Medical Education Medicine Research Articles

Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study.

The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery. The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel. This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants' replies. The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions. The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce.

Creation of a National Emergency Medicine Medical Education Journal Club.

Background There are a relatively limited number of emergency medicine (EM) medical education (MedEd) fellowships with few trainees at each program, creating barriers to local collaboration and networking. While best practices for developing MedEd journal clubs exist, there has not been an established national EM MedEd journal club. To address this need, we created a national journal club, the Council of Residency Directors (CORD) MedEd Journal Club (MEJC), to facilitate collaboration and networking opportunities by providing a synchronous online journal club. Objectives Our primary objective was to create a network for collaboration across geographical barriers to form a virtual community of practice (CoP) around the shared domain of evidence-based MedEd. Our secondary objective was to improve MedEd fellows' knowledge, skills, and attitudes surrounding MedEd research. Tertiary objectives included (1) broadening fellow exposure to key topics within MedEd, (2) describing how to develop scholarly work within MedEd, and (3) filling a perceived need for building a national MedEd virtual CoP. Curricular design The concept and objectives of the CORD MEJC were introduced to fellows and fellowship directors through a national listserv in March of 2022. Fellows volunteered to lead virtual sessions via Zoom on a monthly basis. Session fellow leaders independently chose the topics and were asked to submit two to three journal club articles discussing the topic at least two weeks in advance of each session. No topics were repeated throughout the academic year. Impact/effectiveness Our quality improvement survey results indicated that the CORD MEJC is meeting its primary and secondary objectives. Survey results will be utilized as part of a continuous quality improvement initiative to enhance our program structure and curricula for the 2023-2024 academic year.

Development of entrustable professional activities for emergency medicine medical education fellowships: A modified Delphi study.

It is essential that medical education (MedEd) fellows achieve desired outcomes prior to graduation. Despite the increase in postgraduate MedEd fellowships in emergency medicine (EM), there is no consistently applied competency framework. We sought to develop entrustable professional activities (EPAs) for EM MedEd fellows. From 2021 to 2022, we used a modified Delphi method to achieve consensus for EPAs. EM education experts generated an initial list of 173 EPAs after literature review. In each Delphi round, panelists were asked to make a binary choice of whether to include the EPA. We determined an inclusion threshold of 70% agreement a priori. After the first round, given the large number of EPAs meeting inclusion threshold, panelists were instructed to vote whether each EPA should be included in the "20 most important" EPAs for a MedEd fellowship. Modifications were made between rounds based on expert feedback. We calculated descriptive statistics. Seventeen experts completed four Delphi rounds each with 100% response. After Round 1, 87 EPAs were eliminated and two were combined. Following Round 2, 46 EPAs were eliminated, seven were combined, and three were included in the final list. After the third round, one EPA was eliminated and 13 were included. After the fourth round, 11 EPAs were eliminated. The final list consisted of 16 EPAs in domains of career development, education theory and methods, research and scholarship, and educational program administration. We developed a list of 16 EPAs for EM MedEd fellowships, the first step in implementing competency-based MedEd.

Eye on the Prize: Patient Outcomes Research in Medical Education.

The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the "prize" of medical education research: an understanding of how our educational initiatives impact the health of patients.

Response to "Exploring the Applications of ChatGPT in Family Medicine Medical Education".

Response to "Exploring the Applications of ChatGPT in Family Medicine Medical Education".

