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Introduction The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported. Materials and Methods This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached. Results The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is “raising concerns,” referring to speaking up when something needs to be addressed. The other is “making compromises,” where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care. Conclusions These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team’s ability to judge what is ethically right and wrong, as well as the team’s willingness and ability to act accordingly—to consistently “do the right thing.” There is a collective moral compass, and while the team may not all agree on what exactly is true north—they are all bending that way.

Purpose Research shows that physician empathy can improve patients' reporting of symptoms, participation in care, compliance, and satisfaction; however, success in harnessing these advantages in the ICU hinges on a myriad of contextual factors. This study describes the current state of knowledge about intensivists' empathy. Methods A scoping review was conducted across six databases and grey literature to clarify intensivists' experiences of empathy and identify directions of future inquiries. The search had no date limits and was specific to empathy, intensivists, and ICU environments. Results were blindly and independently reviewed by authors. Results The search yielded 628 manuscripts; 45 met inclusion criteria. Three overarching themes connected the manuscripts: (1) the risks and benefits of empathy, (2) the spectrum of connection and distance of intensivists from patients/families, and (3) the facilitators and barriers to empathy's development. Conclusion Empathy among intensivists is not a dichotomous phenomenon. It instead exists on continua. Four steps are recommended for optimizing empathy in the ICU: clearly defining empathy, addressing risks and benefits transparently, providing education regarding reflective practice, and developing supportive environments. Overall, this review revealed that the state of knowledge about empathy as experienced by intensivists still has room to grow and be further explored.

Mentorship may offer protégés numerous benefits including improved self-esteem, increased interest in research, and/or enhanced productivity. Without proper planning, reflection, and evaluation, however, mentorship programs may result in undesirable consequences. In this paper we describe a mentorship program designed to improve psychosocial support and professional development for residents, that while initially successful, was terminated due to perceptions of inequity that led to strife among residents and ultimately created a toxic learning climate. Leader-member exchange theory provides a lens through which to view our program’s failure and to offer some potential solutions to mitigate such challenges for other programs. Leader-member exchange theory focuses on the importance of relationships, communication, and awareness of biases to optimize interactions between dyads such as a mentor and a protégé. We highlight opportunities during the stranger, acquaintance, and mature partnership phases that could have helped to save a residency mentorship program. Electronic supplementary material The online version of this article (10.1007/s40037-020-00584-2) contains supplementary material, which is available to authorized users.

Teaching medical students how to teach is a growing and essential focus of medical education, which has given rise to student teaching programs. Educating medical students on how to teach can improve their own learning and lay the foundation for a professional identity rooted in teaching. Still, medical student-as-teacher (MSAT) programs face numerous obstacles including time constraints, prioritizing curriculum, and determining effective evaluation techniques. The purpose of this scoping review is to map the current landscape of the literature on medical school initiatives designed to train students to teach to describe why medical student teaching programs are started; the benefits and barriers; who teaches them; what content is taught; and how content is delivered. With this new map, the authors aimed to facilitate the growth of new programs and provide a shared knowledge of practices derived from existing programs.The authors conducted a scoping review, guided by Arksey and O'Malley's framework, to map the literature of MSAT training programs. Six databases were searched using combinations of keywords and controlled vocabulary terms. Data were charted in duplicate using a collaboratively designed data charting tool. This review builds on the Marton et al. review and includes articles published from 2014 to 2020.Of the 1,644 manuscripts identified, the full-text of 57 were reviewed, and ultimately 27 were included. Articles included empirical research, synthetic reviews, opinion pieces, and a descriptive study. Analysis focused on modalities for teaching medical students how to teach; content to teach medical students about teaching; benefits and barriers to starting teaching programs; and the value of teaching programs for medical students.The rapid growth of MSAT programs suggests that this curricular offering is of great interest to the field. Literature shows an increase in evaluative efforts among programs, benefits for students beyond learning to teach, and evidence of effective engagement in medical students' designing and implementing programs.

