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Background Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics. Objectives To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students. Methods Secondary data analyses of all medical students who applied through ERAS from 2005–2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences. Results Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics. Conclusions From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students’ specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation.

Purpose As medical schools adapt their curricula to prepare future physicians for the opioid crisis and for treating patients with substance use disorders (SUDs), educators should refer to courses described in the literature. This scoping review aimed to (1) provide a comprehensive evaluation and summation of peer-reviewed literature reporting on SUD education in medical schools globally and (2) appraise the research quality and educational outcomes reported in SUD education studies in medical schools. Method The authors searched 6 databases (3 Ovid MEDLINE databases, Embase, ERIC, and Web of Science) from inception through May 25, 2018. Original English-language research studies focusing on medical students and describing SUD education in medical schools were included. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess included studies. Results Of 3,178 articles identified, 43 met inclusion criteria. Studies were conducted in 9 countries. Most reported on educational interventions for tobacco (n = 20; 47%); others reported on interventions for SUDs broadly (n = 15; 35%), alcohol (n = 8; 19%), and opioids (n = 1; 2%). The mean MERSQI score was 12.27 (standard deviation 2.30). Four studies (9%) reported on educational outcomes at the level of behaviors or patient or health care outcomes. The majority (n = 39; 91%) reported significant benefits. Conclusions Educational interventions relating to SUDs were effective in improving medical students' knowledge, skills, and attitudes. Educators should develop courses that achieve higher-level educational outcomes, increase education on opioid use disorders, and focus on the greatest public health concerns.

Our school introduced a new curriculum based on faculty-directed, intensive, small-group teaching of clinical skills in the third-year medical students. To examine its effects, we compared the mean scores on an OSCE between the third- and fourth-year medical students. Methods Third- and fourth-year students did rotations at the same five OSCE stations. They then completed a brief self-reporting questionnaire survey to examine the degree of satisfaction with new curriculum in the third-year students and clinical practice in the fourth-year students, as well as their perception of confidence and preparedness. We analyzed the OSCE data obtained from 158 students, 133 of whom also completed the questionnaire. Results Mean OSCE scores on the breast examination and wet smear stations were significantly higher in the third-year group (P < 0.001). But mean OSCE scores of motor-sensory examination and lumbar puncture were significantly higher in the fourth-year group (P < 0.05). The mean OSCE scores had no significant correlation with satisfaction. In addition, the self-ratings of confidence had a high degree of correlation with satisfaction with new curriculum (r = 0.673) and clinical practice (r = 0.692). Furthermore, there was a moderate degree of correlation between satisfaction and preparedness in both groups (r = 0.403 and 0.449). Conclusions There is no significant difference in the effect on the degree of clinical performance and confidence between an intensive-small group teaching and a 1-year clinical practice. If combined, intensive small group teaching and clinical practice would be useful to improve the degree of ability and confidence in medical students.

Summary Introduction Utilizing a qualitative phenomenological design, the Defining Successful Outcomes and Trade-offs study examined stakeholder perspectives regarding optimal healthcare delivery and outcomes for individuals with a difference/disorder of sex development (DSD). Objective We describe study methods and provide an overview of themes and subthemes. Study design Interviews were conducted with individuals with a DSD (n=24), parents of those with a DSD (n=19), healthcare providers (n=37), and others (n=30). Primary questions regarding clinical management of patients with DSD were: “What is a successful outcome?” and “How do you achieve it?” Results Themes included: understanding of DSD diagnosis and self-efficacy in management is necessary but complex; patient and family psychological well-being; support from others versus being stigmatized; affected person experiences physical health and accepts the implications of their condition; complexities in DSD decision making, roles and expectations; and knowledgeable providers and multidisciplinary teams are essential, notwithstanding persisting barriers (See Summary Figure). Participants recognized competing values potentially forcing trade-offs in decision making. Discussion. Recognition of diverse and sometimes conflicting perspectives regarding optimal pathways of care and outcomes – both within and among those with DSD and their providers –promises to enhance shared decision making. Conclusion Diverse perspectives and perceptions of trade-offs associated with DSD healthcare emphasize the need to tailor care for patients and families.

Rationale and Objectives The aims of our study were (1) to describe a new educational intervention for first-year medical students that gave a substantial, early exposure to radiology and (2) to examine how this early exposure was received by the students. Materials and Methods Our new curriculum incorporated a new 2-week course very early in the M1 year entitled Foundations of Diagnostics and Therapeutics. Among other topics, the course included a substantial introduction to radiology primarily through small-group seminars and online materials, administered using a flipped-classroom approach. The students were given pre- and postcourse surveys that assessed the degree to which they felt prepared to learn about radiology, as well as their interest in radiology. Results were analyzed using the Wilcoxon signed-rank test. Results Survey responses were obtained from 170 students before the course and 65 students afterward. Upon completing the course, students showed significantly increased academic interest in radiology (P = .008) and a heightened perception of the effect of radiology on patient care (P = .04), without a significant change in interest in pursuing radiology as a career. Students showed an overwhelmingly positive response to the course, although some noted that previous anatomy training would have been helpful. Eighty percent agreed or strongly agreed that the flipped-classroom structure was an effective educational model. Conclusions Our study demonstrated that students were very excited to gain exposure to radiology early in their medical school curriculum, and such exposure led to an improved perception of the field.

