Undergraduate Medical Education Program Research Articles

Evaluation of the Content and Structure of Otorhinolaryngology Curricula in Libyan Medical Faculties' Undergraduate Program from 2023-2024

This study conducted to evaluate the content and structure of Otorhinolaryngology (ORL) curricula in Undergraduate Medical Education (UME) program in all Libyan medical faculties through surveying the stuff member of the subject. A cross section study conducted from October 2023 to early of January 2024, using structural questionnaire, consisted of 18 questions, [13 closed and 5 opened], administered to stuff members in Libyan medical faculties, 32 out of 52 faculty members completed the survey in (Tripoli, Zawia, Misurata, Sabratha, Benghazi, Omer Elmoukhtar, Alasmarya, Elmergib, Sabha, Tobrouk) medical faculties, other faculties not respond. Respondents represented diverse geographic institutions, lending broader perspectives. The predominant teaching modality was power point lectures were (84.4%), with limited interactive techniques like case-based learning (6.3%), didactic large group lectures (56.3%) were more common than clinical bedside teaching (28.1%). In addition, faculty members expressed concerns on the curriculum is inadequately developing student knowledge (43.3%) and skills (60%), with insufficient teaching hours (62.5%) and suboptimal assessment methods (56.6%). While 57.7% of respondent support establishing separate departmental status for otorhinolaryngology and head/neck specialties from general surgery. This study highlights the necessary to implement a curriculum that includes clinical training alongside standardized lectures and to update the evaluation methods as well as ensure a comprehensive and fair exposure to otorhinolaryngology.

Competency-based and less time-bound: a new approach to the macro-structure of a medical school curriculum

ABSTRACT Shifting to a competency-based (CBME) and not time-bound curricular structure is challenging in the undergraduate medical education (UME) setting for a number of reasons. There are few examples of broad scale CBME-driven interventions that make the UME program less time-bound. However, given the range of student ability and varying speed of acquisition of competencies, this is an area in need of focus. This paper describes a model that uses the macro structure of a UME program to make UME curricula less time-bound, and driven more by student competency acquisition and individual student goals. The 3 + 1 curricular model was derived from the mission of the school, and includes a 3-year core curriculum that all students complete and an individualized phase. Students have an 18 month individualized educational program that meets their developmental needs and their educational and professional goals. This is achieved through a highly structured advising system, including the creation of an Individualized Learning Plan, driven by specific goals and targeted Entrustable Professional Activities (EPA). Students who struggle in achieving core competencies can use individualized time to support competency development and EPA acquisition. For students who have mastered core competencies, options include obtaining a masters degree, clinical immersion, research, and community-based experiences. Students can also graduate after the 3-year core curriculum, and enter residency one year early. Structural approaches such as this may contribute to the norming of the developmental nature of medical education, and can advance culture and systems that support CBME implementation at the UME level.

The Variety of Undergraduate Medical Education Curricula: An Environmental Scan of Diverse Medical School Characteristics within Indones

An educational curriculum is a fundamental component of undergraduate medical education (UME) programmes, and its implementation may differ between medical schools due to multiple factors influencing curriculum development processes, such as medical schools’ characteristics, intended outcomes of educational programmes, resources, and cultures. Consequently, the quality of UME programmes and medical graduates may be affected. This study aimed to collect knowledge on the implementation of UME curricula in Indonesia, a country that has numerous medical schools with diverse characteristics. A nationwide environmental scan with cluster sampling was employed from December 2020 to May 2022. Data were collected from the dean or the staff of medical education units or other relevant stakeholders in medical schools on the curriculum approach, teachinglearning strategy, assessment system, and curriculum evaluation. Data collected were analysed using descriptive statistics and presented using frequency and percentage parameters. Out of 74 medical schools invited, 30 agreed to participate in this study. Most medical schools had established outcomebased UME while employing diverse curricular approaches within the SPICES (student-centred, problem-based, integrated, community-based, elective, and systematic) strategy. Variations were also observed in the teaching-learning processes and assessment systems used. Case-based discussions, lecture-based classes, skills laboratories, laboratory practice, and interprofessional learning were used as teaching-learning methods, while written/computer-based tests, objective structured clinical examinations (OSCEs), and other assessment methods were used to measure student competency. In their policy networks, medical schools involved numerous stakeholders and performed periodic curriculum evaluations using multiple well-established tools to ensure the quality of medical training and graduates. As various strategies of curriculum implementation were reported, it remains critical to establish productive UME curricula. Various potentials, resources, and opportunities in medical education must be optimised to maintain best-practice educational programmes.

