Medical Education Leaders Research Articles

Development of a Generalist Competency Framework for Medical Education Leaders in Longitudinal Integrated Curricula (LILIC)

AbstractRecent shifts in health professions education have prompted significant curriculum reforms toward multidisciplinary, longitudinally integrated courses during the pre-clinical and clinical years of medical school curricula. Faculty who are accustomed to managing discipline-specific courses must now be trained to meet the challenges of implementing new integrated courses. Skills and competencies for Leaders in Longitudinal Integrated Curricula (LILIC) must be identified for faculty development efforts and to assist administrators in recognizing the attributes of well-qualified course/curriculum directors for their appointment/hiring decisions. Drawing on the collective expertise of faculty from multiple medical schools, we developed a framework to meet this new need. Herein, we present a shared mental model, a framework, and higher-level attributes important for the development of these curricular leaders. A proposed development process and future directions for this framework are also presented, underscoring its potential impact on faculty development and the broader educational landscape in health professions.

Validating the 2023 Association of American Medical Colleges Graduate Medical Education Leadership Competencies.

Validating the 2023 Association of American Medical Colleges Graduate Medical Education Leadership Competencies.

Analyzing Gender Issues And Leadership Effectiveness In Medical Education

Medical education is an important aspect in developing a country's health system. However, there are still issues that need to be addressed, especially those related to gender and leadership within medical education. The aim of this research is to analyze gender issues and leadership effectiveness in medical education. This study used qualitative research methods. The data collection technique in this research is literature study. The data that has been collected is then analyzed in three stages, namely data reduction, data presentation and drawing conclusions. The research results show that gender issues in medical education reflect the imbalance that occurred when women first entered the medical field at the end of the 19th century. At that time, women focused more on the field of pediatrics because it was more accepted by societal norms at that time. As a result, history records that many early female physicians in the United States preferred to practice pediatric care and women's health. Meanwhile, in the context of leadership in medical education, the various leadership styles that are generally known are democratic, pacesetting, authoritative, affiliate, training and command styles.

Creating Optimal Clinical Learning Environments Through Interprofessional Bedside Rounding Models: Lessons From the iPACE Story.

The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and implemented at Maine Medical Center in 2016 as part of the Accreditation Council for Graduate Medical Education's Pursuing Excellence in Clinical Learning Environments (CLE) demonstration project. The model is based on the belief that, in optimal CLEs, residents are trained in team-based, interprofessional collaborative care and use clinical care experiences to innovate in the areas of patient safety and quality of care. The model's inclusion of systems engineering principles, such as design thinking, allows teams to design, customize, and iteratively improve their own iPACE model.The iPACE model was further developed and disseminated with support from an American Medical Association Reimagining Residency grant and from the MaineHealth health system's medical education and clinical leadership. iPACE started as a small pilot project on a single inpatient unit and has evolved to become the standard for inpatient team rounds at the bedside. iPACE has received positive feedback from patients, demonstrated benefits to care team members and resident education, and proven its value to the health system through sustained reductions in length of stay and cost of care metrics. The iPACE project has fulfilled MMC's original goal of intentionally redesigning its CLEs to expose residents to high-functioning interprofessional teams with the goal of improving patient care and safety. The model has shown direct learner benefits through increased faculty observation and improved quality of feedback. Interprofessional bedside rounding models like iPACE have the potential to imprint learners with the skills and behaviors essential to provide collaborative patient-centered care. Strategies exist that improve resident and faculty engagement in bedside rounding models like iPACE and should be employed to encourage teaching and learning at the bedside.

Nurse perspectives on the assessment of emergency medicine residents: A qualitative study.

