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Collaborative knowledge construction (KC) is an important process in interprofessional learning and a logical assessment target. A tool supporting the formative evaluation of KC behaviors ideally would be: 1) applicable to interprofessional teams of learners in clinical contexts; 2) informed by contemporary learning frameworks; 3) feasible and useful. No existing assessment tool meets these criteria. This paper describes the development and preliminary validity evidence for a Tool for Observing Construction of Knowledge in Interprofessional teams (TOCK-IP). Following literature review and needs assessment, the TOCK-IP was drafted based upon Gunawardena's five-phase KC model. Educational expert review established content validity. Response process and internal structure validity, feasibility, and utility were assessed through step-wise evaluation. Faculty raters applied the tool to four videos of simulated interactions between health professions learners. Faculty ratings were compared to expert consensus ratings. Thematic analysis of post-rating survey and debrief allowed assessment of feasibility and utility. Across videos, faculty raters' agreement was fair (n = 25; Fleiss' kappa = 0.40,0.001). Excellent agreement (95%) was found for raters' scores compared to consensus rating. Faculty supported tool feasibility and utility. The TOCK-IP meets the three criteria for evaluating team-level KC and offers a progression roadmap to help learners move toward collaborative learning.

Workplace-based interactions between residents and pharmacists, though relatively underexplored, might contribute substantially to learning. This international study sought to investigate the affordances residents use for informal learning about medications, their interactions with pharmacists and patterns of resident-pharmacist engagement, as well as residents’ perceived impact of these interactions on their learning. Contextual differences between US and Dutch residency training and electronic health record (EHR) may impact informal learning about medications. We conducted a cross-sectional, online, 25-item survey study, including closed-format and open-response questions among current resident physicians (post-graduate years 1–6, from a variety of residency programs n = 803) from the University of California San Francisco, the University of Minnesota, and the University Medical Center Utrecht. Responses from 173 residents in both countries revealed that these physician trainees were afforded opportunities to engage in a wide variety of pharmacotherapy-related activities but engaged differently with social and environmental resources for support. Residents from the United States (US) utilized pharmacists and Up-To-Date, whereas Dutch residents preferentially utilized the online Dutch medication information site and EHR-embedded medication resources. US residents interacted with pharmacists significantly more frequently than Dutch residents. Pharmacists provided residents with a wide range of useful information, much of which is integrated into the medication resources in the Dutch EHR-based decision-support system. While US residents reported overwhelmingly that informal interactions with pharmacists contribute to their learning about medications, Dutch residents’ responses did not confirm this. Intentionally designing residents’ training to include opportunities for interactions with pharmacists could potentially positively impact residents’ informal workplace learning.

Background The clinical learning environment (CLE) is a priority focus in medical education. The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review's (CLER) recent addition of teaming and health care systems obligates educators to monitor these areas. Tools to evaluate the CLE would ideally be: (1) appropriate for all health care team members on a specific unit/project; (2) informed by contemporary learning environment frameworks; and (3) feasible/quick to complete. No existing CLE evaluation tool meets these criteria. Objective This report describes the creation and preliminary validity evidence for a Clinical Learning Environment Quick Survey (CLEQS). Methods Survey items were identified from the literature and other data sources, sorted into 1 of 4 learning environment domains (personal, social, organizational, material) and reviewed by multiple stakeholders and experts. Leaders from 6 interprofessional graduate medical education quality improvement/patient safety teams distributed this voluntary survey to their clinical team members (November 2019–mid-January 2021) using electronic or paper formats. Validity evidence for this instrument was based on the content, response process, internal structure, reliability, relations to other variables, and consequences. Results Two hundred one CLEQS responses were obtained, taking 1.5 minutes on average to complete with good reliability (Cronbach's α ≥ 0.83). The Cronbach alpha for each CE domain with the overall item ranged from 0.50 for personal to 0.79 for social. There were strong associations with other measures and clarity about improvement targets. Conclusions CLEQS meets the 3 criteria for evaluating CLEs. Reliability data supports its internal consistency, and initial validity evidence is promising.

Leaders in academic medicine have observed that ‘the goal of faculty development is to provide faculty members with the skills relevant to their institutional setting and faculty position, and to s...

Learning environments shape the experiences of learners and practitioners, making them an important component of program evaluation. However, educators find it challenging to decide whether to measure clinical learning environments with existing instruments or to design their own new instrument and, if using an existing instrument, which to choose. To assist educators with these decisions, the authors compared clinical learning environment instruments based on their characteristics, underlying constructs, and degree to which items reflect 4 domains (personal, social, organizational, material) from a recently developed model for conceptualizing learning environments in the health professions. Building on 3 prior literature reviews as well as a literature search, the authors identified 6 clinically oriented learning environment instruments designed for medical education. They collected key information about each instrument (e.g., number of items and subscales, conceptual frameworks, operational definitions of the learning environment) and coded items from each instrument according to the 4 domains. The 6 instruments varied in number of items, underlying constructs, subscales, definitions of clinical learning environment, and domain coverage. Most instruments focused heavily on the organizational and social domains and less on the personal and material domains (half omitted the material domain entirely). The variations in these instruments suggest that educators might consider several guiding questions. How will they define the learning environment and which theoretical lens is most applicable (e.g., personal vitality, sociocultural learning theory)? What aspects or domains of the learning environment do they most wish to capture (e.g., personal support, social interactions, organizational culture, access to resources)? How comprehensive do they want the instrument to be (and correspondingly how much time do they expect people to devote to completing the instrument and how frequently)? Whose perspective do they wish to evaluate (e.g., student, resident, fellow, attending, team, patient)? Each of these considerations is addressed.