The impact of accreditation on continuous quality improvement process in undergraduate medical education programs: A scoping review

Background Accreditation in medical education has existed for more than 100 years, yet the impact of accreditation remains inconclusive. Some studies have shown the effects of accreditation on student outcomes and educational processes at medical schools. However, evidence showing the impact of accreditation on continuous quality improvement of undergraduate medical education programs is still in its infancy. This scoping review explores the impact of accreditation on continuous quality improvement (CQI). Methods This scoping review followed the methodology of the Preferred Reporting Items of Systematic Reviews and the Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist outlined by Arksey and O'Malley (2005). Databases, including PubMed, Medline, ERIC, CINHAL, and Google Scholar, were searched to find articles from 2000 to 2022 related to the accreditation of undergraduate medical education programs and continuous quality improvement. Results A total of 35 full-text articles were reviewed, and ten articles met our inclusion criteria. The quality assurance approach is based on meeting the standards of accreditation. The quality improvement approach is based on striving for excellence. Literature suggests a requirement to move from student outcomes to CQI measures. CQI requires everyone in the organization to take responsibility and accountability, considering quality as the result of every single step or process and leaders supporting improvements in data collection and data analysis for quality improvement. Conclusions The literature on accreditation and CQI are limited in number. More research studies are required to enhance undergraduate medical education accreditation practices' value to medical students, educators, academic leaders, programs, and the public. It was recommended that medical schools embrace the culture and vision perpetuated by the CQI process.

The Impact of an Undergraduate Community-Based Medical Education Program in a Japanese Urban City.

With an aging global population posing healthcare challenges, especially in community healthcare, training professionals for community healthcare remains a global educational challenge, including in Japan. While previous research shows increased student interest in community healthcare through practical experiences, the focus has primarily been on rural areas, leaving a gap in understanding urban-based community medical education. This study aimed to evaluate the impact of urban community-based medical education on students' understanding and attitudes toward community healthcare. This study was conducted at Kyushu University in Fukuoka City, the sixth-largest city in Japan. For fifth-grade medical students, a community-based medical education program is mandatory, with a one-week schedule that includes orientation, one day in a clinic, and three days in a community hospital. The program aimed to expose students to various healthcare settings, emphasizing outpatient care, inpatient management, home health care, home nursing, and rehabilitation. A self-administered questionnairereferencing the Model Core Curriculum for medical educationwas administered immediately before and after the program, and the differences in students' perceptions were assessed using the Student's t-test. Findings from 188 students completing both pre- and post-program questionnaires revealed significant improvements in perceptions of students' knowledge and skills related to community healthcare. After the training, there was a noteworthy positive shift in attitudes toward community healthcare and increased interest in primary care physicians as a career choice. Although students maintained a preference for urban areas, there was a notable inclination towards rural settings.The study highlights the program's success in enhancing students' understanding and positive attitudes toward community healthcare within an urban context. It challenges prior notions regarding work-life balance and urban-rural preferences in career choices. Urban community-based medical education significantly improved students' perceptions and attitudes toward community healthcare. It offers valuable insights for curriculum planners, emphasizing the need for continued research into sustained effects and broader applicability.

A Journey of Innovation: 40years of Pioneering Medical Education at the Aga Khan University Medical College in Karachi, Pakistan.

This article presents an overview of Aga Khan University's (AKU) pioneering medical education initiatives over the past 40years, exploring its impact on healthcare in the region and its commitment to advancing medical education and research in the developing world. Established in 1983 as the first private university in Pakistan, AKU has evolved into a global institution with a focus on improving healthcare standards and addressing healthcare needs in the developing world. The article also discusses the undergraduate and postgraduate medical education programs at AKU Medical College, Pakistan, highlighting their unique features and pioneering approaches to medical education. The institution's journey highlights its ability to adapt to the evolving healthcare landscape while maintaining a focus on quality and excellence, offering a model for other institutions striving to meet healthcare needs in low- and middle-income countries.