Multisource and 360-degree feedback are emerging methods in the medical education assessment literature. Nursing feedback in particular has been identified as a point of emphasis regarding what medical education leadership would most value for incorporating into their evaluations. There is no currently accepted tool for multisource feedback in the emergency department (ED). To answer this call, we conducted a qualitative study to elucidate nurse perspectives on evaluation of emergency medicine residents. We conducted individual semistructured interviews of ED nurses with experience working alongside residents via volunteer recruitment. Transcripts were coded independently by each author and then reviewed collaboratively to resolve differences. Codes were created by inductive thematic analysis and subsequently underwent constant comparison and classical content analysis. Recruitment continued until analysis of transcripts showed thematic saturation. We organized the interview transcript into chunks of information, arranging 407 quotes from the 10 interview transcripts into 17 codes and six themes regarding observable resident behaviors. Representative quotes and exemplar cases added detailed description to the meaning of these codes. The identified themes for observable resident behaviors included "general communication style," "medical knowledge," "efficiency," "patient communication," "nurse communication," and "professionalism." An additional 13 codes addressed the themes of barriers and catalysts for feedback. The identified themes on observable resident behaviors aligned well with prior literature and with the Accreditation Council for Graduate Medical Education (ACGME) Milestones. The interviews also highlighted nurse perspectives on barriers and catalysts for feedback that would be useful to incorporate into the design of an assessment tool.

Impact of Large Language Models on Medical Education and Teaching Adaptations.

This viewpoint article explores the transformative role of large language models (LLMs) in the field of medical education, highlighting their potential to enhance teaching quality, promote personalized learning paths, strengthen clinical skills training, optimize teaching assessment processes, boost the efficiency of medical research, and support continuing medical education. However, the use of LLMs entails certain challenges, such as questions regarding the accuracy of information, the risk of overreliance on technology, a lack of emotional recognition capabilities, and concerns related to ethics, privacy, and data security. This article emphasizes that to maximize the potential of LLMs and overcome these challenges, educators must exhibit leadership in medical education, adjust their teaching strategies flexibly, cultivate students' critical thinking, and emphasize the importance of practical experience, thus ensuring that students can use LLMs correctly and effectively. By adopting such a comprehensive and balanced approach, educators can train health care professionals who are proficient in the use of advanced technologies and who exhibit solid professional ethics and practical skills, thus laying a strong foundation for these professionals to overcome future challenges in the health care sector.

The tip of the iceberg: Generalism in undergraduate medical education, a systems thinking analysis.

There is a shortage of generalist physicians globally impacting health equity and access to care. An important way in which medical schools can demonstrate social accountability is by graduating learners interested in careers in generalism. While generalism is endorsed as a matter of principle in medical education, how this translates into curricula is less clear. The aim of this study was to identify how generalism is understood and supported by family physician educational leaders in undergraduate medical education (UME) in Canada. We conducted a qualitative study, interviewing 38 family medicine leaders in UME across all 17 Canadian medical schools. We examined the data with template analysis, informed by the iceberg model of systems thinking. Four themes were identified: (1) Teaching and learning strategies in support of generalism-a consistent range existed across UME curricula; (2) Curriculum patterns-changes in leadership and curriculum reform created positive or negative feedback loops that promoted or hindered initiatives to support generalism; (3) Curriculum structures-organ-system-based curricula and availability of generalist faculty presented particular challenges to teaching generalist approaches; (4) Mental models and ways of knowing-the preponderance of biomedical frameworks of thinking in curricula unconsciously undermined generalist approaches to patient care. UME programmes promoted generalism through a range of teaching activities and strategies, but these efforts were countered by curriculum structures and mental models that perpetuate epistemic inequity between biomedical approaches to medical education and generalist models of care. Novel curricular frameworks are needed to align undergraduate programmes' commitment to social accountability with community-based need.

Where Do We Go From Here? An Inventory of Publicly Available Data About Educator Academies, Medical Education Departments, and Offices of Medical Education.