Assessment drives learning; therefore, valid and robust assessments are important. To achieve trustworthy assessments with high-quality multiple choice questions, we established a rigorous system of exam quality improvement (QI). Our exam QI process helps ensure implementation of best practices and evidence-based approaches to student assessment, as well as identify opportunities for process modifications that ultimately lead to systematic improvements. We provide a step-by-step summary of our QI process for consideration by other institutions. The model outlined here may serve as a template for other institutions who hope to improve their exams through exam QI processes.

Background The use of questioning to engage learners is critical to furthering resident education intraoperatively. Previous studies have demonstrated that higher level questioning and optimal wait times (>3 s) result in learner responses reflective of higher cognition and retention. Given the importance of intraoperative learning, we investigated question delivery in the operating room. Methods A total of 12 laparoscopic cholecystectomies were observed and recorded. All questions were transcribed and classified using Bloom's Taxonomy, a framework associated with hierarchical levels of learning outcomes. Wait time between question end and response was recorded. Results Six faculty attendings and seven house officers at our institution were observed. A total of 133 questions were recorded with an average number of questions per case of 11.2. The majority of questions 112 out of 133 (84%) were classified as Bloom's levels 1–3, with only 6% of questions of the highest level. The wait time before the resident answered the question averaged 1.75 s, with attendings interceding after 2.50 s. Question complexity and wait time did not vary based on resident postgraduate year level suggesting limited tailoring of question to learner. Conclusions Intraoperative questioning is not aligned with higher level thinking. The majority of questions were Bloom's level 3 or below, limiting the complexity of answer formulation. Most responses were given within 2 s, hindering opportunity to pursue higher-order thinking. This suggests including higher level questions and tailoring questions to learner level may improve retention and maximize gains. In addition, with attendings answering 20% of their own questions, increasing their wait time offers another area for teaching development.

Background The type of question asked elicits a particular response. The purpose of this study was to determine what types and levels of questions were asked in the operating room. These insights are important for understanding how questions are used to advance learners. Methods 12 laparoscopic cholecystectomy operations were observed and recorded at a single institution. Intraoperative questions asked by faculty were transcribed for all cases. Using revised Bloom's taxonomy, questions were classified into one of 5 levels: (1) remembering , (2) understanding , (3) applying , (4) analyzing , (5) evaluating . Results 141 questions were asked by faculty and ranged from 0 to 34 questions per case. Classification of questions showed there were 43 remembering , 29 understanding , 47 applying, 13 analyzing , and 8 evaluating questions asked. Conclusions Questioning was predominately classified at lower-order and mid-level thinking skills (120/141). Integrating intraoperative questions at higher-order levels has the potential to guide trainees into progressively complex thinking and decision making.

Purpose The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research. Method The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies' quality. Results The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5-15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students' educational outcomes related to SUDs and/or interprofessionalism. Conclusions Interprofessional SUD educational interventions improved health professions students' knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students' behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.

Professionalism and ethics are difficult to define, and it is often a case of "you know it when you see it." In recent years, there have been calls to renew the focus on professionalism and ethics and their teaching in the medical and allied professions, part precipitated by a perceived and probably real decline in doctors' professional values. Medical professionalism has evolved markedly in the last couple of centuries and continues to change today at a rapid pace, spurred by technological advances and generational change. The reasons to promote medical professionalism include regulatory requirements, aligning our professions' outcomes and behaviors, and the moral imperative that being professional is the right thing to do. Radiologists should emphasize, model, and teach professionalism to our colleagues, allied personnel, and trainees whenever opportunity permits. Medical students now receive teaching in professionalism and ethics throughout their training, and there is a need to continue training formally and informally during residency training. Faculty or those charged with teaching professionalism will need to first understand what constitutes medical professionalism, and here we attempt to define and outline what professionalism looks like in practice. The article concludes with a summary of the opportunities within radiology practice, with examples, for us to exhibit professional actions, values, and ideas.