Blended learning offers adult learners unique opportunities for instructional continuity given work and personal commitments. However, learners participating in blended learning may experience a sense of isolation and/or problems with technology. To address the challenges of a blended program, an expanded orientation, called "onboarding," was designed to ensure learners feel connected to their program and clearly understand the programmatic requirements. Onboarding spans six months and includes a series of activities to provide learners with technological, interaction, and self-directed learning skills needed to succeed in a blended program. Results from the evaluation survey reveal that learners feel most engaged with the program through one-to-one interactions with their academic advisors and interactions with peers in an online discussion board. In addition, learners primarily found the onboarding process straightforward and mostly expressed a desire for more explicit instructions. The onboarding, catering to adult learner needs, provides a combination of personal interactions and self-paced activities, offers hands-on experience of the technologies that learners will be using in the program, and contextualizes all the technical activities within programmatic requirements. Providing a comprehensive onboarding process can help returning learners in their transition to blended learning

Background Military general surgeons commonly perform urologic procedures, yet, there are no required urologic procedural minimums during general surgery residency training. Additionally, urologists are not included in the composition of forward operating surgical units. Urologic Care Army/Air Force/Navy Provider Education was created to provide military general surgeons with training to diagnose and treat frequently encountered urologic emergencies when practicing in environments without a urologist present. Study Design A literature review and needs assessment were conducted to identify diagnoses and procedures to feature in the course. The course included a 1-hour didactic session and then a 2-hour hands-on simulated skills session using small, lightweight, cost-effective simulators. Using a pretest–posttest design, participants completed confidence and knowledge assessments before and after the course. The program was granted educational exemption by the institutional review board. Results Twenty-seven learners participated. They demonstrated statistically significant improvement on the knowledge assessment (45.4% [SD 0.15] to 83.6% [SD 0.10], P Conclusion We created the first-ever urologic emergencies simulation curriculum for military general surgeons that has demonstrated efficacy in improving the diagnostic confidence, procedural confidence, and topic knowledge for the urologic emergencies commonly encountered by military general surgeons.

Traditional half-day continuity clinics within primary care residency programs require residents to split time between their assigned clinical rotation and continuity clinic, which can have detrimental effects on resident experiences and patient care within continuity clinics. Most previous efforts to separate inpatient and outpatient obligations have employed block scheduling models, which entail significant rearrangements to clinical rotations, team structures, and didactic education and have yielded mixed effects on continuity of care. A full-day continuity clinic schedule within a traditional, non-block rotation framework holds potential to de-conflict resident schedules without the logistical rearrangements required to adopt block scheduling models, but no literature has described the effect of such full-day continuity clinics on continuity of care or resident experiences within continuity clinic.A pediatric residency program implemented full-day continuity clinics within a traditional rotation framework. We examined the change in continuity for physician (PHY) measure in the six months prior to versus the six months following the switch, as well as changes in how often residents saw clinic patients in follow-up and personally followed up clinic laboratory and radiology results, which we term episodic follow-up. Resident and attending perceptions of full-day continuity clinics were measured using a survey administered 5-7 months after the switch.The switch to full-day continuity clinics occurred in January 2018 within the Wright State University/Wright-Patterson Medical Center Pediatric Residency Program. The program has 46 residents who are assigned to one of two continuity clinic sites, each of which implemented the full-day continuity clinics simultaneously.The PHY for residents at one clinic decreased slightly from 18.0% to 13.6% (p.001) with full-day continuity clinics but was unchanged at another clinic [60.6% vs 59.5%, p=.86]. Measures of episodic follow-up were unchanged. Residents (32/46 = 77% responding) and attendings (6/8 = 75% responding) indicated full-day continuity clinics improved residents' balance of inpatient and outpatient obligations, preparation for clinic, continuity relationships with patients, and clinic satisfaction.Full-day continuity clinics within a traditional rotation framework had mixed effects on continuity of care but improved residents' experiences within clinic. This model offers a viable alternative to block scheduling models for primary care residency programs wishing to defragment resident schedules.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1879652.