With the recent widespread growth and interest among medical educators, analysis of how departments of medical education are structured and their intersection with existing structures within the same institution, such as an office of medical education and/or academy of educators, is warranted. Based on a review of the literature, the authors determined there was a need for an inventory of what medical schools have to offer their faculty, whether it be an office, an academy, or a department. This project sought to inventory the current structures of medical education departments, offices, and academies at U.S. medical schools to explore reporting structure, functions, and characteristics of these entities. Data were extracted from A Snapshot of Medical Student Education in the United States and Canada: Reports From 145 Schools, published in 2020 in the journal Academic Medicine , for each reporting institution. This led to exploration of medical school websites to catalogue institutional structures. Data collected in this inventory demonstrate the range of structures used by medical schools to offer faculty support for their work as teachers and educational researchers. The hypothesis was that departments of medical education would be the least prevalent structures identified in U.S. medical schools, which was indeed a finding. Although the search yielded considerable data for the inventory, there is a dearth of published literature describing current models and characteristics of these different entities. Significant difficulties were encountered locating information clearly delineating roles and responsibilities of each entity on many medical schools' public-facing web pages. Findings are significant because they underscore the challenges medical education leaders have in obtaining information to research, compare, select, and design the administrative model(s) best suited to support faculty educators at their institution. Future work should include creating a detailed catalogue with descriptive information supplied by schools.

What are the Leadership and Management Positions in Medical Education? A Scoping Review

Leadership can be defined as a combination of position, responsibilities, attitude, skills, and behaviours contributing to sustainable success. Despite extensive research on the representation of various groups, including genders and personal qualities, in leadership and management positions in medical education, there remains a lack of clarity regarding what these positions exactly are. In this scoping review, we aimed to determine these positions by following Levac et al.'s framework. We searched four databases; PubMed, ERIC, Scopus, and Web of Science until March 23, 2023, resulting in 558 records for screening after removing duplicates and applying some exclusions. The review included 266 studies for data extraction and synthesis. In addition to the leadership positions, we revealed the studies’ countries, main context, discipline, and year. We identified 396 leadership and management positions in medical education under four categories: academic, administrative, journal- related, and society-related positions. Additionally, the majority of the studies (59.77%) were on gender-related topics, followed by those focusing on underrepresented minorities. The articles covered 40 different disciplines, with the surgical fields exhibiting the highest frequencies, such as orthopaedic surgery, neurosurgery, and plastic and reconstructive surgery. The systematically developed list of positions in our study may be considered as a valuable resource for future research, especially in studies that aim to determine the representation of women and underrepresented minorities in leadership and management positions in medical education.

Developing a Diverse, Equitable, and Inclusive Curriculum for Trainees

The importance of diversity in medical education has become increasingly clear with strong evidence showing its benefits in helping to reduce healthcare disparities and mortality, increase access to medical care, increase the number of clinicians practicing in medically underserved and rural communities, increased patient trust, improvement in patient-physician relationships, and better financial outcomes for health systems. As leaders in graduate medical education, the Teaching and Training Committee of the American Association for Geriatric Psychiatry (AAGP) proposed the creation and development of a curriculum that fosters an inclusive learning environment for our fellows, promotes open dialogue among everyone involved in the clinical process, and establishes anti-bias principles as integral parts of geriatric psychiatry education. The AAGP Diversity, Equity, and Inclusion (DEI) Curriculum Development subcommittee was established to carry out this task. Themes to be explored include ageism, racism and bias, social determinants of health, cultural humility, ethics of decision making in older adults, substance use, neurobiology of stress, the mental health of minoritized older adults, psychosocial and cultural aspects of aging, and laws that impact this population.This session details the process of establishing this important curricular thread as a template or framework that can be used in Geriatric Psychiatry training programs throughout the country and, in acknowledgement of the importance of the workforce that cares for older adults, ensures that it is practical and applicable to clinicians in non-academic settings. The panelists will highlight DEI curricular development in one fellowship program from the view of a trainee, the impact on recruiting a more representative workforce, and how to improve trainee and faculty engagement within and across programs.This presentation is sponsored by the Teaching and Training Committee.