0943 Sleep Medicine Tweet-by-Tweet, an Electronic Platform for Collaborative Medical Education

Abstract Introduction Twitter is a novel and accessible platform for the dissemination of medical education, and it is used by many medical practitioners (1). Many physicians have used Twitter as a means of meeting continuing medical education needs. This can manifest as Twitter-based Journal Clubs, curated conference data and webinars (2). Methods I have created a Sleep Medicine Medical Education Twitter account @SleepyNeuroDoc to share complex cases in all areas of sleep medicine, including sleep-disordered breathing, movement disorders in sleep, circadian rhythm disorders and nocturnal epilepsy. I share notable images of polysomnogram outputs, home sleep apnea tests, compliance data, neuro-imaging, electroencephalogram, cardiopulmonary coupling and more. This digital education platform allows rapid circulation of unique cases and promotes in-depth scholarly discussion, with no geographical limit. Polls are conducted for complex topics to facilitate knowledge exchange and consumer engagement. This educational twitter is followed by the entire spectrum of professions within the sleep medicine care team, including physicians, allied health, and researchers. To date, there are 40 cases posted. Results We conducted online questionnaires with consumers of this Twitter account, and the results so far indicate greater practitioner comfort with management of various sleep medicine conditions. Some consumers report having changed their approach to practice. Conclusion Our work suggests that this unique use of a social medical platform is beneficial for continuing medical education and knowledge exchange in the field of Sleep Medicine.

History of medicine in medical education: new Italian pathways.

There is little doubt that there are currently obstacles in measuring the impact of the history of medicine within medical training. Consequently, there is a clear need to support a vision that can historicize Euro-Western medicine, leading to a greater understanding of how the medical world is a distinct form of reality for those who are about to immerse themselves in the study of medicine. History teaches that changes in medicine are due to the processes inherent to the interaction among individuals, institutions, and society rather than individual facts or individual authors. Therefore, we cannot ignore the fact that the expertise and know-how developed during medical training are the final product of relationships and memories that have a historical life that is based social, economic, and political aspects. Moreover, these relationships and memories have undergone dynamic processes of selection and attribution of meaning, as well as individual and collective sharing, which have also been confronted with archetypes that are still able to influence clinical approaches and medical therapy today.

Insurance Medicine in Medical Education

Insurance Medicine in Medical Education Abstract. Insurance medicine in medical education has a firm place in the teaching of public health. Students learn about the Swiss social insurance system with coverage against sickness, accident and disability, all three central to patient care. Teaching aims to provide students with an overview, stimulate their interest, and make them aware of their role in the system. As with the clinical disciplines, the competency- and outcome-based learning objectives of PROFILES (Principal Relevant Objectives and a Framework for Integrative Learning and Education in Switzerland) map key topics of insurance medicine which the prospective physicians should be familiar with as they complete their studies.

Advancing precision medicine in medical education: Integrated, precise and data‐driven smart solutions

AbstractAdvances in “Precision Medicine” initiative, also known as “Personalized Medicine” is an emerging approach for disease treatment and prevention that has already led to innovative discoveries and has created “smart” applications and solutions tailored to a person's or a group of individuals' genetic profile, lifestyle, and environment interaction. Already many physicians as part of patient care routinely prescribe various molecular/genetic and other tests enabling them to select personalized treatments that improve the chances of survival and reduce exposure to adverse effects. This initiative should provide to medical and healthcare professionals with adequate resources and readily available solutions so that the target to specific treatments and care of the illnesses is achieved while at the same time protecting the privacy and safety of the individual is secured as well as the Electronic Health Records (EHRs) and whatever additional data is necessary within the context of Precision Medicine. This study, through a literature review mostly, and some case study analysis, examine whether personalized medicine is delivered to the patient in an “accurate” and “precise” way, as expected. This requires that Health and Human Services and other stakeholders and agencies collaborate to solicit the right input from patients while at the same time can identify and address any educational, practical, legal, and technical issues and providing smart solutions. The lack of proper medical education and advanced infrastructure are still major barriers to the adoption of Precision Medicine, therefore, the role of medical training in Precision Medicine is also examined and analyzed. Specific examples are discussed in an integrated, precise, and data‐driven manner to provide “smart” solutions.

Gender medicine teaching increases medical students' gender awareness: results of a quantitative survey.