Background Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses—specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). Methods This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. Results 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician’s assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). Conclusions This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today’s pandemic responses on the home front.

The success of the military is significantly supported by highly effective collaborative teams. While much is known about successful military teams outside the context of healthcare delivery, considerably less attention has been paid to teams working in patient care. Thus, this supplement has explored the features of successful military interprofessional healthcare teams (MIHTs). In this summary paper, the authors discuss what this supplement’s investigations have taught us about MIHTs and offer a series of proposed future investigations of MIHTs and their role in military healthcare.

Introduction The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration? Materials and Methods This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed. Results The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study’s key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration. Conclusions This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT’s collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance.

Background Surgeons in resource-limited environments often provide care outside the expected scope of current general surgery training. Geographically isolated patients may be unwilling or unable to travel for specialty care. These same patients also present with life-threatening emergencies beyond the typical breadth of a general surgeon's practice, in hospitals with limited professional and material support. This review characterizes the unique role of isolated surgeons, so individual surgeons and health care organizations may focus professional development resources more efficiently, with the ultimate goal of improved patient care. Methods We performed a scoping review of the isolated surgeon, reviewing 25 years of literature regarding isolated US civilian and military surgeons. We examined emerging themes regarding the definition of an isolated surgeon, the scope of surgical practice beyond current training norms, and training gaps identified by surgeons in an isolated role. Results From 904 articles identified, we included 91 for final review. No prior definition exists for the isolated surgeon, although multiple definitions describe rural surgeons, patients, or hospitals; we propose an initial definition from consistent themes in the literature. Isolated surgeons across varied practice settings consistently performed relatively large volumes of cases of, and identified training gaps in, orthopedic, obstetric and gynecologic, urologic, and vascular surgery subspecialties. Life-threatening, “rare-but-real” cases in the above and neurosurgical disciplines are uncommon, but consistent across practice settings. Conclusions This review represents the largest examination of the isolated surgeon in the current literature. Clarifying the identity, practice components, and training gaps of the isolated surgeon represent the first step in formalizing support for this small but critical group of surgeons and their patients.

Introduction Patient ownership is an important element of physicians’ professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients. Methods Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March–August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives. Results Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations. Discussion Our theory of patient ownership portrays the patient/family as an active participant in the patient–physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives. Electronic supplementary material The online version of this article (10.1007/s40037-020-00635-8) contains supplementary material, which is available to authorized users.

Introduction This article uses alumni survey data from the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine to assess the professional impact of pediatric-trained USU graduates over the course of their careers. We specifically report on the clinical and leadership roles held, career accomplishments, and operational involvement among military pediatricians. Materials and Methods This study analyzed survey data that were collected from alumni of USU. We used descriptive statistics to report the career achievements and operational experiences among USU graduates who completed training in pediatrics. This study was deemed exempt by the USU Institutional Review Board. Results The survey response rate was 49.5% among 2,400 eligible respondents. Out of 1,189 alumni respondents, 110 (9.3%) trained in pediatrics. Among the pediatric-trained USU graduates, 98.2% spent some time as a full-time clinician, 73.6% served as chief of a clinical service, 42.7% held the role of department chair/chief or the equivalent, and 26.3% filled leadership positions in deployed settings. Forty percent of USU-trained military pediatricians deployed to combat areas at least once, and 35.5% participated in at least one peacetime humanitarian mission. Conclusions Our findings contribute to the unique story of military pediatricians who graduated from USU. These uniformed pediatricians participate actively in all realms of military medicine and have demonstrated their versatility through participation in a wide variety of vital functions. Their contributions include the provision of clinical care for both military children and active duty service members, serving in varied leadership positions, engaging in health professions education and other academic pursuits, and participating in operational assignments. Future studies could aim to more fully address the diverse contributions of military pediatricians to the overall mission by including more specific data about career experiences from all uniformed pediatricians.