Study objective Women and students underrepresented in medicine are less likely to apply for residency in emergency medicine. The latter are from racial or ethnic populations that are underrepresented as physicians relative to the general population. The factors that result in lower application rates from women and groups underrepresented in medicine are inadequately described in the literature. This study's objective was to test whether female students and those underrepresented in medicine have lower interest in emergency medicine even after controlling for academic ability, student indebtedness, and common career values consistent with emergency medicine career interest. Methods Secondary data analyses were conducted on a cross section of all residency applicants from 2005 to 2010. Data sources included American Medical College Application Service, the Electronic Residency Application Service, and the Graduating Questionnaire. Data linkage was by the Association of American Medical Colleges and provided deidentified to the authors. A binary logistic regression model was fitted with the outcome variable planned career into emergency medicine versus another specialty on the Graduating Questionnaire. The binary logistic regression model independent variables included demographics, student attitudes, debt, grade point average, standardized tests, and medical school experiences. Results The binary logistic regression model included 17,067 individuals. Being a woman (odds ratio 0.75) and from a background underrepresented in medicine (odds ratio 0.68) independently correlated with lower emergency medicine interest. Age, medical debt, importance of work-life balance, confidence in specialty choice, and plan to care for underserved populations were positively associated with emergency medicine interest. Importance of specialty competitiveness and importance of mentorship advice were correlated with lower emergency medicine interest. Conclusion Female medical students and those underrepresented in medicine were less likely to plan for a career in emergency medicine. This correlation remained significant even when other previously identified factors that have predicted a career in emergency medicine were controlled for.

Writing an educational research grant in health profession education is challenging, not only for those doing it for the first time but also for more experienced scholars. The intensity of the competition, the peculiarities of the grant format, the risk of rejection, and the time required are among the many obstacles that can prevent educational researchers with interesting and important ideas from writing a grant, that could provide the funding needed to turn their scholarly ideas into reality. The aim of this AMEE Guide is to clarify the grant-writing process by (a) explaining the mechanics and structure of a typical educational research grant proposal, and (b) sharing tips and strategies for making the process more manageable.

This large, multi-institutional study examines the relative contribution of residency specialty and institution to resident satisfaction with their learning environment and workload.Survey responses from 798 residents were linked to institution (N = 20) and specialty (N = 10) and to characteristics of individual residency programs (N = 126) derived from the FREIDA Online database. Hierar chical linear modeling was used to estimate relative contributions of these factors to resident satisfaction with workload and learning environment.Institution had greater influence than specialty on resident ratings of satisfaction with their workload and learning environment. Institution and specialty accounted for more variance in satisfaction with workload than with the learning environment. There is evidence that characteristics of a given residency program in a given institution have additional impact beyond these main effects. However, characteristics of institutions or programs, such as program selectivity, off-duty periods, or number of faculty, did not explain statistically significant amounts of variance in resident satisfaction ratings.This study is the first to quantify the degree to which institution and specialty contribute to differences in resident perceptions of their learning environment and workload. Although organizational and institutional cultures are presumed to influence the learning environment, estimating the size of these influences requires a multi-institutional and multispecialty dataset, such as this one. These results suggest that there is empirical justification for institutional interventions to improve the learning environment.

There is a growing demand for health sciences faculty with formal training in education. Addressing this need, the University of Michigan Medical School created a Master in Health Professions Education (UM-MHPE). The UM-MHPE is a competency-based education (CBE) program targeting professionals. The program is individualized and adaptive to the learner's situation using personal mentoring. Critical to CBE is an assessment process that accurately and reliably determines a learner's competence in educational domains. The program's assessment method has two principal components: an independent assessment committee and a learner repository. Learners submit evidence of competence that is evaluated by three independent assessors. The assessments are presented to an Assessment Committee who determines whether the submission provides evidence of competence. The learner receives feedback on the submission and, if needed, the actions needed to reach competency. During the program's first year, six learners presented 10 submissions for review. Assessing learners in a competency-based program has created challenges; setting standards that are not readily quantifiable is difficult. However, we argue it is a more genuine form of assessment and that this process could be adapted for use within most competency-based formats. While our approach is demanding, we document practical learning outcomes that assess competence.

ver the past 2decades, com-petency-based edu-cation (CBE) hasrapidly become thepredominant frame-work for medicaleducation innovationand change. It formsthecoreofgraduatemedicaleducationac-creditation in NorthAmerica and muchof Europe, and ismaking inroads intoundergraduate edu-cation. CBE is an approach to preparing physicians forpractice that is fundamentally oriented toward graduateoutcomes and organized around competencies derived froman analysis of societal and patient needs. It deemphasizestime-based training and promises greater accountability,flexibility, and learner centeredness.

