serve the diverse needs of global users.

Impact of a Grand Rounds Interprofessional Workshop: student perceptions of interprofessional socialization and cultural humility

While uniprofessional education programs develop strong student identities, they may limit the development of behaviors needed for interprofessional socialization. Interprofessional education (IPE) creates an essential platform for student engagement in the development of interprofessional socialization and cultural humility, thus enabling improvement in collaborative communication. In this quasi-experimental observational study, health professional students attended one of three Grand Rounds Interprofessional Workshops (GRIW) and completed online pre- and post-workshop surveys including sociodemographic background, the Interprofessional Socialization and Valuing Scale (ISVS), and the Cultural Competence Self-Assessment Checklist (CCSAC). A total of 394 students from eight professions participated in the workshop with 287 (73%) of attendees completing both pre- and post-workshop surveys. No significant differences were observed in ISVS and CCSAC scores between students across workshops. Significant pre- to post-workshop differences were found in ISVS [t (284) = 13.5, p < .001, 95%], CCSAC [t (286) = 13.8, p < .001] and the cultural competence components of cultural awareness [t (285) = 12.9, p < .001, 95%], knowledge [t (285) = 9.5, p < .001, 95%], and skills [t (286) = 13.3, p < .001, 95%]. Interprofessional education learning opportunities that integrate socialization with health professional students and cultural humility education can improve educational awareness of cultural values and communication for collaborative professional practice.

Creation of a National Emergency Medicine Medical Education Journal Club

Background There are a relatively limited number of emergency medicine (EM) medical education (MedEd) fellowships with few trainees at each program, creating barriers to local collaboration and networking. While best practices for developing MedEd journal clubs exist, there has not been an established national EM MedEd journal club. To address this need, we created a national journal club, the Council of Residency Directors (CORD) MedEd Journal Club (MEJC), to facilitate collaboration and networking opportunities by providing a synchronous online journal club. Objectives Our primary objective was to create a network for collaboration across geographical barriers to form a virtual community of practice (CoP) around the shared domain of evidence-based MedEd. Our secondary objective was to improve MedEd fellows' knowledge, skills, and attitudes surrounding MedEd research. Tertiary objectives included (1) broadening fellow exposure to key topics within MedEd, (2) describing how to develop scholarly work within MedEd, and (3) filling a perceived need for building a national MedEd virtual CoP. Curricular design The concept and objectives of the CORD MEJC were introduced to fellows and fellowship directors through a national listserv in March of 2022. Fellows volunteered to lead virtual sessions via Zoom on a monthly basis. Session fellow leaders independently chose the topics and were asked to submit two to three journal club articles discussing the topic at least two weeks in advance of each session. No topics were repeated throughout the academic year.  Impact/effectiveness Our quality improvement survey results indicated that the CORD MEJC is meeting its primary and secondary objectives. Survey results will be utilized as part of a continuous quality improvement initiative to enhance our program structure and curricula for the 2023-2024 academic year.

Applying self-determination theory to stem medical schools' clinical teacher sustainability crisis

THE PROBLEM

Medical schools require highly skilled and committed clinical faculty to teach, assess, supervise and mentor students' clinical care. Medical education is facing a crisis in recruiting and sustaining these clinical teachers. Faced with multiple demands and responsibilities in fast-paced clinical environments, teachers may not have the time, resources or stamina to sustain these critical roles. Medical school leaders must commit to and provide structures and processes to attract, sustain and retain clinical teachers.

CONCEPTUAL FRAMEWORK

The authors use the lens of self-determination theory to frame approaches to support teacher sustainability. Self-determination theory describes sources of human motivation. The theory and its evidence base characterise three human psychological needs: autonomy, competence, and relatedness. This theory can bridge individual psychological and institutional leadership perspectives to help medical school leaders anticipate and respond to their clinical teachers' needs. The authors propose three practical steps: practices to advance employee-centredness, processes to align individual and institutional values, and restructuring education to support clinical teachers' needs alongside student and patient needs. The authors describe limitations to this relational approach that focuses on leadership actions and consider individual agency as another key factor for sustainability.

DISCUSSION

Medical school leaders can develop and apply theory-driven approaches to advance sustainability. Sustainability now and in the future requires careful attention to the needs of clinical teachers and to their relationships with and within medical schools.

A Quality Improvement Approach to Modification of a Point-of-Care Ultrasound Curriculum

Background

There is increasing emphasis on resident involvement in quality improvement (QI) efforts, yet resident engagement in QI has remained low for many reasons. Although QI methods are classically applied to clinical processes, there are many opportunities to incorporate QI principles into curricular design and implementation.