Education Scholarship Assessment Reconsidered: Expansion of Glassick's Criteria to Incorporate Health Equity.

Recent events have ignited widespread attention to structural racism and implicit bias throughout the U.S. health care system and medical institutions, resulting in a call for antiracism approaches to advance health equity. Medical education leaders are well-positioned to advance health equity, not only through their training of fellows, residents, and medical students, but also in their approach to scholarship. Education scholarship drives innovation and critical evaluation of current practices; it impacts and intersects with multiple factors that have the potential to reduce health inequities. Thus, it is critical to prioritize the assessment of education scholarship through a health equity lens. Medical education scholarly dissemination has markedly expanded over the past 2 to 3 decades, yet medical educators have continued to embrace Boyer's and Glassick and colleagues' definitions of scholarship. The authors propose an approach to medical education scholarship assessment that expands each of Glassick's 6 existing criteria to address health inequities and adds health equity as a seventh criterion. With this, medical educators, researchers, reviewers, and others can consider how education scholarship affects diverse populations and settings, direct educational products and scholarship to address health inequities, and raise the importance of advancing health equity in medical education scholarship. By expanding and standardizing the assessment of scholarship to incorporate health equity, the medical education community can foster a cultural shift that brings health equity to the forefront of education scholarship.

Help Me Help You: How to Request a Letter of Recommendation.

Letters of recommendation (LORs) are an essential component of a career in medicine. The process for obtaining certain letters, particularly those associated with scheduled periods of professional transition, often is governed by established institutional or specialty norms. The process of requesting LORs in more common scenarios-local or national awards, committee assignments, and leadership positions-many times is less clearly defined, however. Despite the important role that LORs play in professional development, the published literature on how to solicit a recommendation is limited, creating challenges for both those requesting LORs ("applicants") and the letter writers. This perspective piece offers insight on how to best identify and communicate with a potential writer. These suggestions are derived from the limited relevant literature and from the authors' experience both with requesting letters themselves and writing letters as leaders in undergraduate and graduate medical education. The goal is to reduce ambiguity for applicants and ensure that writers receive the information necessary to provide an informed and effective recommendation.

Crafting Tomorrow's Medical Leaders: Insights from Medical Students and Interns in Saudi Arabia.

Leadership is increasingly recognized as a crucial competency in medicine, with physicians expected to provide leadership skills throughout their careers. This study explores the perceptions, attitudes, and interests of medical students and interns in Saudi Arabia regarding medical leadership. Medical graduates are expected to "provide leadership skills that enhance team functioning, the learning environment, and the healthcare delivery system", according to the Association of American Medical Colleges (AAMC). A cross-sectional study was conducted from January to July 2023, involving 519 medical students and interns in Saudi Arabia. An online survey covered demographic data, perceptions, attitudes, interests, and self-perceived leadership skills. A pilot study was conducted to ensure the questionnaire's validity and reliability. Data were analyzed using SPSS 26, employing descriptive statistics and inferential tests. Most participants had a positive perception of leadership (38.3%), with higher scores associated with medical specialties as a career choice (p < 0.001). The majority expressed average interest in medical leadership (29.1%). Communication and organizational skills were highly self-rated leadership attributes. Barriers to leadership implementation included lack of interest (49.3%), inadequate training (45.1%), and time constraints (43.2%). Only 14.6% rated leadership education in medical school as "very good". This study underscores the importance of leadership in medical education. Integrating comprehensive and structured leadership programs into medical curricula, addressing barriers, and promoting awareness can foster future medical leaders. Continuous evaluation and adaptation are essential for ensuring the relevance and effectiveness of leadership training.