PURPOSE Learning to make decisions under uncertain conditions is a critical component of diagnostic and therapeutic reasoning. This study sought to determine treatment decisions medical students make when presented with different thresholds of diagnostic uncertainty and whether they appropriately adjust diagnostic probabilities with test information. METHOD Two classes (2015, 2016) of fourth-year students (N = 342) were presented a patient with viral pneumonia and given 10%, 20%, or 50% pretest probabilities of that patient having a superimposed bacterial infection. Students decided to not treat, order a diagnostic test to guide management, or treat without testing based on these probabilities. The 2015 class was provided a posttest probability of 10% or 50% and asked to adjust their initial treatment decision. RESULTS When given a low (10%) pretest probability, students were less likely to decide to treat (6%) and more likely to decide not to treat (36%). The percentage of students deciding to treat increased as the pretest probability of a superimposed infection increased from 10% to 50%, while the percentage of students not wanting to treat decreased. Interestingly, at 10%, 20%, and 50% pretest probability levels, most students were unable to decide and chose to order another test (57%, 67%, and 64%, respectively). When provided low and high posttest probabilities, students appropriately adjusted their decision making, but 29% to 32% still wanted additional testing. CONCLUSIONS Students adjusted treatment decisions to reflect different levels of diagnostic uncertainty, but varied considerably in their individual thresholds to make decisions, possibly contributing to unnecessary testing.

Competency-based medical education (CBME) is both an educational philosophy and an approach to educational design. CBME has already had a broad impact on medical schools, residency programs, and continuing professional development in health professions around the world. As the CBME movement evolves and CBME programs are implemented, a wide range of emerging research questions will warrant scholarly examination. In this paper, we describe a proposed CBME research agenda developed by the International CBME Collaborators. The resulting framework includes questions about the meaning of key concepts of CBME and their implications for learners, faculty members, and institutional structures. Other research questions relate to the learning process, the meaning of entrustment decisions, fundamental measurement issues, and the nature and definition of standards. The exploration of these questions will help to solidify the theoretical foundation of CBME, but many issues related to implementation also need to be addressed. These pertain to, among other things, nurturing independent learning, assembling and using assessment results to make decisions about competence, structuring feedback, supporting remediation, and how best to evaluate the longer-term outcomes of CBME. High-quality research on these questions will require rigorous outcome measures with strong validity evidence. The complexity of CBME necessitates theoretical and methodological diversity. It also requires multi-institutional studies that examine effects at multiple levels, from the learner to the team, the institution, and the health care system. Such a framework of research questions can guide and facilitate scholarly discourse on the theoretical and practical body of knowledge related to competency-based health professions education.

Competency-based medical education (CBME) aims to bring about the sequential acquisition of competencies required for practice. Although it is being adopted in centers of medical education around the globe, there is little evidence concerning whether, in comparison with traditional methods, CBME produces physicians who are better prepared for the practice environment and contributes to improved patient outcomes. Consequently, the authors, an international group of collaborators, wrote this article to provide guidance regarding the evaluation of CBME programs.CBME is a complex service intervention consisting of multiple activities that contribute to the achievement of a variety of outcomes over time. For this reason, it is difficult to apply traditional methods of program evaluation, which require conditions of control and predictability, to CBME. To address this challenge, the authors describe an approach that makes explicit the multiple potential linkages between program activities and outcomes. Referred to as contribution analysis (CA), this theory-based approach to program evaluation provides a systematic way to make credible causal claims under conditions of complexity. Although CA has yet to be applied to medical education, the authors describe how a six-step model and a postulated theory of change could be used to examine the link between CBME, physicians' preparation for practice, and patient care outcomes.The authors argue that adopting the methods of CA, particularly the rigor in thinking required to link program activities, outcomes, and theory, will serve to strengthen understanding of the impact of CBME over time.

Radiologists in teaching hospitals and in practices with residents rotating through are involved in the education of their residents. The Accreditation Council for Graduate Medical Education requires evidence that trainees are taught and demonstrate competency not only in medical knowledge and in patient care-the historic focus of radiology education-but also in the so-called non-interpretative core competencies, which include professionalism and interpersonal skills. In addition to accreditation agencies, the prominent assessment practices represented by the American Board of Radiology core and certifying examinations for trainees, as well as Maintenance of Certification for practitioners, are planning to feature more non-interpretative competency assessment, including professionalism to a greater extent. Because professionalism was incorporated as a required competency in medical education as a whole, more clarity about the justification and expected content for teaching about competence in professionalism, as well as greater understanding and evidence about appropriate and effective teaching and assessment methods, have emerged. This article summarizes justifications and expectations for teaching and assessing professionalism in radiology residents and best practices on how to teach and evaluate professionalism that can be used by busy radiology faculty in their everyday practice supervising radiology residents.