Introduction After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes. Factors associated with this communication are not well understood. This study clarifies how often, and for what reasons, current physicians do or do not communicate back to transferring physicians about transitioned patients. Methods In 2018, 38 physicians at two academic teaching hospitals were interviewed about communication decisions regarding 618 transitioned patients. Researchers recorded quantitative and qualitative data in field notes, then coded communication rationales using directed content analysis. Descriptive statistics and mixed effects logistic regression analyses identified communication patterns and examined associations with communication for three conditions: When current physicians 1) changed transferring physicians’ clinical decisions, 2) perceived transferring physicians’ clinical uncertainty, and 3) perceived transferring physicians’ request for communication. Results Communication occurred regarding 17% of transitioned patients. Transferring physicians initiated communication in 55% of these cases. Communication did not occur when current physicians 1) changed transferring physicians’ clinical decisions (119 patients), 2) perceived transferring physicians’ uncertainty (97 patients), and 3) perceived transferring physicians’ request for communication (12 patients). Rationales for no communication included case contextual, structural, interpersonal, and cultural factors. Perceived uncertainty and request for communication were positively associated with communication (p

PurposeInternationally, health professions education scholarship units (HPESUs) are often developed to promote engagement in educational scholarship, yet little is known about how HPESUs change over time or what factors support their longevity. In hopes of helping HPESUs thrive, this study explored factors that shaped the evolution of 8 HPESUs over the past 14 years.MethodThis study involved retrospective case-study analysis of the 8 American, Canadian, and Dutch HPESUs profiled in a 2004 publication. First, the research team summarized key elements of HPESUs from the 2004 articles, then conducted semistructured interviews with the current unit directors. In the first set of questions, directors were asked to reflect on how the unit had changed over time, what successes the unit enjoyed, what enabled these successes, what challenges the unit encountered, and how these challenges were managed. In the second set of questions, questions were tailored to each unit, following up on unique elements from the original article. The team used Braun and Clarke's 6-phase approach to thematic analysis to identify, analyze, and report themes.ResultsThe histories of the units varied widely-some had grown by following their original mandates, some had significant mission shifts, and others had nearly disappeared. Current HPESU directors identified 3 key factors that shaped their HPESU's longitudinal development: the people working within and overseeing the HPESU (the need for a critical mass of scholars, a pipeline for developing scholars, and effective leadership), institutional structures (issues of centralization, unit priorities, and clear messaging), and funding (the need for multiple funding sources).ConclusionsStudy findings offer insights that may help current HPESU directors to strategically plan for their unit's continued development. Tactically harnessing the factors identified could help directors ensure their HPESU's growth and contend with the challenges that threaten the unit's success.

Purpose Learning from practice is important for continuous improvement of practice. Yet little is known about how physicians assimilate clinical feedback and use it to refine their diagnostic approaches. This study described physicians' reactions to learning that their provisional diagnosis was either consistent or inconsistent with the subsequent diagnosis, identified emotional responses to those findings, and explored potential consequences for future practices. Method In 2016-2017, 22 internal medicine hospitalist and resident physicians at Oregon Health & Science University completed semistructured interviews. Critical incident prompts elicited cases of patient care transitions before the diagnosis was known. Interview questions explored participants' subsequent follow-up. Matrix analysis of case elements, emotional reactions, and perceived practice changes was used to compare patterns of responses between cases of confirming versus disconfirming clinical feedback. Results Participants described 51 cases. When clinical feedback confirmed provisional diagnoses (17 cases), participants recalled positive emotions, judged their performance as sufficient, and generally reinforced current approaches. When clinical feedback was disconfirming (34 cases), participants' emotional reactions were mostly negative, frequently tempered with rationalizations, and often associated with perceptions of having made a mistake. Perceived changes in practice mostly involved nonspecific strategies such as "trusting my intuition" and "broadening the differential," although some described case-specific strategies that could be applied in similar contexts in the future. Conclusions Internists' experiences with posttransition clinical feedback are emotionally charged. Internists' reflections on clinical feedback experiences suggest they are primed to adapt practices for the future, although the usefulness of those adaptations for improving practice is less clear.

What's New This study examined if preclerkship medical students would find it educational to scribe in a pediatric setting. Scribing promoted students' learning about pediatric clinical encounters enhanced their competency with electronic health record use, and moderately reduced attending physician documentation burden.

Although medical schools espouse a commitment to the educational mission, faculty members often struggle to develop and maintain their identities as teachers. Teacher identity is important because it can exert a powerful influence on career choice, academic roles and responsibilities, and professional development opportunities. However, most faculty development initiatives focus on knowledge and skill acquisition rather than the awakening or strengthening of professional identity. The goal of this Perspective is to highlight the importance of faculty members' professional identities as teachers, explore how faculty development programs and activities can support teachers' identities, and describe specific strategies that can be used in professional development. These strategies include the embedding of identity and identity formation into existing offerings by asking questions related to identity, incorporating identity in longitudinal programs, building opportunities for community building and networking, promoting reflection, and capitalizing on mentorship. Stand-alone faculty development activities focusing on teachers' identities can also be helpful, as can a variety of approaches that advocate for organizational change and institutional support. To achieve excellence in teaching and learning, faculty members need to embrace their identities as teachers and be supported in doing so by their institutions and by faculty development.

Objective. To develop and evaluate a mobile learning module to support knowledge construction between medical and pharmacy students through structured dialogue prompts. Methods. Rheumatologists and pharmacists collaboratively developed a two-week, case-based, asynchronous interprofessional learning module that was delivered via a mobile app and focused on collaborative medication management of a complex case involving a patient with systemic lupus erythematosus. The clinical case evolved over three phases: diagnosis, initial treatment, and medication-related complications. Dialogue prompts were incorporated in each phase as a mechanism to support knowledge construction among learners. Pharmacy and medical student pairs were randomized to receive either high guidance or low guidance prompts for collaborative learning. The student pairs worked together, asynchronously, online, to develop three collaborative care plans. The evaluation of the learning module to support knowledge construction included: analysis of text-based dialogue coded for knowledge construction phases; the accuracy and completeness of the three collaborative care plans; and quantitative and qualitative participant feedback. Results. Sixteen pairs of medical and pharmacy students (n=32) participated. Pairs who received high guidance engaged in all phases of knowledge construction more often than pairs who received low guidance. Guidance phase did not differentially impact collaborative care plan scores. Ninety-eight percent of students agreed or strongly agreed that the module improved their clinical reasoning, interprofessional communication, and knowledge of systemic lupus erythematosus. Conclusion. The knowledge construction framework can guide the design and evaluation of educational interventions such as a mobile learning module to support knowledge construction among health professionals.

Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting. Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings. Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning. Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.

Although faculty members may relate strongly to their clinical and/or research identities, they frequently struggle to develop and maintain an educator identity, which may be underdeveloped or in t...

Context This article describes the scholarly work that has addressed the fifth recommendation of the 1988 World Conference on Medical Education: ‘Train teachers as educators, not content experts alone, and reward excellence in this field as fully as excellence in biomedical research or clinical practice’. Progress Over the past 30 years, scholars have defined the preparation needed for teaching and other educator roles, and created faculty development delivery systems to train teachers as educators. To reward the excellence of educators, scholars have expanded definitions of scholarship, defined educator roles and criteria for judging excellence, and developed educator portfolios to make achievements visible for peer review. Despite these efforts, the scholarship of discovery continues to be more highly prized and rewarded than the scholarship of teaching. These values are deeply embedded in university culture and policies. Challenges To remedy the structural inequalities between researchers and educators, a holistic approach to rewarding the broad range of educational roles and educational scholarship is needed. This requires strong advocacy to create changes in academic rewards and support policies, provide a clear career trajectory for educators using learning analytics, expand programmes for faculty development, support health professions education scholarship units and academies of medical educators, and create mechanisms to ensure high standards for all educators.

CONTEXT Although health professions education scholarship units (HPESUs) share a commitment to the production and dissemination of rigorous educational practices and research, they are situated in many different contexts and have a wide range of structures and functions.OBJECTIVES In this study, the authors explore the institutional logics common across HPESUs, and how these logics influence the organisation and activities of HPESUs.METHODS The authors analysed interviews with HPESU leaders in Canada (n = 12), Australia (n = 21), New Zealand (n = 3) and the USA (n = 11). Using an iterative process, they engaged in inductive and deductive analyses to identify institutional logics across all participating HPESUs. They explored the contextual factors that influence how these institutional logics impact each HPESU's structure and function.RESULTS Participants identified three institutional logics influencing the organisational structure and functions of an HPESU: (i) the logic of financial accountability; (ii) the logic of a cohesive education continuum, and (iii) the logic of academic research, service and teaching. Although most HPESUs embodied all three logics, the power of the logics varied among units. The relative power of each logic influenced leaders' decisions about how members of the unit allocate their time, and what kinds of scholarly contribution and product are valued by the HPESU.CONCLUSIONS Identifying the configuration of these three logics within and across HPESUs provides insights into the reasons why individual units are structured and function in particular ways. Having a common language in which to discuss these logics can enhance transparency, facilitate evaluation, and help leaders select appropriate indicators of HPESU success.

Current controversies in medical education associated with professionalism, including disagreements about curriculum, pedagogy, and assessment, are rooted in part in the differing frameworks that are used to address professionalism. Three dominant frameworks, which have evolved in the medical education community, are described. The oldest framework is virtue based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanistic qualities of caring and compassion: The good physician is a person of character. The second framework is behavior based, which emphasizes milestones, competencies, and measurement of observable behaviors: The good physician is a person who consistently demonstrates competence in performing patient care tasks. The third framework is identity formation, with a focus on identity development and socialization into a community of practice: The good physician integrates into his or her identity a set of values and dispositions consonant with the physician community and aspires to a professional identity reflected in the very best physicians. Although each professionalism framework is useful and valid, the field of medical education is currently engaged in several different discourses resulting in misunderstanding and differing recommendations for strategies to facilitate professionalism. In this article, the assumptions and contributions of each framework are described to provide greater insight into the nature of professionalism. By examining each discourse in detail, underlying commonalities and differences can be highlighted to assist educators in more effectively creating professionalism curricula, pedagogy, and assessment.

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 Health professions education scholarship units (HPESUs) in the United States are large in number and diverse in purpose, activities, and contributions. Although each of these units shares a commitment to scholarship, there is no synthetic framework to accurately represent and evaluate their activities and contributions. This study aimed to provide such a framework. Method The authors examined data collected from 11 U.S. HPESU directors. Interviews occurred between April 2015 and February 2016. The research team used a combination of deductive and inductive qualitative techniques to analyze the interview transcripts. The deductive portion drew on Boyer's four-part framework of scholarship; the inductive portion produced a new conceptualization of scholarship at the HPESU level. Results The scholarly activities of HPESUs generally align with Boyer's four types of scholarship-discovery, integration, application, and teaching. However, this categorization fails to capture the interconnectedness and variety of purposes served by these activities. Both are important when considering how best to represent the scholarly contributions made by HPESUs. From their analysis of interviews, the authors developed a three-part framework characterizing HPESU scholarly activities: supporting a scholarly approach to education, supporting educational scholarship within the institution, and supporting HPESU members' scholarship. Conclusions The authors contend that the three-part, unit-level framework for scholarship constructed in this study brings clarity and understanding to the purpose, activities, and contributions made by HPESUs in the United States. The proposed framework may allow unit directors to better justify and advocate for the resources needed to further promote the work of HPESUs.