The Role of Inclusivity in DEI Initiatives: Cultivating an Inclusive Clinical Learning Environment for All

Many U.S. academic medical centers, medical societies, and accreditation bodies are committed to continuing initiatives of recruiting a diverse workforce. It is this focus of DEI that is often weighted towards diversity recruitment within undergraduate and graduate medical education. These recruitment initiatives result in an influx of an underrepresented in medicine (UIM) physician workforce into clinical learning environments that may not reflect inclusivity. The authors provide a brief introduction to the topic of inclusion, discuss its importance in the clinical environment, and suggest ways that medical education leaders can incorporate the tenets of inclusion into their curriculum and training. There are harms to having an exclusionary clinical learning environment that impact the clinical performance and well-being of all learners, particularly those coming from UIM backgrounds. There are also clear benefits to creating inclusion practices, however, there must be intention and strategic planning to work towards solutions to creating a safe, inclusive environment for all.

The Clinical Learning Environment: Past, Present, and Future.

In this issue of AJMQ, Graduate Medical Education leaders from a large nationally renowned academic medical center describe in detail the "Residents and Fellows Leading Interprofessional Continuous Improvement Teams" program with a focus on the collaboration within their health system in alignment with Clinical Learning Environment review since its inception. In addition, the authors share key outcomes of the program using the reach, effectiveness, adoption, implementation, maintenance framework, additional structural (eg, timeline) and outcome (eg, scholarship) measures for further context within Graduate Medical Education and Undergraduate Medical Education, and describe elements which supported the program's success and lessons learned.

Re-conceptualizing medical education in the post-COVID era

Purpose The COVID-19 pandemic has forced changes in the delivery of medical education. We aimed to explore these changes and determine whether they will impact the future of medical education in any way. Methods We invited leaders in medical education from all accessible US-based medical schools to participate in an online individual semi-structured interview. Results Representatives of 16 medical schools participated. They commented on the adequacy of online education for knowledge transfer, and the logistical advantages it offered, but decried its negative influence on social learning, interpersonal relationships and professional development of students, and its ineffectiveness for clinical education. Most participants indicated that they would maintain online learning for didactic purposes in the context of flipped classrooms but that a return to in-person education was essential for most other educational goals. Novel content will be introduced, especially in telemedicine and social medicine, and the students’ roles and responsibilities in patient care and in curricular development may evolve in the future. Conclusions This study is the first to document the practical steps that will be adopted by US medical schools in delivering medical education, which were prompted and reinforced by their experience during the COVID-19 pandemic.

The Eighth Annual Academic International Medicine Congress and Scientific Forum, July 14–16, 2023: Thinking Globally, Acting Locally

The first in-person Academic International Medicine Congress (AIM 2023) since the beginning of the COVID-19 Pandemic took place at Rutgers University in New Brunswick, NJ, almost exactly 4 years after a meeting at the same location had to be canceled due to the global calamity. Featuring 3 days packed with high quality continuing medical education content and leadership development sessions, AIM 2023 set several important records for our organization. Among the most important sessions was the half-day strategic leadership retreat, with a goal of charting ACAIM’s path for the next 3-5 years. The main program featured more than 35 speakers and panelists, and offered more than 20 hours of continuing medical education credits. The scientific program included more than 30 abstracts and interesting case presentations. The AIM 2023 Gala and Awards Ceremonies were among the most attended attractions. This report includes a summary of key events and sessions from the AIM 2023 Congress, inclusive of published abstracts from the meeting. The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, Systems based practice.

