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PURPOSE: Educational program objectives (EPOs) provide the foundation for a medical school's curriculum. In recent years, the Liaison Committee on Medical Education (LCME) endorsed an outcomes-based approach to objectives, to embrace the movement toward competency-based medical education (CBME). The purpose of this study was to explore the CBME frameworks used by medical schools in formulating their EPOs. A secondary aim was to determine factors related to the selection of specific frameworks.METHOD: The authors performed a quantitative content analysis of entries to the 2020 Academic Medicine Snapshot. Publicly available data gathered included demographic features of each program (e.g., year founded, accreditation status, affiliation, etc.), participation in national medical education consortia, and presence of specific CBME frameworks identified in EPOs. Descriptive statistics were used to examine trends in frameworks used by medical schools. Bivariate comparisons between factors and frameworks were conducted using chi-squared tests. Logistic regression was used to examine factors predicting use of more recently developed CBME frameworks.RESULTS: A total of 135 institutions submitted Snapshots (RR = 88%). All institutions endorsed 1 or more CBME frameworks, with 37% endorsing 2 and 20% endorsing 3 or more. The most common was the Accreditation Council for Graduate Medical Education (ACGME) core competencies (63%). In addition to published frameworks, 36% of institutions developed their own competencies. Schools with pending LCME visits were 2.61 times more likely to use a more recently developed curricular framework, P = .022.CONCLUSIONS: Medical schools in the United States have embraced the CBME movement through incorporation of competency-based frameworks in their EPOs. While it is encouraging that CBME frameworks have been integrated in medical school EPOs, the variability and use of multiple frameworks identifies the pressing need for a unified CBME framework in undergraduate medical education.

A medical error in the emergency department causes emotional trauma for a patient, who seeks compassion in the aftermath.

Medical school curricula have evolved from 2010 to 2020. Numerous pressures and influences affect medical school curricula, including those from external sources, academic medical institutions, clinical teaching faculty, and undergraduate medical students. Using data from the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II, the nature of curriculum change is illuminated. Most medical schools are undertaking curriculum change, both in small cycles of continuous quality improvement and through significant change to curricular structure and content. Four topic areas are explored: cost consciousness, guns and firearms, nutrition, and opioids and addiction medicine. The authors examine how these topic areas are taught and assessed, where in the curriculum they are located, and how much time is dedicated to them in relation to the curriculum as a whole. When examining instructional methods overall, notable findings include (1) the decrease of lecture, although lecture remains the most used instructional method, (2) the increase of collaborative instructional methods, (3) the decrease of laboratory, and (4) the prevalence of clinical instructional methods in academic levels 3 and 4. Regarding assessment methods overall, notable findings include (1) the recent change of the USMLE Step 1 examination to a pass/fail reporting system, (2) a modest increase in narrative assessment, (3) the decline of practical labs, and (4) the predominance of institutionally developed written/computer-based examinations and participation. Among instructional and assessment methods, the most used methods tend to cluster by academic level. It is critical that faculty development evolves alongside curricula. Continued diversity in the use of instructional and assessment methods is necessary to adequately prepare tomorrow's physicians. Future research into the life cycle of a curriculum, as well optional curriculum content, is warranted.

Much of the care provided by practicing neurologists takes place in outpatient clinics. However, neurology trainees often have limited exposure to this setting. Adequate incorporation of outpatient care in neurology training is vital; however it is often hampered by numerous challenges. We detail a number of these challenges and suggest potential means for improvement.

PURPOSE To examine resources used in teaching the physical exam to preclerkship students at U.S. medical schools. METHOD The Directors of Clinical Skills Courses developed a 49-question survey addressing resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education-accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size. RESULTS Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors. CONCLUSIONS There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.

