Medical Education Leaders Research Articles

Nimble, Together: A Training Program's Response to the COVID-19 Pandemic.

Nimble, Together: A Training Program's Response to the COVID-19 Pandemic.

The Change to Pass/Fail Scoring for Step 1 in the Context of COVID-19: Implications for the Transition to Residency Process.

In this Invited Commentary, the author considers the February 2020 announcement that scoring on the United States Medical Licensing Examination (USMLE) Step 1 will change to pass/fail no sooner than January 2022 and its effects on the transition to residency process in the context of both the recommendations of the Invitational Conference on USMLE Scoring (InCUS) held in March 2019 and the disruptions caused by the COVID-19 pandemic in the spring of 2020. The author suggests that the medical education community must embrace any positive changes that come about as a result of the pandemic while continuing to systematically review the strengths and areas for improvement in the current transition to residency process.In its recommendations, InCUS provided a thoughtful set of action priorities and an effective process to work together, which can inform and guide the work ahead. The COVID-19 pandemic is dominating the educational and clinical environments and is now the biggest disruptor in all aspects of life, not just medical education. It is the responsibility of leaders in medical education to have a vision for and then implement an improved continuum of education that maintains the core values of the field and fits the health care delivery needs of today and the future.

Medical education leadership: from diversity to inclusivity.

Both in Canada and globally, medical schools are prioritizing diversity in medical education. The ensuing development of innovative approaches to augmenting the representation, comfort, and success of students from under-represented groups has been increasing. Curricula have also expanded to better prepare graduates for the realities of effectively meeting the needs of a diverse patient population. Leadership has however, not kept up with this progress. Evidence shows that diverse leadership teams develop innovative solutions to complex problems, recruit and retain the best talent, and remain relevant to the communities they serve. Our international conference workshop included a literature review on the current state of diversity in medical education and in leadership for medical educators, and case-based models of lived experiences to initiate conversations in three different facets of diversity to stimulate reflection, engagement and discussion. The oft-forgotten side of the conversation in conference offerings, the audience’s perspective, was purposefully included in planning the workshop and presenters adhered to this principle throughout the session. Participants recognized the importance of addressing diversity with leadership in medical education. Themes included the need for communication training, cultural education, sharing these data more broadly with faculty in medical education and continuing these conversations. A final theme “we will never represent all minorities”, led us to a conclusion that a culture of inclusivity and not diversity would be required to successfully meet this challenge.

Are Women Disproportionately Represented in Education Compared to Other Roles in Academic Radiology?

Women in academic medicine, and radiology specifically, are underrepresented in departmental leadership roles and achieve fewer professional metrics of success. We have observed, however, that women are more broadly represented in medical education leadership. The purpose of this study was to determine if women in academic radiology are overrepresented in educational scholarship and educational leadership compared to general research scholarship and leadership positions, and to determine if there is any difference in the distribution of women in these roles compared to internal medicine. We performed a PubMed search of education articles in radiology and internal medicine over the last 5 years, and the gender of the authors was determined. Data on gender for authorship of general research topics, departmental leaders, and society leadership was obtained via literature and internet searches and the data was aggregated. Representation ratios (RR of 1.0 = parity) were obtained via risk ratio calculation to compare education versus general scholarship, and the distribution of leadership roles within and between these fields. Women make up 28.5% of academic radiologists and 40.1% of academic internists. A higher proportion of education articles were first authored by women than would be expected in both fields with an RR of 1.46 (p < 0.001) in radiology and 1.23 (p < 0.001) in internal medicine. This overrepresentation was significant compared to general research scholarship in both fields (p < 0.001). In both fields, women were overrepresented in the position of Medical Student Director (RR of 1.47 and 1.22, respectively). For Program Directors, women were overrepresented in radiology (RR of 1.12) and underrepresented in internal medicine (RR of 0.69-0.75). Women in radiology were overrepresented in education society leadership (RR = 1.63) compared to general society leadership (0.98, p = 0.001). We found that women in radiology are overrepresented in authorship of education articles, and in departmental and society education leadership roles. This trend was also seen in internal medicine, suggesting that women are more broadly represented in medical education.

Journal clubs in Australian medical schools: prevalence, application and educator opinion.