Background Although there is some consensus about the competencies needed to enter residency, the actual skills of graduating medical students may not meet expectations. In addition, little is known about the association between undergraduate medical education and clinical performance at entry into and during residency. Objective We explored the association between medical school of origin and clinical performance using a multi-station objective structured clinical examination for incoming residents at the University of Michigan Health System. Methods Prior to assuming clinical duties, all first-year residents at the University of Michigan Health System participate in the Postgraduate Orientation Assessment (POA). This assesses competencies needed during the first months of residency. Performance data for 1795 residents were collected between 2002 and 2012. We estimated POA variance by medical school using linear mixed models. Results Medical school predicted the following amounts of variance in performance—data gathering scores: 1.67% (95% confidence interval [CI] 0.36–2.93); assessment scores: 4.93% (95% CI 1.84–6.00); teamwork scores: 0.80% (95% CI 0.00–1.82); communication scores: 2.37% (95% CI 0.66–3.83); and overall POA scores: 4.19% (95% CI 1.59–5.35). Conclusions The results show that residents' medical school of origin is weakly associated with clinical competency, highlighting a potential source of variability in undergraduate medical education. The practical significance of these findings needs further evaluation.

Contains fulltext : 175815.pdf (Publisher’s version ) (Closed access) PROBLEM: Health professions education scholarship (HPES) is an important and growing field of inquiry. Problematically, consistent use of terminology regarding the individual roles and organizational structures that are active in this field are lacking. This inconsistency impedes the transferability of current and future findings related to the roles and organizational structures of HPES. APPROACH: Based on data collected during interviews with HPES leaders in Canada, Australia, New Zealand, the United States, and the Netherlands, the authors constructed working definitions for some of the professional roles and an organizational structure that support HPES. All authors reviewed the definitions to ensure relevance across multiple countries. OUTCOMES: The authors define and offer illustrative examples of three professional roles in HPES (clinician educator, HPES research scientist, and HPES administrative leader) and an organizational structure that can support HPES participation (HPES unit). These working definitions are foundational and not all-encompassing and, thus, are offered as stimulus for international dialogue and understanding. NEXT STEPS: With these working definitions, scholars and administrative leaders can examine HPES roles and organizational structures across and between national contexts to decide how lessons learned in other contexts can be applied to their local contexts. Although rigorously constructed, these definitions need to be vetted by the international HPES community. The authors argue that these definitions are sufficiently transferable to support such scholarly investigation and debate.

This study evaluated a simulated pages curriculum that was developed to assess communication and clinical decision making in medical students and interns.A curriculum consisting of 14 simulated pages was administered across 5 institutions to 150 senior medical students. A 3-case subset was administered to interns who did not participate in the curriculum. Six expert surgeons identified critical fails and set passing scores for case-specific assessments using the Graphical Hofstee Method.Participants in the curriculum demonstrated superior clinical decision making compared with non-participants across all cases scenarios (P.01). Average medical student scores for clinical decision making were 46.9%. Global ratings averaged 6.0 for communication and 5.2 for patient care. Passing rates averaged 46%.Participation in a mock page curriculum improved performance. The performance of participants based on expert standards set for simulated page performance highlight the need for innovative approaches to improve interns' preparedness to take calls.

Background Addictive disorders receive little attention in medical school and residency program curricula. Objective To evaluate an innovative learning approach encouraging and stimulating residents to focus on key competencies by testing before and after their addiction psychiatry rotation. Methods We developed a 50-item test on substance use disorders. Twenty-six general psychiatry residents, post-graduate year I (PGY-I) and II (PGY-II), participated in the pilot study and were divided into three groups. PGY-I residents were divided into Group 1, who were tested the last day of the rotation and again 2 months later, and Group 2, who were tested on the first and the last day of the rotation. Eight of 11 PGY-II residents agreed to participate as controls (Group 3), as they had previously completed their 2-month addiction psychiatry rotation as PGY-I's. All residents were informed that the testing would not affect their individual grade. After taking the first test, all three groups received related study materials. Results A statistically significant increase in re-test scores occurred in the combined groups (p

Rationale and Objectives To compare programs with and without 24-hour/7 days a week/365 days a year (24/7/365) in-house radiologist coverage regarding resident perceptions of their on-call experience, volume of resident dictations on call, and report turnaround time. Materials and Methods Residents from six academic radiology departments were invited to participate in an 11-item online survey. Survey items were related to workload, level of autonomy, faculty feedback, comfort level, faculty supervision, and overall educational experience while on call from 8 pm to 8 am . Each site provided data on imaging volume, radiologist coverage, volume of examinations dictated by residents, number of residents on call, and report turnaround time from 8 pm to 8 am . F-ratios and eta-squares were calculated to determine the relationships between dependent and independent variables. A P value Results A total of 146 (67%) of 217 residents responded. Residents in programs with 24/7/365 in-house radiologist coverage dictated a lower percentage of examinations (46%) compared with other residents (81%) and rated faculty feedback more positively (mean 3.8 vs. 3.3) but rated their level of autonomy (mean 3.6 vs. 4.5) and educational experience (mean 3.6 vs. 4.2) more negatively (all P Conclusion More rapid report turnaround time related to 24/7/365 coverage may come at the expense of resident education.