Objective

Demonstrate the utility of QI methods when applied to curricular design and the implementation of a novel point-of-care ultrasound portfolio development and quality assurance program at a large internal medicine residency program.

Methods

We applied foundational QI methods, including process mapping, plan-do-study-act (PDSA) cycles, time-trap identification, run-chart analysis, and qualitative interviews throughout the curricular design and implementation phases to rapidly identify areas for improvement and perform timely tests of change.

Results

Fifty-one interns participated in the curriculum, submitting 731 images in the first trimester. Process mapping and submission review revealed that 29% of images were saved to the incorrect digital archive. Resident-reviewer interpretation concordance was present in 80.7% of submissions. In 95.2% of completed quality assurance cards, the same information was provided in the commentary feedback and the evaluator's checklists, representing a time trap. Interventions included restricting access to image archives and removing redundant fields from quality assurance cards. The time to feedback fell from 69.5 to 6.5 days, demonstrating nonrandom variation via run-chart analysis.

Conclusion

This pilot study demonstrates the successful application of QI methods to a novel point-of-care ultrasound curriculum. The systematic use of these methodologies in curricular design and implementation allows expeditious curricular improvement. Emphasizing the relevance of QI methods to subject matter beyond clinical processes may increase resident engagement in QI efforts.

Evaluation of virtual problem-based tutorials in healthcare professional education

PURPOSE

To explore student and tutor perspectives on the learning efficacy of virtual, compared to in-person, problem-based tutorial (PBT) in occupational therapy, physiotherapy, and speech-language pathology health professional programs.

MATERIALS AND METHODS

This was a quality improvement study using a cross sectional survey at a single institution. Separate student and tutor surveys were disseminated online. Students received the survey at two timepoints, tutors received the survey at one timepoint. Descriptive statistics summarized quantitative survey questions. Chi-squared or Fischer's Exact analyses explored differences between in-person and virtual PBT. Exploratory analyses determined if associations amongst programs and/or between cohorts existed on variables of interest. Open-ended survey questions were analyzed using content analysis.

RESULTS

A total of 241 students and 85 tutors completed the survey. Results demonstrate most students and tutors were satisfied with the use of virtual tutorials (77%; 89% respectively) and felt that they were effective in exploring content within the PBT course. However, students in the most recent cohort rated virtual tutorials more highly (p = 0.01).

CONCLUSIONS

Virtual modes of PBT were successful in achieving course objectives and led to high satisfaction in users. Health professional programs can use this information when designing virtual problem-based tutorial courses in the post-pandemic era.

Pediatrics in Disasters: Evolution of a Hybrid Global Health Training Program During the COVID-19 Pandemic

This report describes the Pediatrics in Disasters (PEDS) course during a novel hybrid in-person and virtual format due to the coronavirus disease 2019 pandemic. International and local faculty collaborated on 2021 precourse revisions and course facilitation for multinational in-person and virtual students. Student and facilitator 2021 surveys and 2019 to 2021 student feedback reported overall satisfaction with the course while suggesting needed improvements to maximize international and virtual student participation. The hybrid PEDS course structure successfully achieved course goals and incorporated international faculty. Lessons learned will guide future course revisions and fellow global health educators.

A review of the American College of Surgeons accredited education institutes' assessment practices for learners, faculty, and continuous program improvement

Purpose

Simulation is an instructional modality that offers opportunities for assessment across many domains. The American College of Surgeons created the Accredited Education Institutes (AEIs) to build a community of high-quality simulation centers focused around improving surgical education and training. The goals of this project were to identify assessment methods used by AEIs, discuss how these methods align with established assessment frameworks, identify best practices, and provide guidance on best practice implementation.

Methods

The authors analyzed responses regarding learner assessment, faculty assessment, and continuous program improvement from AEI accreditations surveys using deductive qualitative analysis.

Results

Data from ninety-six centers were reviewed. Codes for each category were organized into formal and informal themes. For learner assessment, examinations and checklists identified as the most common types of formal assessment used and oral feedback as the most common type of informal assessment. For faculty assessment, written evaluations were the most common formal type and debriefs were the most common informal type. For continuous program improvement, written evaluations were the most common formal type and oral feedback was the most frequent informal type.

Discussion

The goal of assessment should be to encourage learning through feedback and to ensure the attainment of educational competencies. The data revealed a variety of assessment modalities used to accomplish this goal with AEIs frequently utilizing some of the most reliable forms of assessment. We discuss how these forms of assessment can be integrated with best practices to develop assessment portfolios for learners and faculty, performance improvement reports for faculty, and assessments of clinical impact.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-023-00132-6.