PurposeMedically-focused journal clubs have been used as an educational tool for over 100 years, with research indicating that they improve knowledge, reading behaviour, and critical appraisal skills. However, it is unknown how widespread they are in Australian medical schools, nor the opinions of medical education leaders as to their value.MethodsA nationwide cross-sectional study was performed among academic leaders from every Australian medical school. Individuals were asked to complete a survey detailing their attitudes towards journal clubs using single- or multiple-answer questions, Likert scales, and ranked data. They were asked whether students at their institutions were able to partake in journal clubs, and if so, provided details on their implementation.ResultsAt least 1 response was collected from 18 of 19 Australian medical schools. The response rate was 40.8% (60 of 147), and 36 responses (60.0%) were from heads of clinical schools. Respondents from 15 of 18 institutions (83.3%) stated that their institution had a journal club. Of these, 23 (65.7%) were metropolitan institutions and 12 (34.3%) were rural institutions. Eighteen (51.4%) journal clubs were clinician-led, 13 (37.1%) were run through specific hospital departments, and 23 (65.7%) occurred during clinical years. Most respondents (20 [57.1%]) stated that the primary aim of the journal club was to develop critical appraisal skills.ConclusionJournal clubs are a highly regarded educational tool in the armoury of medical school educators, with significant heterogeneity in their structure, geographic prevalence, and intended purpose. Further studies of their efficacy in teaching evidence-based medicine is warranted.

Measuring the continuous quality improvement orientation of medical education programs.

There is a growing interest in applying continuous quality improvement (CQI) methodologies and tools to medical education contexts. One such tool, the "Are We Making Progress" questionnaire from the Malcolm Baldrige National Quality Award framework, adequately captures the dimensions critical for performance excellence and allows organizations to assess their performance and identify areas for improvement. Its results have been widely validated in business, education, and health care and might be applicable in medical education contexts. The measurement properties of the questionnaire data were analyzed using Rasch modeling to determine if validity evidence, based on Messick's framework, supports the interpretation of results in medical education contexts. Rasch modeling was performed since the questionnaire uses Likert-type scales whose estimates might not be amenable to parametric statistical analyses. Leaders and teachers at 16 of the 17 Canadian medical schools were invited in 2015-2016 to complete the 40-item questionnaire. Data were analyzed using the ConQuest Rasch calibration program, rating scale model. 491 faculty members from 11 (69 percent) schools participated. A seven-dimensional, four-point response scale model better fit the data. Overall data fit to model requirements supported the use of person measures with parametric statistics. The structural, content, generalizability, and substantive validity evidence supported the interpretation of results in medical education contexts. For the first time, the Baldrige questionnaire results were validated in medical education contexts. Medical education leaders are encouraged to serially use this questionnaire to measure progress on their school's CQI focus.

In Reply to Azer.

We thank Dr. Azer for his comments on our Innovation Report. We wholeheartedly agree that community stakeholder engagement is ideal when revising teaching cases and applaud him for successfully incorporating such perspectives in his case revisions. With this aim, we had sought feedback about the structured guide from students of diverse minority groups and medical education leaders, some of whom also identified as underrepresented minorities. However, as we acknowledged in our Innovation Report, our final faculty–student workgroup was not fully representative. In the second phase of our project, a new workgroup of 6 medical students who more fully represented minority identities provided concrete edits to Aquifer’s teaching cases using the structured guide. These edits have been incorporated, and feedback from the student workgroup, as well as unsolicited feedback from student users, have helped to affirm the guide’s utility and applicability in improving presentation of race and culture. Although we emphasized the value of student engagement in this process within our paper, we also witnessed the meaningful dialogue and learning that resulted for both students and faculty within the Aquifer Consortium from discussing the guide and implementing case changes. As Dr. Azer notes, thoughtful case review can be a rich source of learning and faculty development, contributing to community building and understanding. We hope our guide, with its accompanying rationale and evidence base for suggested edits, can stimulate dialogue, learning, and understanding for all. Katherine C. Chretien, MDStudent engagement co-lead, Aquifer, Lebanon, New Hampshire; associate dean for student affairs and professor of medicine, George Washington University School of Medicine & Health Sciences, Washington, DC; [email protected]Aparna Krishnan, MD, MPHFirst-year family medicine resident, Swedish Medical Center-First Hill, Seattle, Washington.Molly Rabinowitz, MD, MPHSecond-year pediatric resident, University of California, San Francisco, San Francisco, California.Ariana ZiminskyProduction assistant, Aquifer, Lebanon, New Hampshire.Stephen M. Scott, MD, MPHAcademic director for engagement, Aquifer, Lebanon, New Hampshire; senior associate dean for educational affairs and accreditation and professor of medical education, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, Texas.

A Step-by-Step Guide to Managing the Educational Crisis: Lessons Learned from COVID-19 Pandemic.

