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This article describes the need for health professions educators to consider their and others' epistemologies in their work. It introduces four categories of epistemic beliefs and discusses common topics and their relationships to epistemological traditions, including how they can conflict with one another. It also suggests a mechanism for surfacing and managing epistemological tensions. [ABSTRACT FROM AUTHOR]

The article presents guidelines to help clinical teachers assess the performance of learners/medical students in the pediatric care setting. Topics discussed include the benefits of assessing learners' abilities and knowledge, strategies for assessment for learning including eliciting goals, using direct observation and assessing while teaching, and how the reporter, interpreter, manager and educator (RIME) framework can help clinical teachers in assessing learners' competence.

The article offers a framework for coaching medical students to understand clinical relevance and increase their efficiency in patient care. Topics discussed include challenges faced by medical students when moving from the classroom to the clinical setting, a key challenge for clinical teachers, and a discussion on priming students to focus on pertinent information during clinical encounters.

The article provides information on entrustable professional activities (EPAs), which provide a framework for describing what medical students are expected to be able to do before graduation from medical school. Topics include how entrustment decisions are made, how to teach and assess each EPAs in a busy clinical setting, and why the framework can assist practicing physicians in teaching.

The article provides tips to help busy clinicians incorporate bedside teaching into inpatient and outpatient care. Topics covered include ways how clinical teachers prepare students for bedside teaching, questions that could be asked during an encounter with a patient in respiratory distress, and the use of clinical encounters to model and teach anticipatory guidance.

The article focuses on elements under the control of individual teachers in a learning environment and how clinical teachers can foster a positive learning environment. Topics discussed include the role of teachers in giving students practical tips in communicating with patients and families, the need for students to be oriented about expectations, objectives and logistics when starting a clinical experience and how teachers can enhance the learning environment by being positive role models.

The article focuses on the methods on how medical students can learn the proper approach to "well-child visit" or pediatric health supervision. Topics discussed include sample questions that can be asked during a pediatric visit, the 2008 Bright Futures Pocket Guide by the American Academy of Pediatrics, and other patient-centered communication methods.

Background: Residency work hour restrictions in 2003 changed medical student participation in overnight call.Purposes: The goal is to compare experiences, attitudes, and skills between medical students who did and did not participate in overnight call.Methods: Using a retrospective cohort design, all students at one medical school received a survey at the end of their 3rd-year internal medicine clerkship. Students at 3 clerkship sites were required to take overnight call, and students at 2 sites were not.Results: One hundred four of 167 (62%) students participated. Sixty-one of 104 (59%) took overnight call. Overnight call students reported improved team relationships and were able to evaluate more unstable “cross-cover” patients. Students who took overnight call were more likely to state it was worthwhile (58% vs. 34%;p= .034). Overnight call led to fatigue and the perception of interference with didactics.Conclusions: Overnight call within the internal medicine clerkship has positive and negative effects. With new residency work hour restrictions, schools may consider innovative ways to preserve the positive experiences while working to minimize fatigue and interference with learning. [ABSTRACT FROM PUBLISHER]

Background: Effective written communication is a core competency for medical students, but it is unclear whether or how this skill is evaluated in clinical clerkships.Purpose: This study identifies current requirements and practices regarding required written work during internal medicine clerkships.Methods: In 2010, Clerkship Directors of Internal Medicine (CDIM) surveyed its institutional members; one section asked questions about students’ written work. Results were compared to similar, unpublished CDIM 2001 survey questions.Results: Requirements for student-written work were nearly universal (96% in 2001 and 100% in 2010). Only 23% used structured evaluation forms and 16% reported written work was weighted as a percentage of the final grade, although 72% of respondents reported that written work was “factored” into global ratings.Conclusions: Despite near universal requirements for student written work, structured evaluation was not commonly performed, raising concern about the validity of factoring these assessments into grades. [ABSTRACT FROM PUBLISHER]

Background: There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders. Methods: Using purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding. Results: The 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content. Conclusions: Perspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings. [ABSTRACT FROM AUTHOR]

Background: Our novel teaching approach involved having students actively participate in an unsuccessful resuscitation of a high fidelity human patient simulator with a gun shot wound to the chest, followed immediately by breaking bad news (BBN) to a standardized patient wife (SPW) portrayed by an actress. Methods: Brief education interventions to include viewing a brief video on the SPIKES protocol on how to break bad news, a didactic lecture plus a demonstration, or both, was compared to no pretraining by dividing 553 students into four groups prior to their BBN to the SPW. The students then self-assessed their abilities, and were also evaluated by the SPW on 21 items related to appearance, communication skills, and emotional affect. All received cross-over training. Results: Groups were equal in prior training (2h)and belief that this was an important skill to be learned. Students rated the experience highly, and demonstrated marked improvement of self-assessed skills over baseline, which was maintained for the duration of the 12-wk clerkship. Additionally, students who received any of the above training prior to BBN were rated superior to those who had no training on several communication skills, and the observation of the video seemed to offer the most efficient way of teaching this skill in a time delimited curriculum. Conclusion: This novel approach was well received and resulted in improvement over baseline. Lessons learned from this study have enhanced our curricular approach to this vital component of medical education. [Copyright &y& Elsevier]