Knowledge about gender implications of health is insufficiently integrated into university teaching in Germany. Gender awareness represents a key competence to integrate this knowledge into the medical practice. This study is the first survey of the gender awareness of medical students in a cross-sectional design in Germany. From April to July 2021, a quantitative cross-sectional survey in an online format using the "Nijmegen Gender Awareness in Medicine Scale" (2008) was conducted at four German universities (Charité Berlin, Friedrich-Schiller-University Jena, Ludwig-Maximilians-University Munich, and the University of Cologne) with a varied implementation of teaching gender medicine. Students indicated their agreement or disagreement with assumptions and knowledge about the influence of gender in everyday medical practice (gender sensitivity), as well as gender role stereotypes towards patients and physicians (gender role ideology). The 750 included participants showed relatively high gender sensitivity and low gender role stereotyping towards patients and physicians. The curricular implementation of gender medicine in the universities showed a significant influence on the students' gender sensitivity, as well as on their gender role stereotyping towards patients. Students who reported having taken classes in gender medicine or stated a definite interest in doing so showed significantly higher levels of gender sensitivity. Cis-males showed significantly lower gender sensitivity and significantly higher gender role stereotyping. Implementation of gender medicine in the medical curriculum, attending courses on gender education as well as one's gender and interest have a significant impact on medical students' gender competencies. These results support the need for structural integration of gender medicine in medical education and gender trainings at medical schools in Germany.

A scoping review of regenerative medicine in medical education

Stem cell therapeutics and regenerative medicine have taken a strong foothold in biomedicine. However, most physicians are currently not adequately prepared to identify, refer, and deliver safe regenerative therapies. To understand this gap, we sought to characterize published literature on current physician training in regenerative medicine. Our scoping review describes current training strategies to bridge the gap and integrate such education into medical curricula for adequate training.

A workforce study of emergency medicine medical education fellowship directors: Describing roles, responsibilities, support, and priorities.

IntroductionDespite emergency medicine (EM) medical education fellowships increasing in number, the position of the medical education fellowship director (FD) remains incompletely defined. The goal of this study was to characterize the roles, responsibilities, support, and priorities for medical education FDs.MethodsWe adapted and piloted an anonymous electronic survey consisting of 31 single‐answer, multiple‐answer, and free‐response items. The survey was distributed to FDs via listserv and individual emails from a directory compiled from multiple online resources. We used descriptive statistics to analyze data from items with discrete answer choices. Using a constructivist paradigm, we performed a thematic analysis of free‐response data.ResultsThirty‐four medical education FDs completed the survey, resulting in a response rate of 77%. Thirty‐eight percent of respondents were female. Fifty‐three percent earned master's degrees in education and 35% completed a medical education fellowship. Most respondents held other education leadership roles including program director (28%), associate/assistant program director (28%), and vice chair (25%). Sixty‐three percent received support in their role, including clinical buy‐down (90%), administrative assistants (55%), and salary (5%). There was no difference (χ2 [2, n = 32] = 1.77, p = 0.41) between availability of support and type of hospital (community, university, or public hospital). Medical education FDs dedicated a median of 12 h per month to fellowship responsibilities, include education (median 35% of time), program administration (25%), research mentorship (15%), and recruitment (10%). Medical education FDs describe priorities that can be categorized into three themes related to fellows, fellowship, and institution.ConclusionThis study provides insight into the current position and experience of medical education FDs. The results can clarify the role and responsibilities of FDs as the demand for medical education FDs increases.

Naturopathy, complementary and integrative medicine in medical education – position paper by the GMA Committee Integrative Medicine and Perspective Pluralism

Background: A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process.Objective: The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training.Method: The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine.Results: First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice.Conclusion: Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.

The Philosophicum-Model Project of Philosophy of Medicine in Medical Education and Practice in Germany Perspective Article

Medical and philosophical thinking belong together, cannot be separated neither in scientific theory nor in practice, and only the symbiosis of both can face the challange to reflect the basic phenomenon of both of these desiciplines: human life itself. No patient expects to be treated exclusively on the basis of the latest scientific results, but also wants to be perceived by his doctor as an unique individual. It is the doctor’s specific task to embed the scientifically developed diagnoses therapeutically into each individual patient’s biography. Furthermore such a perspecitve increases patient safety and it enables a future of trust in the doctor-patient relationship. The „Philosophicum“ is a model project in Germany that brings together philosophers, physicians and students to do research and education in the broad and enriching intersection of medicine and philosophy. Based on many years of experience, we are convinced that a structured philosophical education can substantially improve medical studies and subsequently doctors‘ work. Medical anthropology and hermeneutics are necessary and also teachable. The preparation should start early in the medical education and should be strengthened by bedside training while interacting with the patient. This requires philosophically interested and trained doctors and students. Exactely for that reason we favor integrating a philosophicum into the medical eduacation and practice.

