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health professions educators are increasingly called on to engage learners in more meaningful instruction. Many have used Wikipedia to offer an applied approach to engage learners, particularly learning related to evidence-based medicine (EBM). However, little is known about the benefits and challenges of using Wikipedia as a pedagogic tool from the collective experience of educators who have sought to improve their instructional practice with it. This study aims to synthesize the perspectives of health professions education (HPE) instructors on the incorporation of Wikipedia editing into their HPE courses.Applying a constructivist approach, the authors conducted semistructured interviews from July to December 2020, with 17 participating HPE instructors who had substantively integrated Wikipedia into their curriculum at 13 institutions. Participants were interviewed about their experiences of integrating Wikipedia editing into their courses. Thematic analysis was conducted on resulting transcripts.The authors observed 2 broad themes among participants' expressed benefits of teaching with Wikipedia. First, Wikipedia provides a meaningful instructional alternative that also helps society and develops learners' information literacy and EBM skills. Second, Wikipedia supports learners' careers and professional identity formation. Identified challenges included high effort and time, restrictive Wikipedia sourcing guidelines, and difficult interactions with stakeholders.Findings build on known benefits, such as providing a real-world collaborative project that contextualizes students' learning experiences. They also echo known challenges, such as the resource-intensive nature of teaching with Wikipedia. The findings of this study reveal the potential of Wikipedia to enculturate HPE students within a situated learning context. They also present implications for HPE programs that are considering implementing Wikipedia and faculty development needed to help instructors harness crowd-sourced information tools' pedagogic opportunities as well as anticipate their challenges.

Purpose To conduct a bibliometric case study of the journal Perspectives on Medical Education (PME) to provide insights into the journal’s inner workings and to “take stock” of where PME is today, where it has been, and where it might go. Methods Data, including bibliographic metadata, reviewer and author details, and downloads, were collected for manuscripts submitted to and published in PME from the journal’s Editorial Manager and Web of Science. Gender of authors and reviewers was predicted using Genderize.io. To visualize and analyze collaboration patterns, citation relationships and term co-occurrence social network analyses (SNA) were conducted. VOSviewer was used to visualize the social network maps. Results Between 2012–2019 PME received, on average, 260 manuscripts annually (range = 73–402). Submissions were received from authors in 81 countries with the majority in the United States (US), United Kingdom, and the Netherlands. PME published 518 manuscripts with authors based in 31 countries, the majority being in the Netherlands, US, and Canada. PME articles were downloaded 717,613 times (mean per document: 1388). In total 1201 (55% women) unique peer reviewers were invited and 649 (57% women) completed reviews; 1227 (49% women) unique authors published in PME. SNA revealed that PME authors were quite collaborative, with most authoring articles with others and only a minority (n = 57) acting as single authors. Discussion This case study provides a glimpse into PME and offers evidence for PME’s next steps.

Introduction While authorship plays a powerful role in the academy, research indicates many authors engage in questionable practices like honorary authorship. This suggests that authorship may be a contested space where individuals must exercise agency-a dynamic and emergent process, embedded in context-to negotiate potentially conflicting norms among published criteria, disciplines and informal practices. This study explores how authors narrate their own and others' agency in making authorship decisions. Method We conducted a mixed-methods analysis of 24 first authors' accounts of authorship decisions on a recent multi-author paper. Authors included 14 females and 10 males in health professions education (HPE) from U.S. and Canadian institutions (10 assistant, 6 associate and 8 full professors). Analysis took place in three phases: (1) linguistic analysis of grammatical structures shown to be associated with agency (coding for main clause subjects and verb types); (2) narrative analysis to create a 'moral' and 'title' for each account; and (3) dialectic integration of (1) and (2). Results Descriptive statistics suggested that female participants used we subjects and material verbs (of doing) more than men and that full professors used relational verbs (of being and having) more than assistant and associate. Three broad types of agency were narrated: distributed (n = 15 participants), focusing on how resources and work were spread across team members; individual (n = 6), focusing on the first author's action; and collaborative (n = 3), focusing on group actions. These three types of agency contained four subtypes, e.g. supported, contested, task-based and negotiated. Discussion This study highlights the complex and emergent nature of agency narrated by authors when making authorship decisions. Published criteria offer us starting point-the stated rules of the authorship game; this paper offers us a next step-the enacted and narrated approach to the game.

Introduction Health professions educators risk misunderstandings where terms and concepts are not clearly defined, hampering the field’s progress. This risk is especially pronounced with ambiguity in describing roles. This study explores the variety of terms used by researchers and educators to describe “faculty”, with the aim to facilitate definitional clarity, and create a shared terminology and approach to describing this term. Methods The authors analyzed journal article abstracts to identify the specific words and phrases used to describe individuals or groups of people referred to as faculty. To identify abstracts, PubMed articles indexed with the Medical Subject Heading “faculty” published between 2007 and 2017 were retrieved. Authors iteratively extracted data and used content analysis to identify patterns and themes. Results A total of 5,436 citations were retrieved, of which 3,354 were deemed eligible. Based on a sample of 594 abstracts (17.7%), we found 279 unique terms. The most commonly used terms accounted for approximately one-third of the sample and included faculty or faculty member/s (n = 252; 26.4%); teacher/s (n = 59; 6.2%) and medical educator/s (n = 26; 2.7%) were also well represented. Content analysis highlighted that the different descriptors authors used referred to four role types: healthcare (e.g., doctor, physician), education (e.g., educator, teacher), academia (e.g., professor), and/or relationship to the learner (e.g., mentor). Discussion Faculty are described using a wide variety of terms, which can be linked to four role descriptions. The authors propose a template for researchers and educators who want to refer to faculty in their papers. This is important to advance the field and increase readers’ assessment of transferability. Supplementary Information The online version of this article (10.1007/s40037-021-00683-8) contains supplementary material, which is available to authorized users.