In neurology education there is evidence that trainees may have greater ability in general localization and diagnosis than they do in treatment decisions, particularly with considering longer term care and supportive care. We hypothesized that medical students completing a neurology clerkship would exhibit greater skill at considering the acute diagnostic and therapeutic management than at considering supportive management measures. Data from 720 standardized patient encounters by 360 medical students completing a neurology clerkship being evaluated via an objective structured clinical examination were analyzed for skill in three components of clinical decision making: diagnostic evaluation, therapeutic intervention, and supportive intervention. Scores for all standardized patient encounters over the 2008–2012 interval revealed a significantly higher percentage of correct responses in both the diagnostic (mean [M] = 62.6%, standard deviation [SD] = 20.3%) and therapeutic (M = 63.0%, SD = 28.8%) categories in comparison to the supportive (M = 31.8%, SD = 45.2%) category. However, only scores in therapeutic and supportive treatment plans were found to be significant predictors of the USA National Board of Medical Examiners (NBME) clinical neurology subject examination scores; on average, a percent increase in therapeutic and support scores led to 5 and 2 point increases in NBME scores, respectively. We demonstrate empirical evidence of deficits in a specific component of clinical reasoning in medical students at the completion of a neurology clerkship.

We evaluated the reliability and predictive ability of an objective structured clinical examination (OSCE) in the assessment of medical students at the completion of a neurology clerkship.We analyzed data from 195 third-year medical students who took the OSCE. For each student, the OSCE consisted of 2 standardized patient encounters. The scores obtained from each encounter were compared. Faculty clinical evaluations of each student for 2 clinical inpatient rotations were also compared. Hierarchical regression analysis was applied to test the ability of the averaged OSCE scores to predict standardized written examination scores and composite clinical scores.Students' OSCE scores from the 2 standardized patient encounters were significantly correlated with each other (r = 0.347, p0.001), and the scores for all students were normally distributed. In contrast, students' faculty clinical evaluation scores from 2 different clinical inpatient rotations were uncorrelated, and scores were skewed toward the highest ratings. After accounting for clerkship order, better OSCE scores were predictive of better National Board of Medical Examiners standardized examination scores (R(2)Δ = 0.131, p0.001) and of better faculty clinical scores (R(2)Δ = 0.078, p0.001).Student assessment by an OSCE provides a reliable and predictive objective assessment of clinical performance in a neurology clerkship.

Background We systematically reviewed the literature concerning simulation-based teaching and assessment of the Accreditation Council for Graduate Medical Education professionalism competencies to elucidate best practices and facilitate further research. Methods A systematic review of English literature for “professionalism” and “simulation(s)” yielded 697 abstracts. Two independent raters chose abstracts that (1) focused on graduate medical education, (2) described the simulation method, and (3) used simulation to train or assess professionalism. Fifty abstracts met the criteria, and seven were excluded for lack of relevant information. The raters, 6 professionals with medical education, simulation, and clinical experience, discussed 5 of these articles as a group; they calibrated coding and applied further refinements, resulting in a final, iteratively developed evaluation form. The raters then divided into 2 teams to read and assess the remaining articles. Overall, 15 articles were eliminated, and 28 articles underwent final analysis. Results Papers addressed a heterogeneous range of professionalism content via multiple methods. Common specialties represented were surgery (46.4%), pediatrics (17.9%), and emergency medicine (14.3%). Sixteen articles (57%) referenced a professionalism framework; 14 (50%) incorporated an assessment tool; and 17 (60.7%) reported debriefing participants, though in limited detail. Twenty-three (82.1%) articles evaluated programs, mostly using subjective trainee reports. Conclusion Despite early innovation, reporting of simulation-based professionalism training and assessment is nonstandardized in methods and terminology and lacks the details required for replication. We offer minimum standards for reporting of future professionalism-focused simulation training and assessment as well as a basic framework for better mapping proper simulation methods to the targeted domain of professionalism.

This study examined how volume in certain patient case types and breadth across patient case types in the outpatient clinic setting are related to Neurology Clerkship student performance. Case logs from the outpatient clinic experience of 486 students from The University of Chicago Pritzker School of Medicine, USA, participating in the 4 week Neurology Clerkship from July 2008 to June 2013 were reviewed. A total of 12,381 patient encounters were logged and then classified into 13 diagnostic categories. How volume of cases within categories and the breadth of cases across categories relate to the National Board of Medical Examiners Clinical Subject Examination for Neurology and a Neurology Clerkship Objective Structured Clinical Examination was analyzed. Volume of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r = .290, p < .001), the Objective Structured Clinical Examination physical examination (r = .236, p = .011), and the Objective Structured Clinical Examination patient note (r = .238, p = .010). Breadth of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r = .231, p = .017), however was not significantly correlated with any component of the Objective Structured Clinical Examination. Volume of cases correlated with higher performance on measures of specialty knowledge and clinical skill. Fewer relationships emerged correlating breadth of cases and performance on the same measures. This study provides guidance to educators who must decide how much emphasis to place on volume versus breadth of cases in outpatient clinic learning experiences.