Background Increasingly, non-English speaking countries use English as the medium of instruction (EMI) to teach academic subjects. This study investigated the challenges and adaptation strategies of teachers and students in an EMI medical education program in China. Methods Data were collected on EMI and non-EMI students’ test performances and student and teacher perceptions of the program. Test scores and survey results were analyzed using SPSS. Focus group transcripts and open-ended comments from surveys were examined using thematic coding. Results There were no significant differences in admission and graduation test scores for EMI and non-EMI students. Four challenges with the EMI program were identified: (1) insufficient/inappropriate teaching materials, (2) unsatisfactory teaching, (3) inadequate class interactions, and (4) failure to teach medical humanities. To address these challenges, teachers and students used adaptive strategies, such as the use of alternative textbooks, self-learning skills and Chinese language. Conclusions EMI programs are difficult to initiate, requiring faculty development and institutional support, and student self and peer group learning strategies to be successful. The adaptive strategies employed by both students and teachers offer insights into how other EMI programs might strengthen their implementation.

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.

When physicians transition patients, the physician taking over may change the diagnosis. Such a change could serve as an important source of clinical feedback to the prior physician. However, this feedback may not transpire if the current physician doubts the prior physician’s receptivity to the information. This study explored facilitators of and barriers to feedback communication in the context of patient care transitions using an exploratory sequential, qualitative to quantitative, mixed methods design. Twenty-two internal medicine residents and hospitalist physicians from two teaching hospitals were interviewed and data were analyzed thematically. A prominent theme was participants’ reluctance to communicate diagnostic changes. Participants perceived case complexity and physical proximity to facilitate, and hierarchy, unfamiliarity with the prior physician, and lack of relationship to inhibit communication. In the subsequent quantitative portion of the study, forty-one hospitalists completed surveys resulting in 923 total survey responses. Multivariable analyses and a mixed-effects model were applied to survey data with anticipated receptivity as the outcome variable. In the mixed-effects model, four factors had significant positive associations with receivers’ perceived receptivity: (1) feedback senders’ time spent on teaching services (β = 0.52, p = 0.02), (2) receivers’ trustworthiness and clinical credibility (β = 0.49, p

This article was migrated. The article was marked as recommended. Purpose: To identify and describe interventions designed to affect the learning environment (LE) in health professions education, summarize factors that influence the LE, and determine gaps that require additional research. The LE can be thought of as a dynamic and complex construct co-created by people in a particular setting. A positive LE represents a welcoming climate for learning, which enhances satisfaction, well-being, academic performance and collaboration, while a negative LE restricts participation and learning, leading to emotional exhaustion, depersonalization and burnout. Method: A six-step scoping review methodology was followed to identify and report on literature that describes interventions affecting the LE in the health professions education: 1. Identify the research question, 2. Identify relevant studies, 3. Select studies to be included, 4. Chart the data, 5. Collate, summarize and report results, and 6. Consult with stakeholders. Results: 2,201 unique citations were identified and reviewed using titles and abstracts. 240 full-text articles were retained for detailed review, resulting in the inclusion of 68 articles. Study results are reported in relation to essential components of the LE: personal, social, organizational, physical and virtual spaces. Results of four different types to the studies of the LE are described: specific interventionsimpacting the LE, comparisonsof perceptions of the LE by two or more different groups, associations with other variable such as well-being with the LE, and descriptivestudies of the LE. Major influences included accreditation regulations, curricular interventions, faculty/staff development grading practices, instructional interventions, placements, physical and virtual spaces, and support services; and are reported along with specific interventions. Conclusion: These results reflect the complexity of the LE and the need for conceptual clarity. Since the quality of the evidence was not evaluated, the identified influences should be viewed as potential opportunities to improve the LE.

Author(s): Shinkai, Kanade; Chen, Chen Amy; Schwartz, Brian S; Loeser, Helen; Ashe, Cynthia; Irby, David M | Abstract: PROBLEM:Academic medical centers struggle to achieve parity in advancement and promotions between educators and discovery-oriented researchers in part because of narrow definitions of scholarship, lack of clear criteria for measuring excellence, and barriers to making educational contributions available for peer review. Despite recent progress in expanding scholarship definitions and identifying excellence criteria, these advances are not integrated into educator portfolio (EP) templates or curriculum vitae platforms. APPROACH:From 2013 to 2015, a working group from the Academy of Medical Educators (AME) at the University of California, San Francisco (UCSF) designed a streamlined, criteria-based EP (EP 2.0) template highlighting faculty members' recent activities in education and setting rigorous evaluation methods to enable educational scholarship to be objectively evaluated for academic advancement, AME membership, and professional development. OUTCOMES:The EP 2.0 template was integrated into the AME application, resulting in high overall satisfaction among candidates and the selection committee and positive feedback on the template's transparency, ease of use, and streamlined format. In 2016, the EP 2.0 template was integrated into the campus-wide curriculum vitae platform and academic advancement system. NEXT STEPS:The authors plan to increase awareness of the EP 2.0 template by educating promotions committees and faculty at UCSF and partnering with other institutions to disseminate it for use. They also plan to study the impact of the template on supporting educators by making their important scholarly contributions available for peer review, providing guidance for professional development, and decreasing disparities in promotions.

Author(s): Bowen, Judith L; O'Brien, Bridget C; Ilgen, Jonathan S; Irby, David M; Ten Cate, Olle | Abstract: ContextTransitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients.MethodsUsing a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow-up.ResultsThe authors identified three themes related to follow-up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow-up. Analysis of participants' follow-up processes as an activity system highlighted key tensions in the system and participants' work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients' outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients' health information (rules) led to rule-breaking or abandoning activities of locating information. Finding time to conduct desired follow-up produced tension between this and other activity systems.ConclusionIn clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow-up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians' skill development in developing and maintaining tracking systems for follow-up; (iii) dedicate time in physicians' work schedules for conducting follow-up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians' learning and respect patients' privacy.