The voices of authors who publish medical education literature have a powerful impact on the field's discourses. Researchers have identified a lack of author diversity, which suggests potential epistemic injustice. This study investigates author characteristics to provide an evidence-based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing.The authors conducted a bibliometric analysis of all articles published in 24 medical education journals published between 2000 and 2020 to identify author characteristics, with an emphasis on author gender and geographic location and their intersection. Article metadata was downloaded from Web of Science. Genderize.io was used to predict author gender.The journals published 37 263 articles authored by 62 708 unique authors. Males were more prevalent across all authorship positions (n = 62 828; 55.7%) than females (n = 49 975; 44.3%). Authors listed affiliations in 146 countries of which 95 were classified as Global South. Few articles were written by multinational teams (n = 3765; 16.2%). Global South authors accounted for 12 007 (11.4%) author positions of which 3594 (3.8%) were female.This study provides an evidence-based starting point to discuss the imbalance of author voices in medical education, especially when considering the intersection of gender and geographical location, which further suggests epistemic injustice in medical education. If the field values a diversity of perspectives, there is considerable opportunity for improvement by engaging the community in discussions about what knowledge matters in medical education, the role of journals in promoting diversity, how to best use this baseline data and how to continue studying epistemic injustice in medical education.

Ensuring that future physicians are competent to practice medicine is necessary for high quality patient care and safety. The shift toward competency-based education has placed renewed emphasis on ...

Shared decision making, a collaborative approach between patient and provider that considers the patient's values and preferences in addition to the scientific evidence, is a complex clinical activity that has not realized its full potential. Gaps in education and training have been cited as barriers to shared decision making, and evidence is inconsistent on effective educational interventions. Because individual agents with their own social and behavioral contexts co-construct a shared decision, the educational approach may need to consider the role of patient agency and sociocultural influences. To address the inherent complexity in shared decision making, the authors identified cultural historical activity theory (CHAT) as a framework for analysis. Although certainly not the only relevant theory, CHAT offers an appropriate lens through which the multivoiced nature of shared decision making can be more clearly appreciated. In this article, the authors demonstrate the application of CHAT as a lens for researchers and educators to examine the complexity of shared decision making. The fictitious case presented in this article describes the use of CHAT with a patient who experiences 2 clinical encounters; during the second, shared decision making takes place. Elements of the case are threaded through the article, demonstrating a sample analysis of the interacting activity systems of the patient and physician and highlighting inherent tensions and contradictions. The authors propose CHAT as a tool for future research around the role of agency in shared decision making and other complex topics and as a framework for design of novel instructional strategies. Although not applicable to all topics and settings, CHAT has significant potential within health professions education.

INTRODUCTION: Remediation in medical education tends to focus on the struggling learner. However, understanding successful learners may provide valuable insights to problematic academic behavior. This study explored core study strategies reported by high-performing medical school students. METHOD: In the Fall of 2018 and 2019, high-performing first- and second-year medical students, defined as those who had performed over 90% on a national standardized assessment, were requested via e-mail to describe the study strategies that they believe contributed to their success. Student responses were analyzed using a template-driven approach, which drew upon common frameworks from cognitive learning theory. RESULTS: Thirty-seven high-performing students provided brief unstructured descriptions of their study strategies. Retrieval practice—the cognitive learning strategy of attempting to draw out information to active recall, typically through means of self-quizzing, practice questions, or flashcards—was the most commonly endorsed strategy, followed by spaced repetition. Use of outside commercial resources was commonly referenced, and approximately one-third endorsed a perception that some form of regularly practiced self-care contributed to their academic success. DISCUSSION: Retrieval practice, particularly combined with some form of spaced repetition, is often attributed as contributing to the success of high-performing learners. The use of commercial resources bears further exploration and consideration. Finally, the finding that self-care was identified as a contribution to academic performance goes beyond a focus on self-care solely for medical student well-being. This is an important distinction for both medical education and future research in this area.