Background:Medical education is facing great challenges and uncertainties amidst the COVID-19 pandemic.Aims and Objectives:This article aims to provide tips that can provide a guide for medical education leaders to coordinate crisis management referring to the Egyptian context.Materials and Methods:This work was done using a reflection on the COVID-19 response by Egyptian universities and analysis of such responses.Results:Medical Education Institutions are required to build a taskforce team for crisis management. These should be committed to supporting sudden online education transition, academic support, and the psychological well-being of students, staff members, health care professionals, paramedics, and faculty administration. As the situation evolves, the taskforce has to monitor the challenges and provide appropriate plans, guidance, and solutions. Leaders in medical education have a crucial role in response to the pandemic crisis in securing a successful educational process while ensuring the mental and psychological well-being of the stakeholders.Conclusion:Crisis management is the skill of the future and more investment needs to be placed in designing crisis response and in enabling universities to accommodate this response.

A Novel Curriculum for Medical Student Training in LGBTQ Healthcare: A Regional Pathway Experience.

Background:Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face considerable health disparities, often due to a lack of LGBTQ-competent care. Such disparities and lack of access to informed care are even more staggering in rural settings. As the state medical school for the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region, the University of Washington School of Medicine (UWSOM) is in a unique position to train future physicians to provide healthcare that meets the needs of LGBTQ patients both regionally and nationally.Objective:To describe our methodology of developing a student-driven longitudinal, region-wide curriculum to train medical students to provide high-quality care to LGBTQ patients.Methods:A 4-year LGBTQ Health Pathway was developed and implemented as a student-led initiative at the UWSOM. First- and second-year medical students at sites across the WWAMI region are eligible to apply. Accepted Pathway students complete a diverse set of pre-clinical and clinical components: online modules, didactic courses, longitudinal community service/advocacy work, a scholarly project, and a novel clinical clerkship in LGBTQ health developed specifically for this Pathway experience. Students who complete all requirements receive a certification of Pathway completion. This is incorporated into the Medical Student Performance Evaluation as part of residency applications.Results:The LGBTQ Health Pathway is currently in its fourth year. A total of 43 total students have enrolled, of whom 37.3% are based in the WWAMI region outside of Seattle. Pathway students have completed a variety of scholarly projects on LGBTQ topics, and over 1000 hours of community service/advocacy. The first cohort of 8 students graduated with a certificate of Pathway completion in spring 2020.Conclusions:The LGBTQ Health Pathway at UWSOM is a novel education program for motivated medical students across the 5-state WWAMI region. The diverse milestones, longitudinal nature of the program, focus on rural communities, and opportunities for student leadership are all strengths and unique aspects of this program. The Pathway curriculum and methodology described here serve as a model for student involvement and leadership in medical education. This program enables medical students to enhance their training in the care of LGBTQ patients and provides a unique educational opportunity for future physicians who strive to better serve LGBTQ populations.

A Faculty Development Model for Academic Leadership Education Across A Health Care Organization.

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern’s six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course.

Twelve Tips for Medical Education Leadership to Help Faculty in the Transition to Online Teaching.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has had innumerable profound impacts, many of which have resulted in irrevocable changes to both the practice of medicine and the teaching of medicine. Medical educators have adapted to the need for social distancing by providing virtual educational opportunities for their learners, often without training or experience in online teaching. Because these educators require both professional development and technical support for their online teaching to be sustainable and effective, departments need to provide immediate help and support. These twelve tips are designed for those in leadership roles who have recognized the need for investment in online education and are interested in strategies to ensure the success of their educational programs.

Cross-Cultural Validity Study of a Medical Education Leadership Competencies Instrument in Latin American Physicians: A Multinational Study.

PURPOSEPhysicians rarely receive formal training in leadership skills. Çitaku and colleagues have identified a set of leadership competencies (LCs) providing validity evidence in North American (NA) and European Union (EU) medical education institutions. We aim to apply this same survey to a sample of Latin American (LA) medical leaders from the oncology community and related areas, compare the results with those of the previous survey, and perform subgroup analyses within the LA cohort.METHODSThe survey was sent to nearly 8,000 physicians of participating professional organizations. In addition to the 63 questions, we also collected data on the type of institution, country, specialty, sex, age, years of experience in oncology, and leadership position.RESULTSThe 217 LA respondents placed the highest value on task management competencies (91.37% reported these as important or very important v 87.0% of NA/EU respondents; P < .0001), followed by self-management (87.45% of LA respondents v 87.55% of NA/EU respondents; P = not significant [NS]), social responsibility (86.83% of LA respondents v 87.48% of NA/EU respondents; P = NS), innovation (86.69% of LA respondents v 85.31% of NA/EU respondents; P = NS), and leading others (83.31% of LA respondents v 84.71% of NA/EU respondents; P = NS). Social responsibility, which was first in importance in the NA/EU survey, was only third in the LA survey. Subgroup analyses showed significant variations in the ratings of specific LCs within the LA population.CONCLUSIONLCs valued by LA leaders somewhat differ from those valued by their NA and EU counterparts, implying that cultural aspects might influence the perception of desired LCs. We also detected variations in the responses within the LA population. Our data indicate that current physician leadership training programs should be tailored to suit specific needs and cultural aspects of each region. Further validity studies of this instrument with other samples and cultures are warranted.