Shoulder dystocia is an obstetric emergency that requires a coordinated team response. Because it does not occur frequently, it is challenging for providers to gain practical experience and expertise relying solely on clinical exposure. As there is no reliable way to predict shoulder dystocia, efforts must be aimed at timely interventions when it presents, to affect a quick delivery of the body and thus decrease the rate at which adverse outcomes occur. We present here in detail a simulation scenario for response to shoulder dystocia which delineates the roles not only of obstetric providers and nurses, but also of anesthesiology providers, surgical scrub technicians, and unit secretarial clerks. Other practitioners can incorporate this simulation training into their interprofessional educational programs. The educational materials include a simulation scenario with supporting documents, including a list of supplies and debriefing guide, a computer-based training online didactic, checklists of expected actions as defined by role, and two training videos. Shoulder dystocia is an unpredictable but serious obstetric emergency. As there is no reliable way to predict when a shoulder dystocia will occur, clinicians have limited ability to practice and optimize responses. Experts therefore recommend the adoption of shoulder dystocia management algorithms and interprofessional team practice drills to encourage a quick, coordinated response to shoulder dystocia episodes.

Objectives: This study examines factors affecting reliability, or consistency of assessment scores, from an objective structured clinical examination (OSCE) in neurology through generalizability theory (G theory). Methods: Data include assessments from a multistation OSCE taken by 194 medical students at the completion of a neurology clerkship. Facets evaluated in this study include cases, domains, and items. Domains refer to areas of skill (or constructs) that the OSCE measures. G theory is used to estimate variance components associated with each facet, derive reliability, and project the number of cases required to obtain a reliable (consistent, precise) score. Results: Reliability using G theory is moderate (Φ coefficient = 0.61, G coefficient = 0.64). Performance is similar across cases but differs by the particular domain, such that the majority of variance is attributed to the domain. Projections in reliability estimates reveal that students need to participate in 3 OSCE cases in order to increase reliability beyond the 0.70 threshold. Conclusions: This novel use of G theory in evaluating an OSCE in neurology provides meaningful measurement characteristics of the assessment. Differing from prior work in other medical specialties, the cases students were randomly assigned did not influence their OSCE score; rather, scores varied in expected fashion by domain assessed.

The Critical Synthesis Package contains: (1) a Critical Analysis of the psychometric properties and application to health sciences education for the Thanatophobia Scale, and (2) a copy of the Thanatophobia Scale developed by Joseph Merrill, MD. The Thanatophobia Scale measures feelings associated with thanatophobia, or fear of death, and its seven items address the individuals' feeling of discomfort in dealing with dying patients. The scale is a seven-point ordinal scale anchored on end by “strongly disagree” and by “strongly agree” on the other. Scores are calculated by summing the selected points for all seven items. Individuals who have high scores (towards the “strongly agree” anchor) may have difficulty in dealing with dying patients, while those who have low scores may be more comfortable in palliative care settings. This assessment tool has been presented in original and subsequent studies. It has been utilized in multiple health professions and learner groups including medical students, physicians of various specialties, nurses of various specialties, and physician assistants. Additional validity evidence for the Thanatophobia Scale is needed to evaluate characteristics of items in different groups of learners, as it has been used among multiple healthcare professions. Moreover, thanatophobia scores that correlate with observed performances may increase validity evidence for the use of this instrument. Also, many of the publications that have utilized the Thanatophobia Scale have incorporated it with other scales and assessments. The original Thanatophobia Scale contained 7 items, but later it was incorporated in two larger scales of 81 and 110 items by the original authors. The combination of the thanatophobia items with other scales makes analysis of the psychometric properties of the scale itself difficult.