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 demand for faculty development is ongoing, and many medical schools will need to expand their pool of faculty developers to include physicians and scientists whose primary expertise is not education. Insight into what motivates occasional faculty developers can guide recruitment and retention strategies. This study was designed to understand the motivations of faculty developers who occasionally (one to three times each year) lead faculty development workshops. Method Qualitative data were collected in March and April 2012 from interviews with faculty developers who occasionally taught workshops from 2007 to 2012 in the University of California, San Francisco, School of Medicine's faculty development program. The interviews were audiotaped and transcribed. The authors thematically analyzed the transcripts using a general inductive approach and developed codes sensitized by motivation theories. Results The authors interviewed 29/30 (97%) occasional faculty developers and identified five themes: mastery (desire to learn and develop professionally), relatedness (enjoyment of working with and learning from others), duty (sense of obligation to give back and be a good academic citizen), purpose (commitment to improving local teaching and ultimately patient care), and satisfaction (fun and enjoyment). Conclusions Four of the themes the authors found are well addressed in motivation theory literature: mastery, relatedness, duty, and purpose. Whereas these four are motivators for occasional faculty developers, it is the fifth theme-satisfaction-that the authors feel is foundational and links the others together. Armed with this understanding, individuals leading faculty development programs can develop strategies to recruit and retain occasional faculty developers.

The one-minute preceptor (OMP) was originally developed in the ambulatory care setting as a time-efficient teaching technique for learner-centered clinical training. There are also possible advantages of using the OMP in the gross anatomy laboratory. However, in a previous study it was found that providing training to experienced gross anatomy teachers in the use of the OMP did not result in improvement in students' perceptions of their learning, probably because of the fact that the experienced teachers had already developed their own pedagogical approaches. In the current study, we examined the effects of training novice teachers with about four years of gross anatomy teaching experience, in the use of the OMP in the gross anatomy laboratory, by surveying students to collect their views on their learning experiences, by observing the teachers' teaching behaviors before and after they were trained in OMP, and then by interviewing them. More students reported a better learning experience in the session after the teachers had been trained in the OMP than reported worse, in eight out of the nine items related to their learning experiences. The novice teachers were receptive to the OMP. After the OMP training, the novice teachers were observed to engage more in getting commitments from the students and in reinforcing what the students have done right, two of the five OMP microskills. They considered the OMP to be very useful for their development as anatomy teachers.

PurposePhysicians routinely transition responsibility for patient care to other physicians. When transitions of responsibility occur before the clinical outcome is known, physicians may lose opportunities to learn from the consequences of their decision making. Sometimes curiosity about patients does not end with the transition and physicians continue to follow them. This study explores physicians' motivations to follow up after transitioning responsibilities.MethodUsing a constructivist grounded theory approach, the authors conducted 18 semistructured interviews in 2016 with internal medicine hospitalist and resident physicians at a single tertiary care academic medical center. Constant comparative methods guided the qualitative analysis, using motivation theories as sensitizing constructs.ResultsThe authors identified themes that characterized participants' motivations to follow up. Curiosity about patients' outcomes determined whether or not follow-up occurred. Insufficient curiosity about predictable clinical problems resulted in the choice to forgo follow-up. Sufficient curiosity due to clinical uncertainty, personal attachment to patients, and/or concern for patient vulnerability motivated follow-up to fulfill goals of knowledge building and professionalism. The authors interpret these findings through the lenses of expectancy-value (EVT) and self-determination (SDT) theories of motivation.ConclusionsParticipants' curiosity about what happened to their patients motivated them to follow up. EVT may explain how participants made choices in time-pressured work settings. SDT may help interpret how follow-up fulfills needs of relatedness. These findings add to a growing body of literature endorsing learning environments that consider task-value trade-offs and support basic psychological needs of autonomy, competency, and relatedness to motivate learning.

To conduct a scoping review to explore the construct of shared mental models (SMMs) in the context of clinical teamwork among health professions learners.The authors searched the PubMed, ERIC, CINAHL, Scopus, Web of Science, PsychINFO, and EMBASE databases for English-language articles published between 2000 and 2016. Eligible articles mentioned SMMs in relation to clinical teamwork and included health professions learners. Two reviewers screened studies for eligibility and extracted data to determine the depth and breadth of the literature on SMMs. The authors examined definitions of the SMM construct in the context of clinical teams, educational interventions using SMMs, and the measurement of SMMs.Of the 1,273 articles retrieved, 23 met the inclusion criteria. SMMs were defined in less than two-fifths of the articles (9/23). All articles applied the construct to improvements in hospital-based patient safety, often in high-intensity settings (14/23). Most articles included graduate-level physicians (21/23) within clinical teams (18/23). Interventions designed to foster SMMs (6/23) included teamwork curricula/training and teamwork supportive tools. Measurements of SMMs (7/23) included a qualitative task analysis, quantitative analyses of speech, a concept mapping, and Likert-type surveys.In health professions education, the SMM construct lacks clear definition. Few studies described educational interventions aimed at SMM development, and few attempted to measure the construct. The authors propose an operational definition of SMMs in health care and illustrate how interventions intended to foster SMMs, such as team trainings or planning exercises and communication tools, could be developed, implemented, and assessed.

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.

Purpose Faculty developers play a crucial role in preparing faculty members for their instructional responsibilities. In some programs, faculty developers are clinicians and scientists who only occasionally conduct workshops. The authors examine the identity formation of such part-time faculty developers. Method From April 2012 through March 2012, structured interviews were conducted with full-time faculty members who, from 2007 to 2012, periodically volunteered to teach workshops in the University of California, San Francisco School of Medicine's faculty development program. This qualitative study used a modified grounded theory approach. Results The authors interviewed 29 occasional faculty developers who had 1 to 22 years of experience conducting faculty development programs. All faculty had an educator identity along with their professional identity. The additional faculty developer identity generally evolved over time and aligned with their identity in one of four ways: compartmentalized, hierarchical, parallel, or merged. Their roles as faculty developers enhanced their status in their work community and influenced the way they worked with others and advanced their careers. Faculty development influences the institutional culture, and the institutional culture supports faculty development. Conclusions Most occasional faculty developers possessed a merged identity that developed over time and was moderated by the topic that they taught. Although experience contributed to this development, both junior and senior faculty developers could have a merged identity. Those who lead faculty development programs can use these findings to recruit and retain faculty developers.