Education is a key component of patient care, with significant potential to positively impact health outcomes through patient empowerment and behavior change. Patient empowerment through education has the potential to improve knowledge, understanding, adherence, skills, and overall HRQoL through healthier behaviors. Indeed, systematic reviews for patient education as an intervention in chronic illnesses have found reduced hospitalizations and clinic visits, improved quality adjusted life years, or productivity. In an era of increasing demands while time and other resources decrease, best evidence-based practices in educational design for patient care are necessary. Proving specific patient education models are of value is important; however, this has been challenging due to the heterogeneity of interventions and populations studied. While this may appear as a concern, this should be viewed as a significant opportunity rather than a limitation, as educational design has been more rigorously evaluated in other sectors. There is an opportunity for healthcare professionals to apply some lessons from the medical education literature to their patient education. The expanding diversity of educational design options creates an exciting mandate to transform patient education. This chapter presents a discussion of educational design that comes from medical education literature, which can be generalizable to patients as long as potential literacy, culture, and physiological obstacles are kept in mind. The chapter explores how to “make a diagnosis of patient learning needs,” and formulate a “therapeutic intervention” of education that is contextualized to the patient and their individual circumstances, being culturally responsive and non-biased – an intervention that is engaging and relevant to them achieving their learning and healthcare outcomes. Finally, the concept of “formal assessment” to see if the educational therapy worked or not, and how to improve, should be part of patient “follow-up.” Practical strategies to achieve these features of patient education are presented.

Introduction Studies have shown that a physician’s clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance. Methods Seventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes. Results Six categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data. Discussion The presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective.

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

The scope of physicians' responsibility toward patients is becoming increasingly complicated to delimit as interdisciplinary care delivery and degrees of subspecialization increase. Patients can easily be lost across multiple transitions involved in care. Preparing learners to engage in safe and responsible patient care requires that we be clear about parameters of patient ownership. This scoping review (1) explores and synthesizes definitions of patient ownership and (2) describes the factors that influence patient ownership.Searching PubMed, Embase, and PsycINFO, the authors sought out publications of any format (i.e., original research papers, review articles, commentaries, editorials, and author discussions) that (1) addressed patient ownership directly or a closely related concept that explicitly affected patient ownership, (2) included medical care providers (attending/faculty physicians, medical residents, and/or medical students), and (3) were published in English. The authors analyzed findings to construct common themes and categorize findings.Of 411 papers screened, 82 met our inclusion criteria. Twenty-three papers defined patient ownership in highly variable ways. Common themes across definitions included responsibility for patient care, personally carrying out patient care tasks, knowledge of patients' medical information, independent decision making, and putting patients' needs above one's own. Factors influencing patient ownership were (1) logistical concerns, (2) personal attributes, and (3) socially or organizationally constructed expectations.A new definition of patient ownership is proposed encompassing findings from the review, while also respecting the shift from individual to a team-based patient care, and without removing the centrality of an individual provider's commitment to patients.