Several letters to the editor are presented in response to article in the previous issues including the case of a 43-year-old man with recurrent ischemic events, the case of a 64-year-old man who suffers from acute interstitial nephritis, and the article "Homocysteine level and coronary heart disease incidence: A systematic review and meta-analysis," by L. L. Humphrey, R. Fu, K. Rogers, M. Freeman, and M. Helfand.

Objective To explore how patients and physicians describe attitudes and behaviours that facilitate shared decision making. Background Studies have described physician behaviours in shared decision making, explored decision aids for informing patients and queried whether patients and physicians want to share decisions. Little attention has been paid to patients’ behaviors that facilitate shared decision making or to the influence of patients and physicians on each other during this process. Methods Qualitative analysis of data from four research work groups, each composed of patients with chronic conditions and primary care physicians. Results Eighty-five patients and physicians identified six categories of paired physician/patient themes, including act in a relational way; explore/express patient’s feelings and preferences; discuss information and options; seek information, support and advice; share control and negotiate a decision; and patients act on their own behalf and physicians act on behalf of the patient. Similar attitudes and behaviours were described for both patients and physicians. Participants described a dynamic process in which patients and physicians influence each other throughout shared decision making. Conclusions This study is unique in that clinicians and patients collaboratively defined and described attitudes and behaviours that facilitate shared decision making and expand previous descriptions, particularly of patient attitudes and behaviours that facilitate shared decision making. Study participants described relational, contextual and affective behaviours and attitudes for both patients and physicians, and explicitly discussed sharing control and negotiation. The complementary, interactive behaviours described in the themes for both patients and physicians illustrate mutual influence of patients and physicians on each other. [ABSTRACT FROM AUTHOR]

Background: Medical educators must impart not only an immense quantity of knowledge and technical skills but also an essential collection of values, attitudes, and ways of relating that fall under the rubric of professionalism. Along with technical skills and knowledge, becoming a physician requires caring about patients and interacting in ways that meet practical needs. Summary: One way to meet the challenges of teaching about professionalism and communication is to involve experienced patients and families as partners in education. Patients and family members have participated in health care quality assessment, health care advisory groups, and efforts to implement family-centered care. Medical educators have written competencies for communication and professionalism and have begun to involve patients and families in medical education activities. Conclusions: Increased involvement of patients and families in full partnership with medical educators is a logical outgrowth of changes in relationships between patients and health care providers as described in medical literature. [ABSTRACT FROM AUTHOR]

Tools to examine the effects of teaching interventions across a variety of studies are needed. The authors perform a meta-analysis of 24 randomized controlled trials evaluating the effects of teaching on medical students' patient communication skills. Study quality is rated using a modified Jadad score, and standardized mean difference effect size (d) measures are calculated. Fifteen of 24 studies have sufficient data for analysis. Students' ability to establish rapport improves after teaching. The effects are large when the teaching intervention was small group discussion (n = 5) or giving structured feedback on a student-patient interview (n = 6). A similar effect of teaching is seen on student data gathering skills (n = 5). Teaching medical students patient communication skills using small group discussion or providing feedback on a student-patient interview results in improvement in student performance. [ABSTRACT FROM AUTHOR]

Background: Most formal instruction in professionalism and communication occurs in the preclinical years of medical school, with an acknowledged need to fortify and apply these competencies during the clinical years. Role modeling provides a powerful way to teach professionalism, particularly when mentors identify specific learning goals and focus the learners' observations. Description: The authors discuss an innovative process, called Students' Clinical Observations of Preceptors (SCOOP), which reverses the traditional direction of structured observations. With written cues to focus their observations, students observe their preceptors, who intentionally model professionalism and communication during clinical encounters. Students and preceptors discuss the observed patient-physician interaction during postencounter sessions. Evaluation: Most medical students rated the SCOOP process highly and reported professional behaviors they gained. Conclusion: As educators seek methods for learners to attain greater competence in communication and interpersonal skills, the SCOOP provides an explicit framework to optimize modeling for the learning of professionalism. [ABSTRACT FROM AUTHOR]

Evaluating and improving the practice of family-centered care involves planning the evaluation effort collaboratively with families, gathering information from a variety of audiences, investigating the different arenas of family-centered care, following growth in family-centered practice over time, using a variety of evaluation approaches, and integrating evaluation with efforts to change toward family-centered approaches to care. Resources available to guide the evaluation effort include guidelines for reviewing written materials in a unit, program, clinic, or practice; written surveys and checklists; guidelines for focus groups or interviews; suggestions for using health care scenarios to gather information about family-centered approaches to care; and questions for nurses to use to reflect on their own practice. [ABSTRACT FROM AUTHOR]

Presents information on a study which focused on the evaluation and improvement of the practice of family-centered care in the United States. Reasons to do evaluation; Purpose of the efforts to evaluate family-centered nursing practices; Principles to guide evaluation of family-centered care practices.