An Integrated Competency-based Curriculum for Undergraduate Medical Education Programme in Bhutan

Introduction: Training of health human resources is an integral component of strengthening health systems. In Bhutan, the postgraduate training programme commenced in 2014 and the undergraduate programme is scheduled to begin in 2024.Methods: The curriculum was drafted by a team of experts and reviewed over multiple rounds with medical educators, health administrators and field experts from within and outside the country. The curriculum was validated by a team of experts from the university and the medical council. The curriculum for the Bhutan Medicine Programme adopted an integrated approach for teaching-learning and assessments.Results: Core competencies have been defined to meet the needs of a graduate that is prepared to face the challenges of the present and the future. Learning objectives are constructively aligned with teaching-learning and assessment tools. The five-year programme includes the Foundation of Medicine, Early Clinical Exposure, System integration through module-based learning, Clinical rotations including professorial attachments and internship. Community medicine, behavioural sciences and medical humanities are incorporated through the first to fourth years. We foresee a challenge in the acceptance of an integrated curriculum from sections of senior clinicians and teachers who have been trained in a traditional curriculum. A series of faculty development programmes have been conducted to discuss advantages of an integrated approach.Conclusion: Implementation of an integrated curriculum requires adequate faculty together with faculty development. Faculty recruitment is ongoing at the time of publication.

Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum.

Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.

Leading Change from Within: Student-Led Reforms to Advance Anti-Racism within Medical Education.

Racism, physician biases against Indigenous, Black, and racialized people, and the resultant poor health outcomes have been the subject of many institutional position statements and calls to action. Across Canada, undergraduate medical education programs have recognized the importance of addressing racism, but material changes to curriculum and learning environments to incorporate anti-racist lenses have yet to be actualized. To bridge a gap seen within the curriculum, the authors of this manuscript led the co-development, organization, and implementation of a student-led anti-racism initiative at the University of Calgary's Cumming School of Medicine. The initiative consisted of a class-wide anti-racism training session and a strategic review of student governance policies, including elections and decision-making processes through an anti-racist lens to advance equity within student learning environments. Anti-racism praxis was embedded within the co-creation of the anti-racism training by incorporating cultural safety and ethical engagement principles along with paid consultations with racialized students and faculty to identify pertinent topics and inform training priorities. Through this initiative, the authors offer an approach for the larger medical community to consider in their own local efforts to advance anti-racism advocacy and curricular change. This initiative highlighted the unique role of students in disrupting the status quo and modeling an anti-racist lens in their actions and self-governance.

Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users.

Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.

A pilot clinical skills coaching program to reimagine remediation: a cohort study.

Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as 'at risk' based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was "impactful to my clinical learning and practice". Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for 'at risk' early clerkship through final year students. An "implementation template" with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

A novel virtual course to teach medical students high-value decision-making.

Although a clinician's ability to employ high-value decision-making is influenced by training, many undergraduate medical education programmes lack a formal curriculum in high-value, cost-conscious care. We present a curriculum developed through a cross-institutional collaboration that was used to teach students at two institutions about this topic and can serve as a framework for other institutions to develop similar curricula. The faculty from the University of Virginia and the Johns Hopkins University School of Medicine created a 2-week-long online course to teach medical students the fundamentals of high-value care. The course consisted of learning modules, clinical cases, textbook studies, journal clubs and a competitive 'Shark Tank' final project where students proposed a realistic intervention to promote high-value clinical care. Over two-thirds of students rated the course's quality as excellent or very good. Most found the online modules (92%), assigned textbook readings (89%) and 'Shark Tank' competition (83%) useful. To evaluate the student's ability to apply the concepts learned during the course in clinical contexts, we developed a scoring rubric based on the New World Kirkpatrick Model to evaluate students' proposals. Groups chosen as finalists (as determined by faculty judges) were more likely to be fourth-year students (56%), achieved higher overall scores (p = 0.03), better incorporated cost impact at several levels (patient, hospital and national) (p = 0.001) and discussed both positive and negative impacts on patient safety (p = 0.04). This course provides a framework for medical schools to use in their teaching of high-value care. Cross-institutional collaboration and online content overcame local barriers such as contextual factors and lack of faculty expertise, allowed for greater flexibility, and enabled focused curricular time to be spent on a capstone project competition. Prior clinical experience amongst medical students may be an enabling factor in promoting application of learning related to high-value care.

Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran

BackgroundDefining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework.MethodsThe first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards.ResultsAnalysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations.ConclusionsWe developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.

A pilot clinical skills coaching program to reimagine remediation: a cohort study

Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as ‘at risk’ based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was “impactful to my clinical learning and practice”. Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for ‘at risk’ early clerkship through final year students. An “implementation template” with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

Undergraduate Medical Education Leader Performance Predicts Postgraduate Military Leader Performance.

Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account. This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers. Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams. The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond.

Lessons Learned from POCUS Instruction in Undergraduate Medicine During the COVID-19 Pandemic.

Point of care Ultrasound (POCUS) has been adopted into clinical practice across many fields of medicine. Undergraduate medical education programs have recognized the need to incorporate POCUS training into their curricula, traditionally done in small groups with in-person sessions. This method is resource intensive and requires sufficient equipment and expertise. These requirements are often cited as barriers for implementation. During the Coronavirus Disease 2019 (COVID-19) pandemic, POCUS education was required to adapt to physical distancing regulations, giving rise to novel teaching methods for POCUS. This article outlines the implementation of a POCUS teaching session before and during the pandemic. It describes how these innovations can scale POCUS teaching and overcome barriers moving forward. A flipped classroom model was implemented for all learners. Learners were given an introductory POCUS module before the scheduled in-person or virtual teaching session. Sixty-nine learners participated in conventional in-person teaching, while twenty-two learners participated in virtual teaching following the pandemic-related restrictions. Learners completed a written test before and following the teaching. In-person learners were assessed using an objective structured assessment of ultrasound skills (OSAUS) pre- and post-learning sessions. A follow-up survey was conducted three years after the teaching sessions were completed. Both in-person and virtual groups demonstrated statistically significant improvement in knowledge scores (p <0.0001). Both groups had similar post-test learning scores (74.2 ± 13.6% vs. 71.8 ± 14.5 %, respectively). On follow-up questionnaires, respondents indicate that they found our online and in-person modes of teaching helpful during their residency. POCUS education continues to face a variety of barriers, including limitations in infrastructure and expertise. This study describes an adapted POCUS teaching model that is scalable, uses minimal infrastructure and retains the interactivity of conventional small-group POCUS teaching. This program can serve as a blueprint for other institutions offering POCUS teaching, especially when conventional teaching methods are limited.

Competency-Based Medical Education in a Norm-Referenced World: A Root Cause Analysis of Challenges to the Competency-Based Paradigm in Medical School.

Competency-based medical education (CBME) requires a criterion-referenced approach to assessment. However, despite best efforts to advance CBME, there remains an implicit, and at times, explicit, demand for norm-referencing, particularly at the junction of undergraduate medical education (UME) and graduate medical education (GME). In this manuscript, the authors perform a root cause analysis to determine the underlying reasons for continued norm-referencing in the context of the movement toward CBME. The root cause analysis consisted of 2 processes: (1) identification of potential causes and effects organized into a fishbone diagram and (2) identification of the 5 whys. The fishbone diagram identified 2 primary drivers: the false notion that measures such as grades are truly objective and the importance of different incentives for different key constituents. From these drivers, the importance of norm-referencing for residency selection was identified as a critical component. Exploration of the 5 whys further detailed the reasons for continuation of norm-referenced grading to facilitate selection, including the need for efficient screening in residency selection, dependence upon rank-order lists, perception that there is a best outcome to the match, lack of trust between residency programs and medical schools, and inadequate resources to support progression of trainees. Based on these findings, the authors argue that the implied purpose of assessment in UME is primarily stratification for residency selection. Because stratification requires comparison, a norm-referenced approach is needed. To advance CBME, the authors recommend reconsideration of the approach to assessment in UME to maintain the purpose of selection while also advancing the purpose of rendering a competency decision. Changing the approach will require a collaboration between national organizations, accrediting bodies, GME programs, UME programs, students, and patients/societies. Details are provided regarding the specific approaches required of each key constituent group.