As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international trends, Chinese medical education has seen unique transformations that reflect its particular culture and history.

A plenary panel session at the 2012 Academic Emergency Medicine consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" discussed barriers educators face in imagining, designing, and implementing studies to address educational challenges. This proceedings article presents a general approach to getting started in education research. Four examples of studies from the medical education literature that illustrate a distinct way to approach specific research questions are discussed. The study designs used are applicable to a variety of education research problems in emergency medicine (EM). Potential applications of studies are discussed, as well as effects and lessons learned.

Funding is a perennial challenge for medical education researchers. Through a consensus process, the authors developed a multifaceted agenda for increasing funding of education research in emergency medicine (EM). Priority agenda items include developing resources to increase the competitiveness of medical education research faculty in grant applications, identifying means by which departments may bolster their faculty's grant writing success, taking long-term steps to increase the number of grants available to education researchers in the field, and encouraging a shift in cultural attitudes toward education research.

Accreditation and professional organizations have recognized the importance of measuring medical students' perceptions of the learning environment, which influences well-being and professional competency development, to optimize professional development. This study was conducted to explore interactions between students' perceptions of the medical school learning environment, student demographic variables, and students' professional attributes of empathy, coping, tolerance of ambiguity, and patient-centeredness to provide ideas for improving the learning environment.Twenty-eight medical schools at 38 campuses recruited 4,664 entering medical students to participate in the two-cohort longitudinal study (2010-2014 or 2011-2015). The authors employed chi-square tests and analysis of variance to examine the relationship between Medical School Learning Environment Survey (MSLES) scores and student characteristics. The authors used mixed-effects models with random school and campus effects to test the overall variances accounted for in MSLES scores at the end of the first year of medical school.Student attributes and demographic characteristics differed significantly across schools but accounted for only 2.2% of the total variance in MSLES scores. Medical school campus explained 15.6% of the variance in MSLES scores.At year's end, students' perceptions toward the learning environment, as reported on the MSLES, differed significantly according to the medical school campus where they trained. Further studies are needed to identify specific factors, such as grading policies, administrative support, and existence of learning communities, which may influence perceptions of the learning environment at various schools. Identifying such variables would assist schools in developing a positive learning environment.

The Anatomical Donations Program at the University of Michigan Medical School (UMMS) has begun a multiphase project wherein interviews of donors will be recorded and later shown to medical students who participate in the anatomical dissection course. The first phase of this project included surveys of both current UMMS medical students and donors concerning their perceptions of such a program. A five-question survey administered via Qualtrics software was electronically mailed to all current medical students at UMMS, and a survey was mailed to registered and potential donors requesting information from the UMMS on anatomical donations. A total of 224 medical student responses (response rate 33%) and 54 donor responses (response rate 27%) were received. Seventy-four percent of students and 81% of donors reported they would participate in this program if it existed. Students and donors supported the implementation of this program for varying reasons, though many felt strongly they would not want to participate in a donor interview program. These qualitative results support those of previous studies that show a majority of students desire a closer personal relationship with the donor, and these are the first results to be reported on donor perceptions of a donor interview program. Although many students and donors are in favor of instituting this program, others feel strongly that such an experience could be traumatic. The causes of these differing reactions need to be further explored, and the opinions of those who object to this study will be respected by maintaining voluntary participation in future phases of this study.

PurposeThe purpose of this qualitative study was to understand what meaning(s) preclinical students attributed to participation in one-week international service–learning trips (ISLTs) and what specific experiences during the trips accounted for such perspectives.MethodTwenty-four first-year student

Rationale and Objectives To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education. Materials and Methods A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lymph nodes; asymptomatic, small pulmonary embolus; and small lung nodule. The respondents' answers were compared with “truth,” as defined by the best evidence available in the medical literature. Additional questions elicited the respondents' demographics and comfort levels in addressing the findings. Analysis of variance models with a Tukey correction for post hoc comparisons and chi-square tests were used to determine if any demographic factors or comfort levels were predictive of higher correct response rates. Results The overall survey response rate was 28% (445/1600). Correct case response rates ranged from 26% (115/442) to 79% (343/445). Only 6% (28/438) of respondents chose the correct answers for all cases. Up to 80% (353/440) of respondents felt comfortable in addressing findings, and only 57% (252/443) of respondents felt that they needed more training in this area. Fellowship training in cardiothoracic radiology, working in a teaching practice, and subspecialization in abdominal or cardiothoracic radiology were predictive of higher correct response rates. Except for one case question, the comfort level was not predictive of correct response rate. Conclusions There was considerable variability among radiologists and substantial deviation from best medical practice with regard to the interpretation/evaluation of incidental findings at chest CT, signifying a significant need for further education.