The article discusses the strategies for clinical teaching and tackles time management during or after a student case presentation. It evaluates the methods for strengthening student diagnostic reasoning skills. It also mentions the significance of enhancing good clinical reasoning skill as vital component in medical school training and clinical practice.

A personal narrative which explores the author's experience with shared decision making is presented.

Primary care forms a critical part of pediatricians' practices, yet the most effective ways to teach primary care during residency are not known. We established a new primary care curriculum based on Malcolm Knowles' theory of andragogy, with brief clinical content that is easily accessible and available in different formats. We used Kern's model to create a curriculum. In 2013, we implemented weekly e-mails with links to materials on our learning management system, including moderators' curricular content, resident-developed quizzes, and podcasts. After 3 years, we evaluated the curriculum with resident focus groups, retrospective pre-/post-resident surveys, faculty feedback, a review of materials accessed, and resident attendance. From content analysis of focus groups we learned that residents found the curriculum beneficial, but it was not always possible to do the pre-work. The resident survey, with a response rate of 87% (71 of 82), showed that residents perceived improvement in 37 primary care clinical skills, with differences from 0.64 to 1.46 for scales 1–5 (P <.001 for all). Faculty feedback was positive regarding curriculum organization and structure, but patient care often precluded devoting time to discussing the curriculum. In other ways, our results were disappointing: 51% of residents did not access the curriculum materials, 51% did not open their e-mails, only 37% completed any of the quizzes, and they attended a weekly conference 46% of the time. Although residents accessed the curriculum less than expected, their self-assessments reflect perceptions of improvement in their clinical skills after implementation. [ABSTRACT FROM AUTHOR]

Study Objective To develop and evaluate an educational activity designed to teach the adolescent Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety (HEADS) examination. Design, Setting, Participants, Interventions, and Main Outcome Measures Participants were third-year medical students in their pediatric clerkships. Students received an article on the HEADS interview and attended an adolescent medicine educational session. The session included individualized goal-setting and coached role play. Students’ skills in doing a HEADS interview were evaluated through a standardized patient encounter (SPE) with a checklist and a retrospective pre- and post-test survey. The SPE checklist was used to assess whether the students included questions in 6 key areas of a HEADS interview. Results One hundred fifty-two students participated. During the SPE, 90% of students queried the adolescent's home life, 91% education, 82% activities, 84% drug/substance abuse, 95% sexual history, and 61% symptoms of depression. Pre- and postintervention data were compared using the Kruskal-Wallis Test and showed a statistically significant difference in the students' ability to list key topic areas of the HEADS exam ( P < .001) and to use the skills needed for an adolescent interview using the HEADS exam ( P < .001). Conclusion After an introduction to the HEADS examination, most students covered almost all of the topic areas of this screening interview during a SPE. Only three-fifths of the students, however, included questions about symptoms of depression. Coached role play with goal-setting facilitated effective learning of this approach to adolescent interviewing. [ABSTRACT FROM AUTHOR]

PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents. ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized. FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed. InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine. [ABSTRACT FROM AUTHOR]

Introduction: Increases in vaccine hesitancy continue to threaten the landscape of public health. Literature provides recommendations for vaccine communication and highlights the importance of patient trust, yet few studies have examined medical student perspectives on vaccine hesitancy in clinical settings. Therefore, we aimed to explore medical student experiences encountering vaccine hesitancy, mistrust, and personal biases, with the goal of informing medical student education. Methods: A health disparities course including simulated clinical scenarios required students to complete a written reflection. We sorted reflections written in 2014-2016 to identify common topics and used inductive thematic analysis to identify themes relevant to vaccine hesitancy by group consensus. Results: Our sample included 84 de-identified essays sorted into three non-exclusive topics: vaccine hesitancy (n=42), mistrust (n=34), and personal bias (n=39). We identified four themes within medical students' reflections: 1) Building a Relationship, including emphasis on patient-centred approaches; 2) Preparedness and Need to Prepare for Future Encounters, including highlighting gaps in medical education; 3) Reactions to Encountering Hesitant Patients, including frustration; 4) Insights for Providing Information and Developing a Plan with Hesitant Patients, including approaches to presenting knowledge. Conclusion: Reflections in the context of simulated encounters and discussion are useful in students identifying their preparedness for vaccine discussion with patients. Student reflections can assist educators in identifying missing educational frameworks for particular scenarios such as vaccine hesitancy. Without a structured framework regarding addressing vaccine hesitancy, students draw upon other skills that may contradict recommended practices. [ABSTRACT FROM AUTHOR]