Purpose This bibliometric analysis maps the landscape of knowledge syntheses in medical education. It provides scholars with a roadmap for understanding where the field has been and where it might go in the future, thereby informing research and educational practice. In particular, this analysis details the venues in which knowledge syntheses are published, the types of syntheses conducted, citation rates they produce, and altmetric attention they garner. Method In 2020, the authors conducted a bibliometric analysis of knowledge syntheses published in 14 core medical education journals from 1999 to 2019. To characterize the studies, metadata were extracted from PubMed, Web of Science, Altmetrics Explorer, and Unpaywall. Results The authors analyzed 963 knowledge syntheses representing 3.1% of the total articles published (n = 30,597). On average, 45.9 knowledge syntheses were published annually (SD = 35.85, median = 33), and there was an overall 2620% increase in the number of knowledge syntheses published from 1999 to 2019. The journals each published, on average, a total of 68.8 knowledge syntheses (SD = 67.2, median = 41) with Medical Education publishing the most (n = 189; 19%). Twenty-one types of knowledge synthesis were identified, the most prevalent being systematic reviews (n = 341; 35.4%) and scoping reviews (n = 88; 9.1%). Knowledge syntheses were cited an average of 53.80 times (SD = 107.12, median = 19) and received a mean Altmetric Attention Score of 14.12 (SD = 37.59, median = 6). Conclusions There has been considerable growth in knowledge syntheses in medical education over the past 20 years, contributing to medical education’s evidence base. Beyond this increase in volume, researchers have introduced methodological diversity in these publications, and the community has taken to social media to share knowledge syntheses. Implications for the field, including the impact of synthesis types and their relationship to knowledge translation, are discussed. Electronic supplementary material The online version of this article (10.1007/s40037-020-00626-9) contains supplementary material, which is available to authorized users.

Objectives Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. Method The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA‐ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. Results One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA‐ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. Conclusions Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised., Over the last 20 years, the number of #MedEd reviews has grown >2600% (4200% for scoping reviews). To explore this growth, Maggio et al. conducted a scoping review of 101 scoping reviews across 14 journals.

Introduction Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists’ careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown. Methods This study replicates Himmelstein’s work with a sample of 14 HPE journals published between 2008–2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded. Results Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72). Discussion This study presents publication metadata for journals that openly provide it—a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.

Problem While ideal curricular structures for effective teaching of evidence-based medicine (EBM) have not been definitively determined, optimal strategies ensure that EBM teaching is interactive and clinically based, aligns with major trends in education and health care, and uses longitudinally integrated, whole-task activities. Approach The authors developed a longitudinal, semester-long project, embedded in a first-year medicine course, through which they taught EBM using Wikipedia as a platform. Students worked individually and in small groups to choose a medicine-related Wikipedia article, identify information gaps, search for high-quality resources, appraise the sources, and incorporate the new information into the article (i.e., by editing Wikipedia). Students also applied their new appraisal skills to critique a second article. The authors used an online tool to track and record student editing, and they obtained qualitative data on student perceptions of the project via survey. Duplicate marking of a sample of assignments was performed using the Valid Assessment of Learning in Undergraduate Education critical thinking rubric developed by Finley and Rhodes. Outcomes In fall 2017, 101 students made over 1,000 unique edits to 16 online Wikipedia articles, adding over 10,000 words. Through thematic analysis of qualitative data, the authors highlighted several aspects of the project that students appreciated, as well as barriers related to completing their projects. Correlation of the 17 consenting students' final assignments with the critical thinking rubric supports the assignment structure as a tool for assessing critical thinking. Next steps This authentic task adheres to the principles of high-quality EBM instruction and could be implemented by a variety of health care educational programs. Modifications to the delivery model are underway to address challenges identified.

Introduction The use of social media is rapidly changing how educational content is delivered and knowledge is translated for physicians and trainees. This scoping review aims to aggregate and report trends on how health professions educators harness the power of social media to engage physicians for the purposes of knowledge translation and education. Methods A scoping review was conducted by searching four databases (PubMed, Scopus, Embase, and ERIC) for publications emerging between 1990 to March 2018. Articles about social media usage for teaching physicians or their trainees for the purposes of knowledge translation or education were included. Relevant themes and trends were extracted and mapped for visualization and reporting, primarily using the Cook, Bordage, and Schmidt framework for types of educational studies (Description, Justification, and Clarification). Results There has been a steady increase in knowledge translation and education-related social media literature amongst physicians and their trainees since 1996. Prominent platforms include Twitter (n = 157), blogs (n = 104), Facebook (n = 103), and podcasts (n = 72). Dominant types of scholarship tended to be descriptive studies and innovation reports. Themes related to practice improvement, descriptions of the types of technology, and evidence-based practice were prominently featured. Conclusions Social media is ubiquitously used for knowledge translation and education targeting physicians and physician trainees. Some best practices have emerged despite the transient nature of various social media platforms. Researchers and educators may engage with physicians and their trainees using these platforms to increase uptake of new knowledge and affect change in the clinical environment. Electronic supplementary material The online version of this article (10.1007/s40037-019-00542-7) contains supplementary material, which is available to authorized users.