Item does not contain fulltext Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support.

Traditional promotion standards rely heavily on quantification of research grants and publications in the curriculum vitae. The promotion and retention of educators is challenged by the lack of accepted standards to evaluate the depth, breadth, quality, and impact of educational activities. The authors sought to develop a practical analysis tool for the evaluation of educator portfolios (EPs), based on measurable outcomes that allow reproducible analysis of the quality and impact of educational activities.The authors, 10 veteran educators and an external expert evaluator, used a scholarly, iterative consensus-building process to develop the tool and test it using real EPs from educational scholars who followed an EP template. They revised the template in parallel with the analysis tool to ensure that EP data enabled valid and reliable evaluation. The authors created the EP template and analysis tool for scholar and program evaluation in the Educational Scholars Program, a three-year national certification program of the Academic Pediatric Association.The analysis tool combines 18 quantitative and 25 qualitative items, with specifications, for objective evaluation of educational activities and scholarship.The authors offer this comprehensive, yet practical tool as a method to enhance opportunities for faculty promotions and advancement, based on well-defined and documented educational outcome measures. It is relevant for clinical educators across disciplines and across institutions. Future studies will test the interrater reliability of the tool, using data from EPs written using the revised template.

Objective This study measures diabetes care perceptions of patients and their providers, and examines perceptions differences of patient–provider pairs. Methods Patient and provider perceptions were assessed using the Diabetes Semantic Differential Scales (DSDS) which ask respondents to rate diabetes care concepts using contrasting adjective pairs. The DSDS was scored by two methods: using means and using factor analysis. Persons with diabetes 40-years-old or older were recruited. Using a “snowball” sampling strategy, potential provider participants were identified by their patients; 71 providers agreed. These providers represented 51% of the patient participants and created 138 patient–provider pairs. Results For the mean scores, there were significant differences between patients and providers for 5 of the 18 semantic differentials (28%). Similarly, the factor scores indicated significant differences for 14 of 54 factors (26%). The effect sizes indicated practical differences. Conclusion Significant differences exist between patient and provider perceptions. Generally, patients have the more positive diabetes perceptions. Practice implications During patient and provider discussions, participants can perceive diabetes concepts differently. The DSDS can determine perception differences. While it is best to use factor analyses to score the DSDS, mean scores are more easily calculated and indicate the broad conceptual areas where patient and provider differ.

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population's health.

Context Competency-based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time-based training, and promotion of learner centredness. Each of these features has implications and potential challenges for implementing CBE. Methods As an experiment in CBE programme design and implementation, the University of Michigan Master of Health Professions Education (UM-MHPE) degree programme was examined for lessons to be learned when putting CBE into practice. The UM-MHPE identifies 12 educational competencies and 20 educational entrustable professional activities (EPAs) that serve as the vehicle for both learning and assessment. The programme also defines distinct roles of faculty members as assessors, mentors and subject-matter experts focused on highly individualised learning plans adapted to each learner. Conclusions Early experience with implementing the UM-MHPE indicates that EPAs and competencies can provide a viable alternative to traditional courses and a vehicle for rigorous assessment. A high level of individualisation is feasible but carries with it significant costs and makes intentional community building essential. Most significantly, abandoning a time-based framework is a difficult innovation to implement in a university structure that is predicated on time-based education.

Objectives To investigate the difficulties Japanese female doctors face in continuing professional practice. Design A qualitative study using the Kawakita Jiro method. Setting A survey conducted in 2011 of 13 private Japanese medical school alumni associations. Participants 359 female doctors. Primary outcome measures Barriers of balancing work and gender role. Results The female doctors reported that professional practice was a struggle with long working hours due to a current shortage of doctors in Japan. There was also a severe shortage of childcare facilities in the workplace. Some women appeared to have low confidence in balancing the physician9s job and personal life, resulting in low levels of professional pursuit. There appeared to be two types of stereotypical gender roles, including one expected from society, stating that “child rearing is a woman9s job”, and the other perceived by the women themselves, that some women had a very strong desire to raise their own children. Male doctors and some female doctors who were single or older were perceived to be less enthusiastic about supporting women who worked while raising children because these coworkers feared that they would have to perform additional work as a result of the women taking long periods of leave. Conclusions Important factors identified for promoting the continuation of professional practice among female doctors in Japan were the need to improve working conditions, including cutting back on long working hours, a solution to the shortage of nurseries, a need for the introduction of educational interventions to clarify professional responsibilities, and redefinition of the gender division of labour for male and female doctors. In addition, we identified a need to modernise current employment practices by introducing temporary posts to cover maternity leave and introducing flexible working hours during specialist training, thus supporting and encouraging more women to continue their medical careers.