Paving the Way Forward for Evidence-Based Continuing Professional Development

ABSTRACT

Continuing professional development (CPD) fosters lifelong learning and enables health care providers to keep their knowledge and skills current with rapidly evolving health care practices. Instructional methods promoting critical thinking and decision making contribute to effective CPD interventions. The delivery methods influence the uptake of content and the resulting changes in knowledge, skills, attitudes, and behavior. Educational approaches are needed to ensure that CPD meets the changing needs of health care providers. This article examines the development approach and key recommendations embedded in a CE Educator's toolkit created to evolve CPD practice and foster a learning experience that promotes self-awareness, self-reflection, competency, and behavioral change. The Knowledge-to-Action framework was used in designing the toolkit. The toolkit highlighted three intervention formats: facilitation of small group learning, case-based learning, and reflective learning. Strategies and guidelines to promote active learning principles in CPD activities within different modalities and learning contexts were included. The goal of the toolkit is to assist CPD providers to design educational activities that optimally support health care providers' self-reflection and knowledge translation into their clinical environment and contribute to practice improvement, thus achieving the outcomes of the quintuple aim.

Scholarship in anesthesiology: the role of critical appraisal, literature review, quality improvement, journal club, and presentation skills

If asked to describe the term "anesthesiologist scholar", one may receive a variety of definitions depending on the individual's area of practice, location in the world, and the generation in which they trained. In this article, we review the roles of five core elements that make an anesthesiologist a "scholar": skills in critical appraisal, literature review, quality improvement, journal club participation, and presentation delivery. Although this list of scholarly components is not comprehensive, review of each element's role in the everyday practice and training of physicians will offer insight into their evolution and may offer a glimpse into the future of anesthesiologist scholars. Overall, through the dissemination, recognition, and support of scholarship through these practices, we will continue to achieve meaningful outcomes for our patients and promote a culture of collaboration worldwide. We should ensure that these topic areas become a bedrock of medical education globally, and we must foster opportunities for those who have already completed training to develop and master these skills as a part of their clinical and academic practice.

Disability inclusion in medical education: Towards a quality improvement approach

THE ISSUE

The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community.

OBSERVATIONS

Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care.

APPROACH

Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice.

CONCLUSION

We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.

How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review

INTRODUCTION

Medical students experience significant stress and impacts on mood due to multiple factors. Unmitigated stress impacts both physical and mental health while increasing the risk of unethical behavior. It is important for medical institutions to identify strategies that effectively reduce perceived stress and improve the well-being of their students.

METHODS

The authors undertook a scoping review of the literature to identify strategies implemented by medical educational programs to improve the well-being of medical students.

RESULTS

Of 1068 articles identified, 19 studies met the inclusion criteria. Interventions were categorized as mindfulness-based programs, reflection groups, curriculum changes, and 'miscellaneous.' All studies assessed outcomes of student stress/resilience, as well as additional domains including academic performance, mental health, and interpersonal skills. Some also assessed the acceptability of the intervention to students.

CONCLUSIONS

Despite the heterogeneity of interventions and outcome measures, a clear theme emerged that institutionally-provided strategies to promote student well-being tend to be effective when students opt into the program. It was noted that adding mandatory content or activities to a medical program without creating adequate space or support for it can have the opposite effect. Further high quality intervention studies involving randomization, blinding and rigorous controls are warranted.

The Harvard Medical School Pathways curriculum: A comprehensive curricular evaluation

PURPOSE

The Harvard Medical School Pathways curriculum represents a major reform effort. Our goals were to enhance reasoning and clinical skills and improve the learning environment and students' approach to learning via use of collaborative, case-based pedagogy; early clinical exposure; and enhanced approaches to teaching and evaluating clinical skills. We evaluated the impact of Pathways on key outcomes related to these goals.

MATERIALS AND METHODS

In this prospective, mixed-methods study, we compared the last prior-curriculum cohort (2014 matriculation, n = 135) and first new-curriculum cohort (2015 matriculation, n = 135). Measures included Likert-type surveys, focus groups, and test scores to assess outcomes.

RESULTS

Compared with prior-curriculum students, new-curriculum students reported higher mean preclerkship learning environment ratings (Educational Climate Inventory, 62.4 versus 51.9, p < 0.0001) and greater satisfaction with the quality of their preclerkship education (88% versus 73%, p = 0.0007). Mean USMLE Step-1 and Step-2 scores did not differ between groups. At graduation, new-curriculum students rated their medical school experience higher in 6 of 7 domains, including 'fostering a culture of curiosity and inquiry' (4.3 versus 3.9, p = 0.006) and focus on 'student-centered learning' (3.9 versus 3.4, p = 0.002).