When Bioethics Is Too Narrow – The Relevance of Philosophy of Medicine in Medical Education

What do these terms have in common? Drapetomania Female hysteria Homosexuality Sluggish schizophrenia If you guessed “former medical conditions that were used to pathologize socially-undesirable persons and their behaviors”, you are correct! Drapetomania was described as a mental illness that caused African-American slaves to run away. Female hysteria was first noted in the second millennium BCE and was subsequently used to institutionalize women. Sluggish schizophrenia was used to subjugate political dissidents in the USSR, and homosexuality is one of the more recent “disorders” to undergo depathologization. These diseases, of course, are now obsolete or exist as behaviors that are widely accepted in western society. So why do they matter? In a sentence – the medical profession exists to treat disease. The corollary – to treat disease, we must first determine what disease is. The historical legacies of medicine are riddled with abuses of human rights stemming from treatment of conditions that were not diseases at all. Today’s medical students will go on to discover and classify new diseases, and competency with theories that conceptualize disease and illness are an educational imperative. Clinical bioethics, in particular, often takes for granted terms such as ‘disease’, ‘illness’, and ‘health’. Knowledge of basic abstract concepts within philosophy of medicine should be foundational, rather than tangential, to medical school humanities curricula. Naturalistic and normative theories comprise the major types of disease-conceptualizing theories. Normative theories aim to define disease in terms of value judgments, often taking the form of ‘X condition is a disease because it is bad for the person who has it’. Theories differ in their assessment of why the condition is bad (that is, they differ in their value judgements). Naturalistic theories aim to define disease without the use of value judgements. This is typically achieved through appeal to deviance from statistical and/or evolutionary function. Each type of theory has its own strengths and limitations, and couching this discussion in terms of historical nosology lends itself to critical examination of pathologization within medicine. Integrating these ideas in medical school curricula will enrich students’ understanding of disease, and may mitigate diagnoses that historically harmed patients.

Just-in-Time Teaching (JiTT) screencasts for the resident inpatient oncology service: A pilot study evaluating feasibility and effectiveness.

11025 Background: Just-in-Time Teaching (JiTT) screencasts have been viewed positively in some undergraduate and graduate medical settings. JiTT screencast effectiveness has not yet been evaluated for medical trainees in the inpatient adult hematology/oncology setting. Objectives: Our pilot study’s goal was to identify relevant learning objectives, to assess feasibility of screencast development, and to optimize screencast delivery. Methods: To identify key clinical topics, a mixed methods approach first utilized institutional retrospective data (6/1/2018-6/30/2019) to determine the most common inpatient medical problems followed by qualitative interviews of teaching faculty and senior residents. The following six topics were identified for inclusion: 1. Metastatic disease to spine 2. Brain metastases 3. Oncologic emergencies 4. Cancer associated venous thromboembolism 5. Hematologic emergencies 6. Sickle cell disease: inpatient management For each topic, a literature review was performed to develop teaching points which were then refined with input from clinician experts. Each screencast went through several rounds of edits by faculty and trainees prior to submission to the instructional design team for final editing. Screencast length ranged from 13 – 25 minutes (mean of 18 minutes). Qualitative and quantitative feedback was obtained from residents by structured focus group session and online surveys. Results: All residents reported that educational content was “just right.” The series of 6 screencasts was completed within 2 months of dedicated fellow research time. Preferred screencast length was 10-20 minutes and preferred viewing speed was 1.5x original speed (7/10). All residents reported that a screencast database would be a helpful resource for future clinical rotations. All residents (n = 10) reported that screencasts improved medical oncology knowledge base and will improve care provided to cancer patients. Conclusions: Creation of a screencast series was feasible for a hematology-oncology fellow. Systematic identification of key clinical topics led to materials which were confirmed by faculty and trainees to be important for internal medicine medical education on inpatient oncology services. This pilot data indicate that JiTT screencasts may be an effective educational intervention and directly informed a randomized educational research study which is currently enrolling participants.