Mentoring is often identified as a crucial step in achieving career success. However, not all medical trainees or educators recognize the value of a mentoring relationship. Since medical educators rarely receive training on the mentoring process, they are often ill equipped to face challenges when taking on major mentoring responsibilities. This article is based on half-day workshops presented at the 11th Ottawa International Conference on Medical Education in Barcelona on 5 July 2004 and the annual meeting of the Association of American Medical Colleges in Boston on 10 November 2004 as well as a review of literature. Thirteen medical faculty participated in the former and 30 in the latter. Most participants held leadership positions at their institutions and mentored trainees as well as supervised mentoring programs. The workshops reviewed skills of mentoring and strategies for designing effective mentoring programs. Participants engaged in brainstorming and interactive discussions to: (a) review different types of mentoring programs; (b) discuss measures of success and failure of mentoring relationships and programs; and (c) examine the influence of gender and cultural differences on mentoring. Participants were also asked to develop an implementation plan for a mentoring program for medical students and faculty. They had to identify student and faculty mentoring needs, and describe methods to recruit mentors as well as institutional reward systems to encourage and support mentoring.

Objective The objective of this study was to compare the students' actual work hours with their self-reported work hours during the obstetrics and gynecology clerkship, and to determine whether the number of hours worked correlate with the amount of “scut” reported or students' rating of the quality of the clerkship. Study design Students self-reported work hours were compared against their actual scheduled hours over 2 different academic years. Pearson's correlation was performed to correlate the actual hours with the amount of reported “scut” work and the overall rating of the quality of the clerkship. Results The actual hours per week worked by students averaged 59 hours in 2003 and 48 hours in 2004. Students overestimated their work hours both years. Students who worked more hours rated the clerkship lower and the quality of the clerkship significantly improved from 2003 to 2004 (4.2 vs 3.8 P Conclusion The majority of third-year students overestimate their work hours in obstetrics and gynecology. The rating of the overall quality of the clerkship increase significantly with fewer hours worked, and it is not affected by the amount of “scut” work.

Study Objective. To determine the relationship between symptoms and health-related quality of life (HRQOL) in patients receiving drug therapy for hypertension. Design. Cross-sectional survey. Setting. Outpatient general medicine and university-based hypertension clinics. Patients. All patients prescribed one or more antihypertensive drugs seen during a 6-month period in the clinics. Intervention. Data were obtained from a mailed questionnaire and medical records. Measurements and Main Results. Symptoms were measured by a symptom count and total symptom distress. Two scores derived from the Short Form-36 (SF-36)—the Physical Component Summary (PCS) and the Mental Component Summary (MCS)—were used to assess HRQOL. Responses were received from 125 of 220 patients (56.8%). Mean ± SD values were 8.8 ± 7.8 for symptom count, 31.6 ± 46.2 for total symptom distress, 48.7 ± 9.3 for PCS, and 51.6 ± 10.1 for MCS. Higher symptom counts and symptom distress scores were strongly associated with lower HRQOL scores in multivariate models, with standardized coefficients from −0.62 to −0.41. These were greater in magnitude than any other predictor, including demographic information (age, sex, race, education level, income), disease variables (blood pressure, years of hypertension), and drug treatment (number of antihypertensive drugs and duration of regimen). Model-adjusted R2 values were 0.22–0.41. Conclusion. Symptoms have a greater impact on HRQOL than patient characteristics, blood pressure, or drug-related factors. Among patients receiving drug therapy for hypertension, detailed review of symptoms may yield important information for assessing and improving HRQOL.

Although studies have examined medical students' ability to self-assess their performance, there are few longitudinal studies that document the stability of self-assessment accuracy over time. This study compares actual and estimated examination performance for three classes during their first 3 years of medical school.Students assessed their performance on classroom examinations and objective structured clinical examination (OSCE) stations. Each self-assessment was then contrasted with their actual performance using idiographic (within-subject) methods to define three measures of self-assessment accuracy: bias (arithmetic differences of actual and estimated scores), deviation (absolute differences of actual and estimated scores), and covariation (correlation of actual and estimated scores). These measures were computed for four intervals over the course of 3 years. Multivariate analyses of variance and correlational analyses were used to evaluate the stability of these measures.Self-assessment accuracy measures were relatively stable over the first 2 years of medical school with a decease occurring in the third year. However, the correlational analyses indicated that the stability of self-assessment accuracy was comparable to the stability of actual performance over this same period.The apparent decline in accuracy in the third year may reflect the transition from familiar classroom-based examinations to the substantially different clinical examination tasks of the third year OSCE. However, the stability of self-assessment accuracy compares favorably with the stability of actual performance over this period. These results suggest that self-assessment accuracy is a relatively stable individual characteristic that may be influenced by task familiarity.