Physicians have many information needs that arise at the point of care yet go unmet for a variety of reasons, including uncertainty about which information resources to select. In this study, we aimed to identify the various types of physician information needs and how these needs relate to physicians’ use of the database PubMed and the evidence summary tool UpToDate. We conducted semi-structured interviews with physicians (Stanford University, United States; n = 13; and University Medical Center Utrecht, the Netherlands; n = 9), eliciting participants’ descriptions of their information needs and related use of PubMed and/or UpToDate. Using thematic analysis, we identified six information needs: refreshing, confirming, logistics, teaching, idea generating and personal learning. Participants from both institutions similarly described their information needs and selection of resources. The identification of these six information needs and their relation to PubMed and UpToDate expands upon previously identified physician information needs and may be useful to medical educators designing evidence-based practice training for physicians.

To examine student perceptions and learning outcomes of three different third-year clerkship models: a yearlong, longitudinal, integrated clerkship (LIC); six-month clerkships with continuity (hybrid); and traditional, discipline-specific block clerkships (BCs).The authors compared the perceptions regarding the clerkship year and the hidden curriculum, as well as the pre- and postclerkship academic performance, of third-year medical students participating in LIC, hybrid, and BC models between 2006 and 2010.Generally, LIC students rated the following clerkship experiences higher than did the hybrid and BC students: faculty teaching, faculty observation of clinical skills, feedback, and the clerkship overall. Students in the LIC observed more positive role-modeling behaviors and had more patient-centered experiences than BC students. All students preferred to see patients more than once, work within a consistent site or system, and work with a stable group of peers and faculty mentors over time. Whereas students in both the LIC and the hybrid models outperformed their BC counterparts in clinical skills, student performance on the U.S. Medical Licensing Exam Step 2 (clinical knowledge) was equivalent across models.Key differences in student experiences and outcomes between the continuity clerkship models (LIC and hybrid) and BCs reinforce the literature and the educational framework for continuity in clinical learning. The benefits to student outcomes seem to increase with greater opportunities for continuity.

ProblemTraining the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner.InterventionThe University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation.ContextThrough course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice.OutcomeFrom 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment).Lessons learnedLearners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.

Previous studies on the identity development and motivation of faculty developers have occurred with seasoned developers in a research-rich environment. We sought to determine if the findings of those studies could be replicated with novice faculty developers in a resource-constrained environment.We interviewed 15 novice faculty developers from Muhimbili University of Health and Allied Sciences (MUHAS) who, at the time, had led faculty development activities for no more than two years. We conducted a qualitative analysis sensitized by the previous findings.Results were very similar to the previous work. The developers described compartmentalized, hierarchical, and merged identities. The impact was on their teaching as well as on others at MUHAS and on the institution itself. The motivations related to mastery, purpose, duty, satisfaction, and relatedness.This replication led us to conclude that identity development as a faculty developer occurs even in novice developers who do faculty development as only part of their work and despite constrained resources and a different culture. These developers find the work richly rewarding and their motivations benefit the institution. This body of research highlights how faculty development provides benefits to the institution as well as engaging career opportunities.

Research Report Perceptions of Peer-to-Peer Interprofessional Feedback Among Students in the Health Professions Sandrijn M. van Schaik, MD, PhD, Glenn Regehr, PhD, Kevin W. Eva, PhD, David M. Irby, PhD, and Patricia S. O’Sullivan, EdD Abstract Purpose Interprofessional teamwork should include interprofessional feedback to optimize performance and collaboration. Social identity theory predicts that hierarchy and stereotypes may limit receptiveness to interprofessional feedback, but literature on this is sparse. This study explores perceptions among health professions students regarding interprofessional peer feedback received after a team exercise. interprofessional exercise early in clinical training. Afterward, they wrote anonymous feedback comments for each other. Each student subsequently completed an online survey to rate the usefulness and positivity (on five-point scales) of feedback received and guessed each comment’s source. Data analysis included analysis of variance to examine interactions (on usefulness and positivity ratings) between profession of feedback recipients and providers. Method In 2012–2013, students from seven health professions schools (medicine, pharmacy, nursing, dentistry, physical therapy, dietetics, and social work) participated in a team-based Results Of 353 study participants, 242 (68.6%) accessed the feedback and 221 (62.6%) completed the survey. Overall, students perceived the feedback as useful (means across professions = 3.84–4.27) and I nterprofessional teamwork is recognized as essential for quality patient care, 1 a notion which has led to the formulation of interprofessional competencies 2 and widespread implementation of interprofessional education (IPE) programs. 3 One competency domain is interprofessional communication, which includes “giving timely, sensitive, instructive feedback to others about their performance on the team, [and] responding respectfully as a team member to feedback from others.” 2 Studies have shown that intrateam feedback improves team performance, 4–6 which, in interprofessional settings, requires team members to be receptive to feedback from other professionals. Please see the end of this article for information about the authors. Correspondence should be addressed to Sandrijn M. van Schaik, 505 Parnassus Ave., Box 0106, San Francisco, CA 94143-0106; telephone: (415) 476- 3731; e-mail: vanschaiks@peds.ucsf.edu. Acad Med. 2016;91:807–812. First published online November 9, 2015 doi: 10.1097/ACM.0000000000000981 Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A312. Academic Medicine, Vol. 91, No. 6 / June 2016 Little is known about acceptability of interprofessional feedback between health care professionals, and how to introduce giving and receiving such feedback into IPE curricula. Social identity theory conceptualizes human behavior as having both interpersonal and intergroup aspects, with social identity defined as a person’s self-concept derived from perceived membership in a particular group. 7 From this framework emerges a prediction that tensions between different professional groups may create unique challenges for interprofessional feedback. Contributing factors include hierarchy, professional identity, stereotypes, societal expectations, and attitudes toward collaboration. 8,9 Indeed, the implementation of team training programs in aviation and the military that incorporate intrateam feedback has hit barriers due to power differences among team members. 10 Nonetheless, such programs have been adapted for health care teams, where similar barriers exist. 11,12 In several countries, feedback from other professions has positive (means = 4.17–4.86). There was no main effect of profession of the feedback provider, and no interactions between profession of recipient and profession of provider regardless of whether the actual or guessed provider profession was entered into the analysis. Conclusions These findings suggest that students have positive perceptions of interprofessional feedback without systematic bias against any specific group. Whether students actually use interprofessional feedback for performance improvement and remain receptive toward such feedback as they progress in their professional education deserves further study. become an integral part of physicians’ (continuing) education, embedded in multisource feedback programs. 13,14 Such programs are generally well received, but most reports do not separate findings regarding feedback within and outside the profession. A few studies indicate that not all physicians are receptive to feedback from nurses or act on such feedback. 15,16 To our knowledge, whether the reverse is true and how receptiveness to feedback plays out among other health care professionals and at varying levels of training has received limited attention thus far. Thus, much remains to be clarified about the acceptability of interprofessional feedback in the health professions before it can be effectively integrated into interprofessional teamwork and education. We undertook the current study as a first step in clarifying these issues by examining health professions students’ perceptions of learner-to- learner feedback after an interprofessional team exercise. In particular, we analyzed whether students found it challenging to give students from other professional Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.