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

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

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

Introduction Research into healthcare delivered via interprofessional healthcare teams (IHTs) has uncovered that IHTs can improve patient satisfaction, enhance collaborative behaviors, reduce clinical error rates, and streamline management of care delivery. Importantly, these achievements are attained by IHTs that have been trained via interprofessional education (IPE). Research indicates that IHT training must be contextualized to suit the demands of each care context. However, research into the unique demands required of military IHTs has yet to be explored. For any form of IPE to be successfully implemented in the military, we need a clear understanding of how IHT competencies must be tailored to suit military care contexts. Specifically, we must know: (1) What evidence is currently available regarding IHTs in the military?; and (2) What gaps in the evidence need to be addressed for IPE to be customized to meet the needs of military healthcare delivery? Method A scoping review of the literature was conducted to identify the breadth of knowledge currently available regarding military interprofessional healthcare teams (MIHTs). A search of PubMed, EMBASE, PsycInfo, ERIC, DTIC.mil, and NYAM Gray Literature databases was conducted without date restrictions. The search terms were: (interprofessional* OR inter-professional*) AND (military OR Army OR Navy OR Naval OR Marines OR “Air Force” OR “Public Health Service”) AND (health OR medicine). Of the 675 articles identified via the initial search, only 21 articles met inclusion criteria (i.e., involved military personnel, included teams that were medically focused, comprised at least two professional disciplines, and had at least two people). Results The manuscripts included: seven original research studies, six commentaries, five reviews, one letter, one annual report, and one innovation report. Analyses identified three themes (i.e., effective communication, supportive team environments, shared role understanding, and equity among team members) related to successful MIHT collaborations and five related to unsuccessful MIHT collaborations (i.e., inability to develop team cohesion, lack of trust, ineffective communication and communication breakdowns, unaddressed or unresolved conflicts, and rank conflicts). These manuscripts highlighted contextual factors that shape MIHTs. For example, MIHTs often work and live together for extended periods of time when deployed. Also, military rank can facilitate collaboration by establishing clear lines of reporting but can problematize collaboration when inexperienced care providers (e.g., early career physicians) outrank other team members (e.g., medics) who have more experience providing care in deployment contexts. Discussion Given that the experiences of military personnel can be perilous and unpredictable, the military has an obligation to study the unique contexts of care where MIHTs are employed. In doing so, educational interventions can be tailored to better aid our service men and women, as well as their families.

Objective Within residency programs, half-day continuity clinics can lead to difficulties transitioning between inpatient and outpatient obligations and achieving continuity of care. We examined resident and attending perceptions of a switch to full-day continuity clinics in order to determine its impact on work balance, continuity of care, patient ownership, and clinic satisfaction. Methods In January 2018, a pediatric residency program transitioned to full-day continuity clinics. From six to eight months after the transition, we administered a retrospective pre-post implementation survey to gauge resident and attending perceptions of the change. Surveys included 20 matched pairs of 5-point Likert-style questions for residents and 18 matched pairs for attendings, with two free-response questions asking for specific benefits or problems encountered. Survey responses pre vs. post-implementation were compared using two-tailed, paired t-tests. Results 32/46 residents (70%) and 6/8 attendings (75%) completed the survey. Residents and attendings agreed that full-day continuity clinics made it easier for residents to balance inpatient and outpatient obligations (p Conclusion Full-day continuity clinics improved perceptions of residents balance of inpatient and outpatient obligations, continuity of care, patient ownership, and overall clinic satisfaction.

This article was migrated. The article was marked as recommended. Introduction: Peer coaching is a faculty development approach that improves teaching practice. Elements include peer observation of teaching, feedback, and collegial exchange. Peer coaching supports reflection on teaching, cultivates workplace learning, and fosters learning cultures. Yet, limited resources are available to guide faculty developers in designing and implementing peer coaching initiatives. This gap may lead to initiatives that fail to optimize teaching effectiveness. Methods: The authors convened a focus group of seven participant experts, via video-teleconference, to arrive at consensus on best practices of peer coaching for medical educators. The focus group utilized Nominal Group Technique, a consensus building methodology. Process steps included an introduction, silent idea generation, idea sharing, group discussion, and voting. Consensus was reached with over 50% agreement. Data were qualitatively analyzed using inductive content analysis, and quotes were extracted to support the identification of best practices. Results: Seventeen best practices were identified. All participant experts recommended a framework for the peer observation process including a pre-observation meeting and post-observation debrief. The participant experts stressed the importance of confidentiality and behaviorally-based feedback. To promote collegial exchange, most agreed peer coaching should be a formative process conducted in an environment that is safe and nonthreatening. Finally, peer coaching should be supported at multiple levels within an organization. Conclusion: Expert consensus generated 17 best practices of peer coaching for medical educators that optimize teaching effectiveness. The results provide a practical resource for faculty developers. Future researchers should explore common pitfalls and barriers to the implementation of peer coaching initiatives from the perspectives of academic leadership, peer coaches, and observed educators.