Radical reform of the undergraduate medical education program in a developing country: the Egyptian experience

Medical educators are in a continuous quest to close the gap between the needs of medical practice and the rising expectations of the communities in their countries. During the past two decades, competency-based medical education has been evolving as an appealing strategy to close this gap. In 2017, the Egyptian medical education authorities mandated all medical schools to change their curricula to comply with revised national academic reference standards, which changed from outcome-based to competency-based. In parallel, they also changed the timeline of all medical programs for six years of studentship and one-year internship to five years and two years, respectively. This substantial reform involved the assessment of the existing situation, an awareness campaign for the proposed changes and an extensive national faculty development program. Monitoring the implementation of this substantial reform was performed through surveys, field visits and meetings with students, teaching staff and program directors. In addition to the expected challenges, the COVID-19-associated restrictions presented a significant further challenge during the implementation of this reform. This article presents the rationale for and steps of this reform, the challenges faced and how they were addressed.

The Current State of Antiracism Curricula in Undergraduate and Graduate Medical Education: A Qualitative Study of US Academic Health Centers

We undertook a study to evaluate the current state of pedagogy on antiracism, including barriers to implementation and strengths of existing curricula, in undergraduate medical education (UME) and graduate medical education (GME) programs in US academic health centers. We conducted a cross-sectional study with an exploratory qualitative approach using semistructured interviews. Participants were leaders of UME and GME programs at 5 institutions participating in the Academic Units for Primary Care Training and Enhancement program and 6 affiliated sites from November 2021 to April 2022. A total of 29 program leaders from the 11 academic health centers participated in this study. Three participants from 2 institutions reported the implementation of robust, intentional, and longitudinal antiracism curricula. Nine participants from 7 institutions described race and antiracism-related topics integrated into health equity curricula. Only 9 participants reported having "adequately trained" faculty. Participants mentioned individual, systemic, and structural barriers to implementing antiracism-related training in medical education such as institutional inertia and insufficient resources. Fear related to introducing an antiracism curriculum and undervaluing of this curriculum relative to other content were identified. Through learners and faculty feedback, antiracism content was evaluated and included in UME and GME curricula. Most participants identified learners as a stronger voice for transformation than faculty; antiracism content was mainly included in health equity curricula. Inclusion of antiracism in medical education requires intentional training, focused institutional policies, enhanced foundational awareness of the impact of racism on patients and communities, and changes at the level of institutions and accreditation bodies.

COVID Faces: Unmasking the Emotional Impact of the Pandemic

Background: In April 2020, most undergraduate medical education programs across the country ceased in-person activities. In the months that followed, the return to clinical care was often inconsistent, sporadic and unpredictable. As the pandemic wore on, the impact of COVID-19 on professional identity formation in medical students was an area ripe for investigation. This study reveals student perceptions of the impact of COVID-19 on their developing sense of professional identity. Methods: Students in the Class of 2021 at the Pennsylvania State University College of Medicine were invited to participate. After approval from the Institutional Review Board, participating students submitted an image of themselves wearing a mask of their choosing ("selfie") with an accompanying reflective narrative describing the impact of the pandemic on their educational experience. In addition, students submitted words to describe the self they projected (external) on the outside of a templated surgical mask and words to describe their true (internal) sense of self on the inside of the mask. Results: Common narrative themes that emerged included doubt, anxiety, fear, disconnection, loss of control, guilt, sacrifice, resilience and survival. Analysis of descriptors of internal and external aspects of the templated surgical masks revealed common themes of anxiety, fear, confusion and hope. Conclusions: This study provides a glimpse into the student experience of COVID-19 through several lenses. From the narrative perspective, students expressed elements of disconnection and doubt as well as resilience and grit. From the visual perspective, similar themes emerged from the mask descriptors. Overall, COVID-19 significantly impacted the emotional experiences of this cohort of fourth-year medical students, particularly in the context of sustained uncertainty and feelings of anxiety.