Purpose Recent calls to improve transparency in peer review have prompted examination of many aspects of the peer-review process. Peer-review systems often allow confidential comments to editors that could reduce transparency to authors, yet this option has escaped scrutiny. Our study explores 1) how reviewers use the confidential comments section and 2) alignment between comments to the editor and comments to authors with respect to content and tone. Methods Our dataset included 358 reviews of 168 manuscripts submitted between January 1, 2019 and August 24, 2020 to a health professions education journal with a single blind review process. We first identified reviews containing comments to the editor. Then, for the reviews with comments, we used procedures consistent with conventional and directed qualitative content analysis to develop a coding scheme and code comments for content, tone, and section of the manuscript. For reviews in which the reviewer recommended “reject,” we coded for alignment between reviewers’ comments to the editor and to authors. We report descriptive statistics. Results 49% of reviews contained comments to the editor (n = 176). Most of these comments summarized the reviewers’ impression of the article (85%), which included explicit reference to their recommended decision (44%) and suitability for the journal (10%). The majority of comments addressed argument quality (56%) or research design/methods/data (51%). The tone of comments tended to be critical (40%) or constructive (34%). For the 86 reviews recommending “reject,” the majority of comments to the editor contained content that also appeared in comments to the authors (80%); additional content tended to be irrelevant to the manuscript. Tone frequently aligned (91%). Conclusion Findings indicate variability in how reviewers use the confidential comments to editor section in online peer-review systems, though generally the way they use them suggests integrity and transparency to authors.

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Introduction Authors of knowledge syntheses make many subjective decisions during their review process. Those decisions, which are guided in part by author characteristics, can impact the conduct and conclusions of knowledge syntheses, which assimilate much of the evidence base in medical education. To better understand the evidence base, this study describes the characteristics of knowledge synthesis authors, focusing on gender, geography, and institution. Methods In 2020, the authors conducted meta-research to examine authors of 963 knowledge syntheses published between 1999 and 2019 in 14 core medical education journals. Results The authors identified 4,110 manuscript authors across all authorship positions. On average there were 4.3 authors per knowledge synthesis (SD = 2.51, Median = 4, Range = 1–22); 79 knowledge syntheses (8%) were single-author publications. Over time, the average number of authors per synthesis increased (M = 1.80 in 1999; M = 5.34 in 2019). Knowledge syntheses were authored by slightly more females (n = 2047; 50.5%) than males (n = 2005; 49.5%) across all author positions. Authors listed affiliations in 58 countries, and 58 knowledge syntheses (6%) included authors from low- or middle-income countries. Authors from the United States (n = 366; 38%), Canada (n = 233; 24%), and the United Kingdom (n = 180; 19%) published the most knowledge syntheses. Authors listed affiliation at 617 unique institutions, and first authors represented 362 unique institutions with greatest representation from University of Toronto (n = 55, 6%). Across all authorship positions, the large majority of knowledge syntheses (n = 753; 78%) included authors from institutions ranked in the top 200 globally. Conclusion Knowledge synthesis author teams have grown over the past 20 years, and while there is near gender parity across all author positions, authorship has been dominated by North American researchers located at highly ranked institutions. This suggests a potential overrepresentation of certain authors with particular characteristics, which may impact the conduct and conclusions of medical education knowledge syntheses.

BACKGROUND The field of medical education remains poorly delineated such that there is no broad consensus of articles or journals that comprise 'the field'. This lack of consensus indicates a missed opportunity for researchers to generate insights about the field that could facilitate conducting bibliometric studies and other research designs (e.g., systematic reviews) and also enable individuals to identify themselves as 'medical education researchers'. Other fields have utilised bibliometric field delineation, which is the assigning of articles or journals to a certain field in an effort to define that field. PROCESS In this Research Approach, three bibliometric field delineation approaches-information retrieval, core journals, and journal co-citation-are introduced. For each approach, the authors describe attempts to apply it in medical education and identify related strengths and weaknesses. Based on co-citation, the authors propose the Medical Education Journal List 24 (MEJ-24), as a starting point for delineating medical education and invite the community to collaborate on improving and potentially expanding this list. PEARLS As a research approach, field delineation is complicated, and there is no clear best way to delineate the field of medical education. However, recent advances in information science provide potentially fruitful approaches to deal with the field's complexity. When considering these approaches, researchers should consider collaborating with bibliometricians. Bibliometric approaches rely on available metadata for articles and journals, which necessitates that researchers examine the metadata prior to analysis to understand its strengths and weaknesses, and to assess how this might affect data interpretation. While using bibliometric approaches for field delineation is valuable, it is important to remember that these techniques are only as good as the research team's interpretation of the data, which suggests that an expanded approach is needed to better delineate medical education, an approach that includes active discussion within the medical education community.

Bibliometrics is the study of academic publishing that uses statistics to describe publishing trends and to highlight relationships between published works. Likened to epidemiology, researchers seek to answer questions about a field based on data about publications (e.g., authors, topics, funding) in the same way that an epidemiologist queries patient data to understand the health of a population. In this Eye Opener, the authors introduce bibliometrics and define its key terminology and concepts, including relational and evaluative bibliometrics. Readers are introduced to common bibliometric methods and their related strengths and weaknesses. The authors provide examples of bibliometrics applied in health professions education and propose potential future research directions. Health professions educators are consumers of bibliometric reports and can adopt its methodologies for future studies.

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Purpose Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance defined as behavior change and/or patient outcomes? Method In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's levels 3 and/or 4. Result Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 27 (43%) incorporated eLearning interventions - either stand-alone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. Conclusions Across health professions CPD is an umbrella term incorporating formal and informal approaches in a multi-component approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.