Emotional intelligence among medical students in Sweden – a questionnaire study

BackgroundEmotional intelligence (EI), the ability to understand and regulate one’s and other’s emotions, has been linked to academic and clinical performance and stress management, making it an essential skill to develop during medical school. Nevertheless, uncertainty remains about the impact of medical education on EI, its association with sociodemographic factors, and the potential moderating role of gender. Therefore, this study aimed to explore levels of global EI among Swedish medical students based on their completed semesters while analyzing the potential moderator role of gender and identifying potential EI differences associated with age, gender, prior education, work experience, and previous experience working in a leadership position.MethodsThe participants were medical students in semesters 1, 3, 5, 7, 9, and 11 at a Swedish University. Participants answered the self-report Trait Emotional Intelligence Questionnaire - Short Form (TEIQue-SF) and demographic questions. For each participant, the mean global trait EI was calculated (range 1–7), and differences were compared based on semesters and sociodemographic factors. In addition, we investigated the relationship between semester and EI scores with gender as a moderator.ResultsOf the 663 invited medical students, 429 (65%) responded, including 269 women (62.7%), 157 men (36.6%), and 3 identifying as others (0.7%). The participants had a mean global trait EI score of 5.33. Final-year students demonstrated significantly higher global trait EI scores than first-year students, and gender did not have a moderating effect across semesters. Furthermore, students in the age group 25–29 years showed higher EI scores compared to those in the age group 21–24 years, while there were no significant differences in EI scores for older students (≥ 30 years) compared to other age groups. Higher EI scores were also positively associated with previous work-and leadership experiences. Gender and previous education did not significantly impact EI scores.ConclusionsOur findings suggest that higher EI scores are associated with semesters of medical education, age, and previous work and leadership experience. Future longitudinal studies are needed to identify factors that could improve EI among medical students to design curricular activities aimed at supporting the EI of the next generation of physicians.

The Use and Teaching of Telemedicine in Allergy/Immunology Training Programs.

The use of telemedicine has greatly increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This review discusses the types of telemedicine, current telehealth curricula in medical education, and benefits and disadvantages of incorporation of telemedicine into Allergy/Immunology training programs. The majority of Allergists/Immunologists use telemedicine in their clinical practice with leaders in graduate medical education recommending inclusion of telemedicine in training. Fellows-in-training reported that use of telemedicine in Allergy/Immunology training during the pandemic mitigated some concerns for lack of adequate clinical experience. Still, no standardized curriculum for telemedicine training in Allergy/Immunology exists, although curricula from internal medicine and primary care residencies can provide a framework for incorporation of telemedicine training into fellowship. Benefits of telemedicine in Allergy/Immunology training include enhanced immunology training, home environment monitoring, and flexibility to reduce physician burnout while disadvantages include limited physical examination skill building and lack of a standardized curriculum. As telemedicine has been widely accepted in medicine with high patient satisfaction, it is necessary to incorporate a standardized telehealth curriculum in Allergy/Immunology fellowship training, both as a tool for patient care as well as trainee education.

Improving Graduate Medical Education by Aggregating Data Across the Medical Education Continuum.

Meaningful improvements to graduate medical education (GME) have been achieved in recent decades, yet many GME improvement pilots have been small trials without rigorous outcome measures and with limited generalizability. Thus, lack of access to large-scale data is a key barrier to generating empiric evidence to improve GME. In this article, the authors examine the potential of a national GME data infrastructure to improve GME, review the output of 2 national workshops on this topic, and propose a path toward achieving this goal.The authors envision a future where medical education is shaped by evidence from rigorous research powered by comprehensive, multi-institutional data. To achieve this goal, premedical education, undergraduate medical education, GME, and practicing physician data must be collected using a common data dictionary and standards and longitudinally linked using unique individual identifiers. The envisioned data infrastructure could provide a foundation for evidence-based decisions across all aspects of GME and help optimize the education of individual residents.Two workshops hosted by the National Academies of Sciences, Engineering, and Medicine Board on Health Care Services explored the prospect of better using GME data to improve education and its outcomes. There was broad consensus about the potential value of a longitudinal data infrastructure to improve GME. Significant obstacles were also noted.Suggested next steps outlined by the authors include producing a more complete inventory of data already being collected and managed by key medical education leadership organizations, pursuing a grass-roots data sharing pilot among GME-sponsoring institutions, and formulating the technical and governance frameworks needed to aggregate data across organizations.The power and potential of big data is evident across many disciplines, and the authors believe that harnessing the power of big data in GME is the best next step toward advancing evidence-based physician education.