A Medical School Dean's Guide to Orienting Educational Leaders on Roles, Responsibilities, and Resources.

Continuing professional development of physicians often revolves around clinical activities. Accordingly, there is a lack of intentional development and support of medical education leaders despite such individuals having critical influence over key organizational functions. Unequivocally, educational leaders have complex and dynamic jobs that require clear delineation of roles, responsibilities, and resources available to successfully train the next generation of health professionals. Although there is guidance on how to longitudinally onboard medical education leaders, there is little information on how to effectively orient such leaders on the functional nature of their jobs. Baylor College of Medicine's medical school dean developed and delivered a 2-day orientation program to educational leaders to clarify roles, responsibilities, and resources. Postevaluation surveys aimed to identify key session content that would be frequently used by educational leaders to oversee key aspects of medical education. The purpose of this article is to outline the structure and content of an orientation program designed for medical education leaders, and share postevaluation data to identify which sessions were most used in practice. Other deans are encouraged to take ownership over the professional development of their educational leaders and delivering similar programming.

Identifying and Remediating Quality Issues at Clinical Teaching Sites: A CERA Clerkship Directors Survey

Background and Objectives: Family medicine clerkship directors must secure an adequate number of teaching sites while maintaining or improving the quality of teaching. This survey details how family medicine clerkship directors identify community-based clinical sites with performance challenges, types of challenges, and whether a remediation option exists for struggling clinical sites or preceptors. This study also investigates the relationship between clerkship structure and problems with maintaining high-quality teaching sites. Methods: Data were gathered and analyzed as part of the 2018 Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. Results: There was a significant relationship between ease/difficulty of identifying clinical sites and paying preceptors (P=.032). A lower proportion of sites where a system is in place for remediation reported it being difficult to identify clinical sites (70.0% vs 92.2%, respectively, P=.011). Having a remediation system in place was also associated with less removal of sites (2.5% removed three or more sites vs 25% removed three or more sites, respectively, P=.005). Conclusions: Medical education leaders can explore payment to incentivize community-based preceptors in schools where identifying clinical sites is a challenge. Offering centralized preceptor development activities from medical schools, geared toward the importance of evaluations, balancing learners and opportunities for student engagement, may overcome some of the identified challenges. Medical schools may also consider providing additional time and support for clerkship directors to assist with tracking teaching quality at sites, and to assist struggling preceptors prior to removing them from teaching.

The Declining Presence of Family Physicians in Hospital-Based Care.

Despite training to provide care across the continuum of health delivery settings, the proportion of family physicians (FPs) reporting inpatient care has decreased by 26% between 2013 and 2017, leaving approximately 1 in 4 of FPs practicing hospital medicine in 2017. Policy makers, payers, and leaders in medical education should closely track the impact of these trends, given previous evidence associating better cost and utilization outcomes with broader scope of practice.

Successful Implementation of a Resident Liaison to Medical Students in Emergency Medicine Rotations.

As the role of the resident-as-teacher grows, some residents are inspired to develop themselves early as leaders in education while in training. We describe the successful implementation of a resident liaison (RL) to medical students in emergency medicine (EM) as a way to develop resident leaders in medical education. This position was implemented to develop interested residents as leaders in medical education and to provide medical students access to an EM physician who is closer to their training level and may be more approachable than the clerkship director. RLs are mentored by the clerkship director and are involved in curricular programming and education research. This innovation has strengthened our student EM rotations and has provided residents with a unique opportunity to explore a career in medical education. Residents have made tangible contributions to our educational programming in this role and have pursued careers in medical education. The program has been recognized as a "best practice" by students and the school of medicine. The RL initiative has conferred significant benefits to residents and medical students. Implementation of a RL program may benefit EM rotations outside of our institution and perhaps outside of the EM specialty.