Assessing competence for teamwork is a challenging task. Neverthesless, health professions training programs are asked to assure collaborative competency in their learners. Interprofessional education (IPE) programs seek tools to assess team member effectiveness and demonstrate collaborative competency. The Comprehensive Assessment of Team Member Effectiveness (CATME), originally developed for use in engineering, has been applied in various learning settings, with limited use in IPE. This paper presents validity evidence in 4 domains (content, response processes, internal structure, and relations to other variables) for the use of the CATME in a classroom-based IPE course taught with Team-Based Learning. [ABSTRACT FROM AUTHOR]

The article reviews a framework that can help preceptors write narratives that fully reflect observed performance. Topics discussed include how intelligent and accomplished faculty can suffer writer's block as they try to write meaningful descriptions of students, a tool developed by Doctor Louis Pangaro for improving written evaluations known as RIME and a proposal to add "P" to RIME to highlight professionalism and remind evaluators to incorporate comments into each RIME domain.

Abstract: Background/Objectives: Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents’ knowledge and changed their clinical management of AD. Methods: Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30‐question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two‐sided, two‐sample independent t tests and repeated‐measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test. Results: Twenty‐five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P < .001). This final value was greater than that of the control cohort (20.7 ± 4.5; P = .01). Meaningful differences in practice behaviors were not seen. Conclusion: Pediatric residents who reviewed an online module about AD demonstrated statistically significant improvement in disease‐specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching. [ABSTRACT FROM AUTHOR]

Background: A specialties’ lifestyle is known to be important for specialty selection, but how medical students define this concept is unknown. Purpose: The aim of this article is to determine how 4th-year medical students perceive lifestyle of specialties. Methods: All 4th-year U.S. medical students graduating in 2009 with a military service obligation were invited to participate in an electronic survey. Responses to an open-ended question, “When someone says ‘That specialty has a good lifestyle,’ what does that mean to you?” were classified into themes by a consensus of the authors and then compared to the students’ selected specialty. Results: Response rate for the questionnaire was 46% (369 of 797). Four themes describing lifestyle emerged: “schedule control” (67% of students), “off time” (53%), “financial aspects” (48%), and “work life” (26%). Conclusions: Medical students’ definition of a “good lifestyle” includes four themes, which should be used in future research of the lifestyle factor of specialty selection. [ABSTRACT FROM PUBLISHER]

Purpose: To determine the impact of a geriatrics home visit program for third-year medical students on attitudes, skills, and knowledge.Methods: Using a mixed methods, prospective, controlled trial, volunteer control group students (n = 17) at two sites and intervention group students (n = 16) at two different sites within the same internal medicine clerkship were given Internet and CDROM-based geriatric self-study materials. Intervention group students identified a geriatrics patient from their clinical experience, performed one "home" visit (home, nursing home, or rehabilitation facility) to practice geriatric assessment skills, wrote a structured, reflective paper, and presented their findings in small-group teaching settings. Papers were qualitatively analyzed using the constant comparative method for themes. All students took a pre-test and post-test to measure changes in geriatrics knowledge and attitudes.Results: General attitudes towards caring for the elderly improved more in the intervention group than in the control group (9.8 vs 0.5%; p = 0.04, effect size 0.78). Medical student attitudes towards their home care training in medical school (21.7 vs 3.2%; p = 0.02, effect size 0.94) improved, as did attitudes towards time and reimbursement issues surrounding home visits (10.1 vs -0.2%; p = 0.02, effect size 0.89). Knowledge of geriatrics improved in both groups (13.4 vs 15.2% improvement; p = 0.73). Students described performing a mean of seven separate geriatric assessments (range 4-13) during the home visit. Themes that emerged from the qualitative analysis of the reflective papers added depth and understanding to the quantitative data and supported results concerning attitudinal change.Conclusions: While all participants gained geriatrics knowledge during their internal medicine clerkship, students who performed a home visit had improved attitudes towards the elderly and described performing geriatric assessment skills. Requiring little faculty time, a geriatrics home visit program like this one may be a useful clerkship addition to foster medical students' professional growth. [ABSTRACT FROM AUTHOR]

The article focuses on the development of professionalism in medical students. The Council on Medical Student Education in Pediatrics and other bodies in the field agree that professionalism is essential to the practice of medicine. It is important to address professionalism early, because professional misbehavior in medical school may result in subsequent censure by state medical boards.