Introduction Wikipedia is an online encyclopedia read by millions seeking medical information. To provide health professions students with skills to critically assess, edit, and improve Wikipedia’s medical content, a skillset aligned with evidence-based medicine (EBM), Wikipedia courses have been integrated into health professions schools’ curriculum. This literature review and curricular inventory of Wikipedia educational initiatives provides an overview of current approaches and identifies directions for future initiatives and research. Methods Five databases were searched for articles describing educational interventions to train health professional students to edit Wikipedia. Course dashboards, maintained by Wiki Education (Wiki Edu), were searched for curricular materials. From these sources, key details were extracted and synthesized, including student and instructor type, course content, educational methods, and student outcomes. Results Six articles and 27 dashboards reported courses offered between 2015 and 2019. Courses were predominantly offered to medical and nursing students. Instructors delivered content via videos, live lectures, and online interactive modules. Course content included logistics of Wikipedia editing, EBM skills, and health literacy. All courses included assignments requiring students to edit Wikipedia independently or in groups. Limited details on assessment of student learning were available. Discussion A small but growing number of schools are training health professions education students to improve Wikipedia’s medical content. Course details are available on Wiki Edu dashboards and, to a lesser extent, in peer-reviewed publications. While more needs to be done in conducting and sharing assessment of student learning, integrating Wikipedia into health professions education has potential to facilitate learning of EBM and communication skills, improve Wikipedia’s online content, and engage students with an autonomous environment while learning. Future considerations should include a thorough assessment of student learning and practices, a final review of student edits to ensure they follow Wikipedia’s guidelines and are written in clear language, and improved sharing of teaching resources by instructors. Electronic supplementary material The online version of this article (10.1007/s40037-020-00620-1) contains supplementary material.

Background and Objectives: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. Methods: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs’ current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. Results: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. Conclusions: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.

Engaging in questionable research practices (QRPs) is a noted problem across many disciplines, including medical education. While QRPs are rarely discussed in the context of medical education, that does not mean that medical education researchers are immune. Therefore, the authors seek to raise medical educators' awareness of the responsible conduct of research (RCR) and call the community to action before QRPs negatively affect the field. The authors define QRPs and introduce examples that could easily happen in medical education research because of vulnerabilities particular to the field. The authors suggest that efforts in research, including medical education research, should focus on facilitating a change in the culture of research to foster RCR, and that these efforts should make explicit both the individual and system factors that ultimately influence researcher behavior. They propose a set of approaches within medical education training initiatives to foster such a culture: empowering research mentors as role models, open airing of research conduct dilemmas and infractions, protecting whistle blowers, establishing mechanisms for facilitating responsibly conducted research, and rewarding responsible researchers. The authors recommend that efforts at culture change be focused on the growing graduate programs, fellowships, and faculty academies in medical education to ensure that RCR training is an integral component for both students and faculty. They encourage medical education researchers to think creatively about solutions to the challenges they face and to act together as an international community to avoid wasting research efforts, damaging careers, and stunting medical education research through QRPs.

Manuscripts submitted to Academic Medicine (AM) undergo an internal editor review to determine whether they will be sent for external peer review. Increasingly, manuscripts are rejected at this early stage. This study seeks to inform scholars about common reasons for internal editor review rejections, increase transparency of the process, and provide suggestions for improving submissions.A mixed-methods approach was used to retrospectively analyze editors' free-text comments. Descriptive content analysis was performed of editors' comments for 369 manuscripts submitted between December 2014 and December 2015, and rejected prior to external peer review from AM. Comments were analyzed, categorized, and counted for explicit reasons for rejection.Nine categories of rejection reasons were identified: ineffective study question and/or design (338; 92%); suboptimal data collection process (180; 49%); weak discussion and/or conclusions (139; 37%); unimportant or irrelevant topic to the journal's mission (137; 37%); weak data analysis and/or presentation of results (120; 33%); text difficult to follow, to understand (89; 24%); inadequate or incomplete introduction (67; 18%); other publishing considerations (42; 11%); and issues with scientific conduct (20; 5%). Manuscripts had, on average, three or more reasons for rejection.Findings suggest that clear identification of a research question that is addressed by a well-designed study methodology on a topic aligned with the mission of the journal would address many of the problems that lead to rejection through the internal review process. The findings also align with research on external peer review.

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Purpose Despite calls to improve nutrition education, training for medical students is inadequate. This systematic review provides an overview of published educational interventions for undergraduate-level health professionals and makes recommendations for improving nutrition training. Method The authors conducted a systematic review of articles (through July 16, 2015) and examined resources in MedEdPORTAL (through September 28, 2015) focused on materials published since January 2004 that describe nutrition educational interventions for undergraduate-level health professionals. The authors extracted data on pedagogical characteristics, content areas covered, study design, and study outcomes. Results Of 1,616 article citations, 32 met inclusion criteria. Most were designed at a single institution (n = 29) for medical students (n = 24). Of 51 MedEdPORTAL resources, 15 met inclusion criteria. Most were designed at a single institution (n = 12) for medical students (n = 15). Interventions spread across several countries, learner levels, and settings. Content areas covered included basic science nutrition, population health, counseling, and training framed by specific patient populations and organ systems. No clear trends were observed for intended learning outcomes, type of instructor, method of instruction, or duration. Conclusions The heterogeneity of interventions and the content areas covered highlight the lack of adopted curricular standards for teaching clinical nutrition. Recommendations that educators should consider include interprofessional education approaches, online learning, placing an emphasis on learners’ personal health behaviors, and standardized and real patient interactions. Educators should continue to publish curricular materials and prioritize the evaluation and sharing of resources.