Empathy Leading to Clinical Medicine in Medical Education

Empathy Leading to Clinical Medicine in Medical Education

Restructuring the final year of the model study programme MaReCuM at the Medical Faculty Mannheim: the academic quarter in ambulatory medicine.

Introduction: To reflect the ever-growing importance of outpatient care in medical education, MaReCuM – a reformed curriculum, also referred to as a model study programme – was introduced at the Medical Faculty Mannheim in 2006. It divided the final year of medical study into quarters and added a mandatory quarter dedicated to ambulatory medicine. This project report presents our experiences, the costs and the evaluation results connected with making specific changes to the final year of undergraduate medical study.Project description: The final-year quarter in ambulatory medicine, taught at the Medical Faculty’s outpatient teaching placements, allows final-year medical students to gather practical experience in one of four elective areas in outpatient care. The parallel coursework encompasses interactive case presentations and practical reviews. Relevant curricular content on ambulatory medicine is then tested in the oral/practical section of the M3 medical examination.Results: Students are very satisfied with the academic quality of the final-year quarter in ambulatory medicine. Restructuring the final year, generating the concept and recruiting teaching placements at outpatient facilities required additional full-time positions in the beginning.Discussion: The processes of reforming MaReCuM have not only contributed to a stronger recognition of ambulatory medicine in the final year and in the clinical phase of study, but have also enabled broader opportunities for focussing individual choices during medical education. A high caliber of academics in the quarter in ambulatory medicine can be achieved with a calculable amount of organisational effort.Conclusion: Anchoring a curriculum on ambulatory medicine in medical education is possible through restructuring the final year and is received positively by students. The success of MaReCuM demonstrates the feasibility of the recommendations made by the German Council of Science and Humanities (Wissenschaftsrat).

Including Lifestyle Medicine in Medical Education: Rationale for American College of Preventive Medicine/American Medical Association Resolution 959

Introduced by the American College of Preventive Medicine and released by the American Medical Association House of Delegates in 2017, Resolution 959 (I-17) supports policies and mechanisms that incentivize and/or provide funding for the inclusion of lifestyle medicine education and social determinants of health in undergraduate, graduate and continuing medical education. Resolution 959 was passed to help address the current healthcare costs of lifestyle-related, noncommunicable chronic diseases that exert a devastating economic burden on the U.S. healthcare system. Approximately 86% of $2.9 trillion is spent annually on obesity, cardiovascular disease, type 2 diabetes, and some cancers, with very poor return on investment for health outcomes. Lifestyle medicine provides an evidence-based solution to the noncommunicable chronic disease epidemic; however, medical education in lifestyle medicine is minimal to nonexistent. This paper provides the case for healthcare innovation to include lifestyle medicine in the prevention and treatment of noncommunicable chronic diseases. Our medical education system recommendation is to provide lifestyle medicine training for prevention and treatment of noncommunicable chronic diseases. Exemplar lifestyle medicine schools are showcased and guidance for reform is highlighted that can be used to aid lifestyle medicine integration across the medical school education continuum. With a transformation of curriculum and development of new policies to support a focus on lifestyle medicine education in medical education across the continuum, a new healthcare model could be successful against noncommunicable chronic diseases and U.S. citizen wellness could become a reality.

The State of Ambulatory Undergraduate Internal Medicine Medical Education: Results of the 2016 Clerkship Directors in Internal Medicine Annual Survey

The State of Ambulatory Undergraduate Internal Medicine Medical Education: Results of the 2016 Clerkship Directors in Internal Medicine Annual Survey