Background: Advancing patient safety during handoffs remains a public health priority. The application of cognitive load theory offers promise, but is currently limited by the inability to measure cognitive load types. Objective: To develop and collect validity evidence for a revised self-report inventory that measures cognitive load types during a handoff. Methods: Based on prior published work, input from experts in cognitive load theory and handoffs, and a think-aloud exercise with residents, a revised Cognitive Load Inventory for Handoffs was developed. The Cognitive Load Inventory for Handoffs has items for intrinsic, extraneous, and germane load. Students who were second- and sixth-year students recruited from a Dutch medical school participated in four simulated handoffs (two simple and two complex cases). At the end of each handoff, study participants completed the Cognitive Load Inventory for Handoffs, Paas’ Cognitive Load Scale, and one global rating item for intrinsic load, extraneous load, and germane load, respectively. Factor and correlational analyses were performed to collect evidence for validity. Results: Confirmatory factor analysis yielded a single factor that combined intrinsic and germane loads. The extraneous load items performed poorly and were removed from the model. The score from the combined intrinsic and germane load items associated, as predicted by cognitive load theory, with a commonly used measure of overall cognitive load (Pearson’s r = 0.83, p Conclusion: These results offer encouragement that intrinsic load during handoffs may be measured via a self-report measure. Additional work is required to develop an adequate measure of extraneous load.

Context The handover represents a high-risk event in which errors are common and lead to patient harm. A better understanding of the cognitive mechanisms of handover errors is essential to improving handover education and practice. Objectives This paper reports on an experiment conducted to study the effects of learner knowledge, case complexity (i.e. cases with or without a clear diagnosis) and their interaction on handover accuracy and cognitive load. Methods Participants were 52 Dutch medical students in Years 2 and 6. The experiment employed a repeated-measures design with two explanatory variables: case complexity (simple or complex) as the within-subject variable, and learner knowledge (as indicated by illness script maturity) as the between-subject covariate. The dependent variables were handover accuracy and cognitive load. Each participant performed a total of four simulated handovers involving two simple cases and two complex cases. Results Higher illness script maturity predicted increased handover accuracy (p

As we mark the 100th anniversary of the Flexner report which revolutionized the process of medical education, there is again concern that we face a critical need for change in the process of medical education in order to meet the needs of learners, teachers, and patients. In this symposium, panelists shared perspectives on medical education reform from throughout the world, including The Future of Medical Education in Canada, the role of regulators in contributing to reform, the evolution of accreditation standards, the current state of medical education in Southeast Asia, and the perspectives of a medical student on medical education reform. In the "Audience discussion" section, themes emerged surrounding medical education as a social good, the need for governmental support of medical education, the cost of medical education and the rise of for-profit medical schools, and embracing a broader view of health professional education. There remain remarkable parallels in calls for reform in medical education at the turn of the twentieth and twenty-first centuries but education which is patient-centered and actively involves the voices of our patients and our students is likely to be a hallmark.

In both 1910 and 2010, The Carnegie Foundation for the Advancement of Teaching used existing educational innovations and learning theory to point the way to the future of medical education. Flexner's transformative report of 1910 was strongly influenced by the innovative curriculum at Johns Hopkins University School of Medicine and by educational principles of the Progressive Era. In 1912, Flexner wrote a similar critique of medical education in Europe. These two reports have powerfully shaped medical education for the past century. Yet much has changed since then, which prompted The Carnegie Foundation for the Advancement of Teaching to commission another report that was published in 2010. Drawing on contemporary educational innovations and research from the learning sciences, the authors make four recommendations for reform: (1) standardize on learning outcomes while individualizing the learning process, (2) integrate formal knowledge with clinical experience, (3) imbue habits of inquiry and improvement to achieve lifelong learning and excellence, and (4) explicitly cultivate the formation of professional identity. In this article, the author describes educational innovations and educational principles relevant to each of these four recommendations.