Supplemental Digital Content is available in the text., Problem Most medical students use Wikipedia as an information source, yet medical schools do not train students to improve Wikipedia or use it critically. Approach Between November 2013 and November 2015, the authors offered fourth-year medical students a credit-bearing course to edit Wikipedia. The course was designed, delivered, and evaluated by faculty, medical librarians, and personnel from WikiProject Medicine, Wikipedia Education Foundation, and Translators Without Borders. The authors assessed the effect of the students’ edits on Wikipedia’s content, the effect of the course on student participants, and readership of students’ chosen articles. Outcomes Forty-three enrolled students made 1,528 edits (average 36/student), contributing 493,994 content bytes (average 11,488/student). They added higher-quality and removed lower-quality sources for a net addition of 274 references (average 6/student). As of July 2016, none of the contributions of the first 28 students (2013, 2014) have been reversed or vandalized. Students discovered a tension between comprehensiveness and readability/translatability, yet readability of most articles increased. Students felt they improved their articles, enjoyed giving back “specifically to Wikipedia,” and broadened their sense of physician responsibilities in the socially networked information era. During only the “active editing months,” Wikipedia traffic statistics indicate that the 43 articles were collectively viewed 1,116,065 times. Subsequent to students’ efforts, these articles have been viewed nearly 22 million times. Next Steps If other schools replicate and improve on this initiative, future multi-institution studies could more accurately measure the effect of medical students on Wikipedia, and vice versa.

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Phenomenon: Peer coaching is a form of faculty development in which medical educators collegially work together to improve their teaching. Benefits include use of evidence-based teaching practices, promotion of collegial discussions, and reflection within the workplace teaching context. Some faculty developers have expertise in designing and offering peer coaching initiatives for medical educators. However, because of a paucity of reporting on these initiatives in the literature, this specialized knowledge is not readily accessible to the health professions education community. This gap hinders practice advancement and creates barriers for new initiative implementation. Approach: The authors conducted a website review to identify, examine, and conceptually map characteristics of peer coaching initiatives at Association of American Medical Colleges-accredited medical schools. Forty-five initiatives were included that maintained publicly accessible websites, performed direct observation of teaching with feedback, and had a stated purpose of improving teaching. Data collection included details related to initiative purpose, structure, participation, observation of teaching, feedback, and support of learning. Findings: Most initiatives were voluntary and provided formative feedback with the sole purpose of improving teaching. Nearly all used a three-phase process with a preobservation meeting for goal setting, direct observation of teaching, and a postobservation meeting with feedback. Many initiatives required peer coach training and expertise. Reflection, collaboration, confidentiality, and use of an observation instrument were frequently mentioned. Insights: This website review provides faculty developers with a knowledge synthesis of how present-day peer coaching initiatives are structured and enacted-laying a foundation to collaborate, build best practices, and identify areas for future research. These findings enable faculty developers to learn from and build upon others' examples. Future research should explore whether there is an ideal coaching model and location for peer coaching within the higher level organization. In addition, researchers should seek to build consensus on initiative characteristics that enhance participation and foster teaching effectiveness.

Context Authorship has major implications for researchers' careers. Hence, journals require researchers to meet formal authorship criteria. However, researchers frequently admit to violating these criteria, which suggests that authorship is a complex issue. This study aims to unpack the complexities inherent in researchers' conceptualisations of questionable authorship practices and to identify factors that make researchers vulnerable to engaging in such practices. Methods A total of 26 North American medical education researchers at a range of career stages were interviewed. Participants were asked to respond to two vignettes, of which one portrayed honorary authorship and the other described an author order scenario, and then to describe related authorship experiences. Data were analysed using thematic analysis. Results Participants conceptualised questionable authorship practices in various ways and articulated several ethically grey areas. Personal and situational factors were identified, including hierarchy, resource dependence, institutional culture and gender; these contributed to participants' vulnerability to and involvement in questionable authorship practices. Participants described negative instances of questionable authorship practices as well as situations in which these practices were used for virtuous purposes. Participants rationalised engagement in questionable authorship practices by suggesting that, although technically violating authorship criteria, such practices could be reasonable when they seemed to benefit science. Conclusions Authorship guidelines portray authorship decisions as being black and white, effectively sidestepping key dimensions that create ethical shades of grey. These findings show that researchers generally recognise these shades of grey and in some cases acknowledge having bent the rules themselves. Sometimes their flexibility is driven by benevolent aims aligned with their own values or prevailing norms such as inclusivity. At other times participation in these practices is framed not as a choice, but rather as a consequence of researchers' vulnerability to individual or system factors beyond their control. Taken together, these findings provide insights to help researchers and institutions move beyond recognition of the challenges of authorship and contribute to the development of informed, evidence-based solutions.