CONCLUSIONS

The new curriculum outperformed or was equal to the prior one on most measures of learning environment and perceived quality of education, without a decline in medical knowledge or clinical skills. Robust longitudinal evaluation provided important feedback for ongoing curriculum improvement.

Developing Mentee Skills: A Curriculum Guide

The transition to the practice period presents challenges for both new graduates and their employers. Mentorship can support veterinary students' preparation for their career and improve their transition to practice. To actively and productively engage in mentoring, veterinary colleges can prepare students to develop their skills as mentees. The Western College of Veterinary Medicine developed a pilot mentee skills training program, woven through students' 4-year professional education. The curriculum emphasizes self-directed learning skills and competencies essential for lifelong learning. The pilot curriculum, with learning tools, is presented here.

Quality improvement for age-friendly care: an experiential model for instructing medical students in system-based practice

Early learning experiences in quality improvement (QI) can prepare medical students for practice in complex health systems and can improve processes of care for various groups, including older adult patients with multiple chronic conditions. We applied the Institute for Healthcare Improvement (IHI) Age-Friendly Health Systems 4Ms framework to a twelve-week geriatrics-focused QI project for third-year medical students training in rural medicine. Students (N = 40) conducted their projects at primary care practice sites and focused on the identified needs of older adult patients within the 4Ms framework areas of Mobility, Mentation, Medication, and What Matters. Students completed evaluation surveys to rate the usefulness of training and to self-assess knowledge and skills using five-point Likert-type items. Students (n = 23) reported increased knowledge and skills in conducting QI activities and improved understanding of the importance of improving processes and patient care. Such projects for QI training can support competency development in systems-based practice while also implementing practice frameworks for improving processes and patient care, such as the use of Age-Friendly practices and resources within a health care setting.

Graduate medical education-led continuous assessment of burnout and learning environments to improve residents' wellbeing

BACKGROUND

Promoting residents' wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents' wellness and learning.

OBJECTIVE

To determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents' burnout.

METHODS

From November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles.

RESULTS

The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents' positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents' self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents' perception of impaired personal relationships (p < 0.001), self-defined burnout (p = 0.013), program burn-out support (p = 0.002) and program back-up support (p = 0.028). For the Internal Medicine Residency program, there were statistically significant improvements in all three MBI factors (p < 0.001) and in clinical learning environment measures (p = 0.006 to < 0.001). Interventions introduced during the PDSA cycles included organization-directed interventions (such as: faculty and administrative leadership recruitment, workflow interventions and residents' schedule optimization), and individual interventions (such as: selfcare, mentoring and resilience training).

CONCLUSION

In our study, for all GME residents, clinical learning environment factors in contrast to MBI factors showed significant improvements. Residents' positive perception of the clinical learning environment was associated with improved burnout measures. Residents in separate programs responded differently with one program reaching significance in all MBI and clinical learning environment factors measured. Continuous wellbeing assessment of all GME residents and introduction of Institutional and individual program interventions was accomplished.

Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education

Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

Tensions in describing competency-based medical education: a study of Canadian key opinion leaders

The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.

From Utopia Through Dystopia: Charting a Course for Learning Analytics in Competency-Based Medical Education

The transition to the assessment of entrustable professional activities as part of competency-based medical education (CBME) has substantially increased the number of assessments completed on each trainee. Many CBME programs are having difficulty synthesizing the increased amount of assessment data. Learning analytics are a way of addressing this by systematically drawing inferences from large datasets to support trainee learning, faculty development, and program evaluation. Early work in this field has tended to emphasize the significant potential of analytics in medical education. However, concerns have been raised regarding data security, data ownership, validity, and other issues that could transform these dreams into nightmares. In this paper, the authors explore these contrasting perspectives by alternately describing utopian and dystopian futures for learning analytics within CBME. Seeing learning analytics as an important way to maximize the value of CBME assessment data for organizational development, they argue that their implementation should continue within the guidance of an ethical framework.

Mindful Medical Education Online

The COVID-19 pandemic disrupted medical education. In-person classes and clinical rotations were urgently canceled, followed by a historic and unprecedented migration to online teaching. Most medical school courses were not designed to be fully online, and faculty and students are novices in the process. The purpose of this article is to provide recommendations for educators to optimize their approach to online curricular transformation. Mindful teaching online creates presences that set climate and support discourse, establish routines that build practice, model professional expectations, and challenge but support learners.