Research on faculty development has focused primarily on individual participants and has produced relatively little generalizable knowledge that can guide faculty development programs. In this article, the authors examine how current research on faculty development in medical education can be enriched by research in related fields such as teacher education, quality improvement, continuing medical education, and workplace learning. As a result of this analysis, the authors revise the old model for conceptualizing faculty development (preferably called professional development). This expanded model calls for research on educational process and outcomes focused on two communities of practice: the community created among participants in faculty development programs and the communities of teaching practice in the workplace (classroom or clinic) where teaching actually occurs. For the faculty development community, the key components are the participants, program, content, facilitator, and context in which the program occurs and in which the faculty teach. For the workplace community, associated components include relationships and networks of association in that environment, the organization and culture of the setting, the teaching tasks and activities, and the mentoring available to the members of that academic and/or clinical community of teaching practice. This expanded model of faculty development generates a new set of research questions, which are described along with six recommendations for enhancing research, including establishment of a national center for research in health professions education.

Background By 2050, infections due antimicrobial-resistant organisms are predicted to account for 10 million deaths/year worldwide. Physician antibiotic prescribing patterns are a significant factor in the development of antibiotic resistance organisms. Early, continual, and integrated medical student education may help students develop a framework for responsible antimicrobial use as they develop prescribing patterns. Methods We designed a spiral antimicrobial stewardship curriculum (defined as revisiting the same concept but with increasing complexity) for medical students in years 2–4. Data provided by the Graduation Questionnaire (GQ) administered by the US Association of American Colleges were used. We compared student responses during the curriculum rollout in 2013–2015 between students at our institution and other schools. We also surveyed graduating seniors in 2015 about antimicrobial stewardship training. Results Using GQ data for the class of 2013 (preintervention), a similar proportion of UCSF medical students compared with other US medical students rated microbiology clinical preparation as excellent (43.6% vs. 45.1%, P > 0.20). For the 2014 class, we developed interactive case-based sessions at the beginning of years 3 and 4. After this first intervention, a higher proportion of UCSF students rated the microbiology clinical preparation as excellent (51.3%) compared with responses at all schools (39.8%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.1–2.3, P = 0.013). For the class of 2015, we added content during the medicine clerkship and 1 week before graduation. For the 2015 class, an even higher proportion of UCSF students rated microbiology preparation as excellent (57.6%), compared with all schools (41.2%, OR 2.23, 95% CI 1.54–3.22, P < 0.0001). From our survey, 88% were very or extremely satisfied with antimicrobial stewardship training. Conclusion A spiral curriculum focusing on antimicrobial stewardship and infectious diseases increases student perception of clinical preparation prior to graduation. As the curriculum was incrementally introduced, students’ knowledge increased indicating a dose–response pattern. Based on these positive results, we plan to introduce more content throughout UME, and link to curriculum for GME and practicing clinicians. Disclosures All authors: No reported disclosures.

Despite widespread endorsement of competency-based assessment of medical trainees and practicing physicians, methods for identifying those who are not competent and strategies for remediation of their deficits are not standardized. This literature review describes the published studies of deficit remediation at the undergraduate, graduate, and continuing medical education levels. Thirteen studies primarily describe small, single-institution efforts to remediate deficient knowledge or clinical skills of trainees or belowstandard-practice performance of practicing physicians. Working from these studies and research from the learning sciences, the authors propose a model that includes multiple assessment tools for identifying deficiencies, individualized instruction, deliberate practice followed by feedback and reflection, and reassessment. The findings of the study reveal a paucity of evidence to guide best practices of remediation in medical education at all levels. There is an urgent need for multiinstitutional, outcomes-based research on strategies for remediation of less than fully competent trainees and physicians with the use of long-term follow-up to determine the impact on future performance. Acad Med. 2009; 84:1822–1832. Medical educators and accrediting organizations have shifted their emphasis from what is taught in the curriculum to what a medical student, resident, or practicing physician can perform. Whereas most trainees and practicing physicians can demonstrate competence in clinical and communication skills, a minority fail to meet the expected standard and require remediation. Despite widespread endorsement of the expectation that physicians-in-training and practicing physicians be assessed for their competence, it remains challenging to identify accurately and reliably those trainees and physicians who are incompetent or less than fully competent and to remediate their deficiencies effectively. Less than fully competent physicians or trainees fail to maintain acceptable standards in one or more areas of professional physician practice, whereas incompetent physicians lack the abilities (cognitive, noncognitive, and communicative) and qualities needed to

PURPOSE Medical schools increasingly employ comprehensive standardized patient assessments to ensure medical students' clinical competence. The consequences of poor performance on the assessment and the institutional factors associated with imposing consequences are unknown. METHOD In 2006, the investigators surveyed 122 U.S. medical school curriculum deans about comprehensive assessments using standardized patients after core clerkships, with questions about exam characteristics, institutional commitment to the examination (years of experience, exam infrastructure, clerkship director involvement), academic consequences of failing the assessment, and satisfaction with remediation. RESULTS Ninety-three of 122 (76%) deans responded. Eighty-two (88%) conducted a comprehensive assessment in years three or four of medical school. Of those, required remediation was the only consequence of failing employed by 61 schools (74%), and only 39 (47%) required retesting for graduation. Participants were somewhat satisfied with (mean 3.45 out of maximum 5, SD 1.08) and confident in (3.37, SD 1.17) their remediation process. Satisfaction and confidence were associated with requiring remediation (P = .003) and retesting (P < .001), but experience with the exam, exam infrastructure, and clerkship director involvement were not. No school demographic characteristics or measures of institutional commitment were related to external reporting of students' comprehensive assessment scores. CONCLUSIONS Despite the prevalence of comprehensive assessments, schools attach few academic consequences to poor performance. Educators are only moderately satisfied with their efforts to remediate poor performers. However, schools with greater trust in their remediation process than other schools are more likely to enforce consequences of poor performance.