Entrustable professional activities (EPAs) are a hot topic in undergraduate medical education (UME); however, the usefulness of EPAs as an assessment approach remains unclear. The authors sought to better understand the literature on EPAs in UME through the lens of the 2010 Ottawa Conference Criteria for Good Assessment.The authors conducted a scoping review of the health professions literature (search updated February 2018), mapping publications to the Ottawa Criteria using a collaboratively designed charting tool.Of the 1,089 publications found, 71 (6.5%) met inclusion criteria. All were published after 2013. Forty-five (63.4%) referenced the 13 Core Entrustable Professional Activities for Entering Residency developed by the Association of American Medical Colleges (AAMC). Forty (56.3%) were perspectives, 5 (7.0%) were reviews, and 26 (36.6%) were prospective empirical studies. The publications mapped to the Ottawa Criteria 158 times. Perspectives mapped more positively (83.7%) than empirical studies (76.7%). Reproducibility did not appear to be a strength of EPAs in UME; however, reproducibility, equivalence, educational effect, and catalytic effect all require further study. Inconsistent use of the term "EPA" and conflation of concepts (activity vs assessment vs advancement decision vs curricular framework) limited interpretation of published results. Overgeneralization of the AAMC's work on EPAs has influenced the literature.Much has been published on EPAs in UME in a short time. Now is the time to move beyond opinion, clarify terms, and delineate topics so that well-designed empirical studies can demonstrate if and how EPAs should be implemented in UME.

The learning environment (LE) is an important and frequently discussed topic in the health professions education literature. However, there is considerable inconsistency in how the LE is defined and described. The authors propose a definition of the LE and a conceptual framework to facilitate health professions educators in understanding, studying, and designing interventions to improve the LE. To arrive at this conceptual framework, the authors employed a living systems perspective that draws on various frameworks and theories, including ecological psychology, workplace learning, situated cognition, and sociomateriality theory. The conceptual framework identifies five overlapping and interactive core components that form two dimensions: the psychosocial dimension and material dimension. The psychosocial dimension comprises three components: the personal, social, and organizational. Intertwined with the psychosocial dimension at each level is the material dimension, which encompasses physical and virtual spaces. This theoretical lens can facilitate identifying and analyzing problems in the LE and guide development of interventions to mitigate them. The authors conclude with several practical suggestions for health professions educators, investigators, and editors.

Purpose To maintain scientific integrity and engender public confidence, research must be conducted responsibly. Whereas deliberate scientific misconduct such as data fabrication is clearly unethical, other behaviors-often referred to as questionable research practices (QRPs)-exploit the ethical shades of gray that color acceptable practice. This study aimed to measure the frequency of self-reported misconduct and QRPs in a diverse, international sample of health professions education (HPE) researchers. Method In 2017, the authors conducted an anonymous, cross-sectional survey study. The web-based survey contained 43 items that asked respondents to rate how often they had engaged in a variety of irresponsible research behaviors. The items were adapted from previously published surveys. Results In total, 590 HPE researchers took the survey. The mean age was 46 years (SD = 11.6), and the majority of participants were from the United States (26.4%), Europe (23.2%), and Canada (15.3%). The three most frequently reported irresponsible research behaviors were adding authors who did not qualify for authorship (60.6%), citing articles that were not read (49.5%), and selectively citing papers to please editors or reviewers (49.4%). Additionally, respondents reported misrepresenting a participant's words (6.7%), plagiarizing (5.5%), inappropriately modifying results (5.3%), deleting data without disclosure (3.4%), and fabricating data (2.4%). Overall, 533 (90.3%) respondents reported at least one irresponsible behavior. Conclusions Notwithstanding the methodological limitations of survey research, these findings indicate that a substantial proportion of HPE researchers report a range of misconduct and QRPs. Consequently, reforms may be needed to improve the conduct of HPE research.

Introduction Although evidence-based medicine (EBM) teaching activities may improve short-term EBM knowledge and skills, they have little long-term impact on learners' EBM attitudes and behaviour. This study examined the effects of learning EBM through stand-alone workshops or various forms of deliberate EBM practice. Methods We assessed EBM attitudes and behaviour with the evidence based practice inventory questionnaire, in paediatric health care professionals who had only participated in a stand-alone EBM workshop (controls), participants with a completed PhD in clinical research (PhDs), those who had completed part of their paediatric residency at a department (Isala Hospital) which systematically implemented EBM in its clinical and teaching activities (former Isala residents), and a reference group of paediatric professionals currently employed at Isala's paediatric department (current Isala participants). Results Compared to controls (n = 16), current Isala participants (n = 13) reported more positive EBM attitudes (p < 0.01), gave more priority to using EBM in decision making (p = 0.001) and reported more EBM behaviour (p = 0.007). PhDs (n = 20) gave more priority to using EBM in medical decision making (p < 0.001) and reported more EBM behaviour than controls (p = 0.016). Discussion Health care professionals exposed to deliberate practice of EBM, either in the daily routines of their department or by completing a PhD in clinical research, view EBM as more useful and are more likely to use it in decision making than their peers who only followed a standard EBM workshop. These findings support the use of deliberate practice as the basis for postgraduate EBM educational activities.