852 Changing Preclinical Medical Student Perspective on IBD Through a Novel Patient-Centered Education Panel

INTRODUCTION: Background &amp; Purpose: Leaders in medical education strive to develop more interactive and efficacious teaching methods as preclinical teaching typically occurs in passive didactic lectures. The pathophysiology, diagnosis and treatment of diseases are explored in textbooks. However, the effect of disease on patients’ lives and the difficulty of managing chronic conditions are often not conveyed. Preclinical students would benefit from more patient interaction as patient care is the essence of being a physician. In this patient-centered educational panel, we focus on Inflammatory Bowel Disease (IBD). LEARNING OBJECTIVES: 1. Understand how IBD impacts patients’ lives 2. Expose students to the challenges of living with IBD from patient and caregiver perspective 3. Recognize how the Crohn’s &amp; Colitis Foundation supports IBD patients 4. Review the role of a multidisciplinary approach in treating IBD patients and the potential role of complementary medicine METHODS: In 2017 and 2018, Albany Medical College incorporated an IBD patient panel into the preclinical gastrointestinal curriculum. Students (n = 140), having already been lectured on IBD, attended an interactive 2-hour panel in which patients, caregivers, physicians and the Crohn's &amp; Colitis Foundation shared their experiences. Students then completed a Qualtrics survey. RESULTS: Student responses indicated that 96% strongly agreed/agreed that learning from patients helped to understand the complexity of managing a chronic disease, 89% strongly agreed/agreed that the patient panel supported traditional IBD lectures well and 94% strongly agreed/agreed that future students would benefit from a similar panel (Figure 1). Additionally, 73% strongly agreed/agreed that there is a role for complementary medicine (Figure 2). Student narratives suggested that the panel enriched their medical education (Figure 3). CONCLUSION: This panel showcased the challenges of diagnosing, managing and living with IBD. Learning about chronic disease from a patient encouraged future physicians to consider how the disease affects many aspects of one’s life. The panel challenged students to consider a role for complementary medicine in IBD. Survey responses found that the panel enhanced students’ understanding of IBD beyond what could be learned from traditional lectures and textbook readings. The success of this panel illustrates that patient-centered learning enriches preclinical education and should be incorporated in medical curriculum moving forward.

Focused Teaching Improves Medical Student Professionalism and Data Gathering Skills in the Emergency Department.

Introduction: Leaders in medical education have developed milestones and core competencies in an attempt to ensure that relational skills, such as communication and professionalism, are emphasized in addition to the usual skills of medical knowledge, data gathering, and emergency stabilization during students' emergency medicine (EM) medical education. Providers facile in each of these areas have better patient outcomes, patient experiences, and decreased incidence of malpractice cases. The authors attempted to demonstrate that by deliberate teaching of these skills during an EM medical student clerkship, students could significantly improve their clinical performance.Methods: This prospective, randomized, single-blinded cohort study was performed at an academic, tertiary, urban ED to investigate the effects of a one-on-one preceptor shift on the clinical performance of fourth-year medical students. Students were randomized into two groups and assessed by pre- and post-intervention objective structured clinical encounters (OSCEs) with standardized patients (SPs) at weeks one and three. A crossover design was employed so that students in the control group participated in a preceptor shift after their second OSCE. Measurements were based on a five-point Likert scale assessment linked to early EM milestones as defined by the Accreditation Council on Graduate Medical Education (ACGME). Results: The mean improvement in total overall score was significantly greater in the intervention group: 4.31 versus 2.57 (Cohen’s d = 0.57, p = 0.029). When each milestone was assessed individually, students in the intervention group improved significantly in data gathering (Cohen’s d = 0.47, p = 0.048) and professionalism (Cohen’s d = 0.66, p = 0.011). There was a nonstatistically significant improvement for the intervention compared to control group in emergency management and communication skills. There was no improvement for either group in medical knowledge.Conclusion: A one-on-one preceptor shift can result in a statistically significant improvement in data gathering and professionalism skills as measured by OSCEs.

Professionalism and leadership in medical education: how do they differ and how are they related?

It is widely accepted that both professionalism and leadership are important in medicine and in recent years have been defined and mandated by the General Medical Council (GMC).1–3 Yet, the...

Models of Resident Physician Training in Opioid Use Disorders

Medications for addiction treatment (MAT) are the standard of care for treating opioid use disorder (OUD) and reducing overdose deaths, yet demand for MAT providers has outstripped supply in the USA. Public policy and graduate medical education (GME) leaders have called for increased focus on addiction medicine training for resident physicians to mitigate this provider gap. We sought to characterize the current state of OUD training at the GME level by reviewing published literature on GME educational interventions designed to enhance the care of patients with OUD. We identified 31 articles describing 29 unique interventions. The majority of these articles detailed specific, reproducible interventions with outcomes, and tended to focus on training resident physicians in behavioral approaches to treat OUD, rather than MAT. Fewer than half of interventions involved direct patient care. MAT training is under-represented within the current landscape of educational interventions, despite MAT being the standard of care for OUD.