A Correction to this paper has been published: https://doi.org/10.1007/s40037-020-00627-8

Recent crises over the credibility of research in psychology and the biomedical sciences have highlighted the need for researchers to view and treat replication research as essential to the accumulation of knowledge. In this article, the authors make the case for the utility of replication in medical education research. Specifically, the authors contend that because research in medical education often adopts theories from other disciplines, replication is necessary to gauge the applicability of those theories to the specific medical education context. This article introduces readers to the two major types of replication – direct and conceptual – and provides a primer on conceptual replication. In particular, the article presents key elements of conceptual replication and considers how it can be used to strengthen approaches to knowledge generation, theory testing, and theory development in medical education research.

Evidence-based medicine (EBM) is a fixture in many medical school curricula. Yet, little is known about the challenges medical students face in learning EBM or the educational approaches that medical schools use to overcome these challenges.A qualitative multi-institutional case study was conducted between December 2013 and July 2014. On the basis of the Association of American Medical Colleges 2012 Medical School Graduation Questionnaire data, the authors selected 22 U.S. and Canadian Liaison Committee on Medical Education-accredited medical schools with graduates reporting confidence in their EBM skills. Participants were interviewed and asked to submit EBM curricular materials. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach.Thirty-one EBM instructors (17 clinicians, 11 librarians, 2 educationalists, and 1 epidemiologist) were interviewed from 17 medical schools (13 in the United States, 4 in Canada). Four common EBM learning challenges were identified: suboptimal role models, students' lack of willingness to admit uncertainty, a lack of clinical context, and students' difficulty mastering EBM skills. Five educational approaches to these challenges that were common across the participating institutions were identified: integrating EBM with other courses and content, incorporating clinical content into EBM training, EBM faculty development, EBM whole-task exercises, and longitudinal integration of EBM.The identification of these four learner-centered EBM challenges expands on the literature on challenges in teaching and practicing EBM, and the identification of these five educational approaches provides medical educators with potential strategies to inform the design of EBM curricula.

Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

Purpose The authors sought to summarize quantitative and qualitative research addressing electronic knowledge resources and point-of-care learning in a scoping review. Method The authors searched MEDLINE, Embase, PsycINFO, and the Cochrane Database for studies addressing electronic knowledge resources and point-of-care learning. They iteratively revised inclusion criteria and operational definitions of study features and research themes of interest. Two reviewers independently performed each phase of study selection and data extraction. Results Of 10,811 studies identified, 305 were included and reviewed. Most studies (225; 74%) included physicians or medical students. The most frequently mentioned electronic resources were UpToDate (88; 29%), Micromedex (59; 19%), Epocrates (50; 16%), WebMD (46; 15%), MD Consult (32; 10%), and LexiComp (31; 10%). Eight studies (3%) evaluated electronic resources or point-of-care learning using outcomes of patient effects, and 36 studies (12%) reported objectively measured clinician behaviors. Twenty-five studies (8%) examined the clinical or educational impact of electronic knowledge resource use on patient care or clinician knowledge, 124 (41%) compared use rates of various knowledge resources, 69 (23%) examined the quality of knowledge resource content, and 115 (38%) explored the process of point-of-care learning. Two conceptual clarifications were identified, distinguishing the impact on clinical or educational outcomes versus the impact on test setting decision support, and the quality of information content versus the correctness of information obtained by a clinician-user. Conclusions Research on electronic knowledge resources is dominated by studies involving physicians and evaluating use rates. Studies involving nonphysician users, and evaluating resource impact and implementation, are needed.

Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.

Introduction Researchers, funders, and institutions are interested in understanding and quantifying research dissemination and impact, particularly related to communicating with the public. Traditionally, citations have been a primary impact measure; however, citations can be slow to accrue and focus on academic use. Recently altmetrics, which track alternate dissemination forms (e. g., social media), have been suggested as a complement to citation-based metrics. This study examines the relationship between altmetrics and traditional measures: journal article citations and access counts. Methods The researchers queried Web of Science and Altmetric Explorer for articles published in HPE journals between 2013–2015. They identified 2,486 articles with altmetrics. Data were analyzed using negative binomial and linear regression models. Results Blogging was associated with the greatest increase in citations (13% increase), whereas Tweets (1.2%) and Mendeley (1%) were associated with smaller increases. Journal impact factor (JIF) was associated with a 21% increase in citations. Publicly accessible articles were associated with a 19% decrease, but the interactive effect between accessible articles and JIF was associated with a 12% increase. When examining access counts, publicly accessible articles had an increase of 170 access counts whereas blogging was associated with a decrease of 87 accesses. Discussion This study suggests that several altmetrics outlets are positively associated with citations, and that public accessibility, holding all other independent variables constant, is positively related to article access. Given the scientific community’s evolving focus on dissemination these findings have implications for stakeholders, providing insight into the factors that may improve citations and access of articles.