PROBLEM: Telehealth and telemedicine skills are critical to medical practice. Embedding telehealth education into medical school curricula in a way that enhances other elements of the medical school curriculum and emphas...PROBLEM: Telehealth and telemedicine skills are critical to medical practice. Embedding telehealth education into medical school curricula in a way that enhances other elements of the medical school curriculum and emphasizes its relevance to medical practice can be challenging. APPROACH: Beginning in 2022, the initial telemedicine course at the Uniformed Services University of the Health Sciences has evolved into a longitudinal, 4-year curriculum that integrates telemedicine concepts throughout multiple courses. This integration supports learners' motivation to master material and leverages their evolving experiences in telehealth throughout medical school. OUTCOMES: Over a 4-year longitudinal curriculum, student skills in telemedicine are assessed during 2 Objective Structured Clinical Examinations, one in the pre-clerkship period and one during the clerkship period. Outcomes from one class that has undergone both assessments show improvement in skills between assessments, although students continue to struggle with telemedicine physical examinations. NEXT STEPS: Telemedicine can be presented as an integrated, longitudinal curriculum that supports clinical skill development. Future directions include focusing on telemedicine physical examination skills, ongoing assessment of student performance, and investigation into the use of telemedicine in residency and clinical practice.
PURPOSE: Medical schools prioritize education as central to their mission; however, most exist within complex academic medical centers and health care systems where prioritization of education, clinical, and research mis...PURPOSE: Medical schools prioritize education as central to their mission; however, most exist within complex academic medical centers and health care systems where prioritization of education, clinical, and research missions varies. Support for medical student education has diminished in many settings. This study aimed to understand how leaders broadly consider the value of medical student education programs and consequently make choices to invest resources in undergraduate medical education (UME). METHOD: Value measurement methodology (VMM) was used to develop a semistructured interview guide to assess value across 5 domains: individual, operational, financial, social and societal, and strategic and political. Hospital executives, department chairs, and deans from 4 health care systems affiliated with the University of Colorado School of Medicine participated in interviews from November 2023 to March 2024. A hybrid thematic analysis was performed using the VMM framework. RESULTS: Twenty-nine leaders across systems and departments were interviewed. Leaders consider the value of UME aligned with their strategic priorities. Leaders ascribed both tactical and symbolic value to investments in student education and considered student impact on their current and future workforce as well as their mission. Student education is perceived as a connecting force between academic missions, attracting talented faculty, and encouraging reciprocity of learning in clinical settings. Leaders voiced responsibility to train the next generation and influence how the future workforce is trained. CONCLUSIONS: The strongest reason leaders invest in student education is return on investment: education is an upfront cost, but value manifests in anticipated mission and workforce outcomes. Understanding how leaders consider the value of UME is paramount as medical educators propose collaborative efforts to enhance investment in clinician educators and curricular efforts.
Health care organizations often face challenges in managing risks, inefficiencies, fragmented processes, and duplicated efforts. In academic medicine, stakeholder engagement is also a pain point because lack of understan...Health care organizations often face challenges in managing risks, inefficiencies, fragmented processes, and duplicated efforts. In academic medicine, stakeholder engagement is also a pain point because lack of understanding or poor communication between departments and service providers creates friction. This article discusses why and how a school of medicine in a large academic medical center (AMC) implemented a shared services model and addressed key challenges. In the 6 years since its creation in 2019, the shared services model has promoted economies of scale, efficiencies, and high quality of work performed around the administrative functions of human resources, finance, research administration for preaward support services, communications, and facilities. In an AMC, this model ensures that units are consistently well supported in these functions and can focus their energies on the central mission areas of research, patient care, and education. This is especially relevant in the current climate, with the focus falling even more pointedly on efficiency and resource management in institutions that receive federal funding. Additionally, the model created an ecosystem of continuous information sharing and professional development. Importantly, it achieved these benefits without compromising individual units' autonomy and unique strengths, balancing centralized support with unit independence. The AMCs that adopt a shared services model often report benefits such as consistency, structure, collaboration, and flexibility. This combination leads to smoother operations, a more engaged workforce, and greater overall efficiency, creating a supportive environment that benefits faculty, staff, and the institution as a whole. The shared services model discussed in this article is generalizable and translatable to other AMCs as well as to large, complex organizations in both the private and public sectors that seek to improve efficiencies in administrative productivity and processes.
PURPOSE: Working on the electronic health record (EHR) after usual clinic hours (pajama time) is associated with burnout and decreased professional satisfaction in attending physicians. This study examines the associatio...PURPOSE: Working on the electronic health record (EHR) after usual clinic hours (pajama time) is associated with burnout and decreased professional satisfaction in attending physicians. This study examines the association between resident pajama time and burnout, professional satisfaction, and medical knowledge among family medicine (FM) residents. METHOD: A cross-sectional survey of US FM residents was administered by the American Board of Family Medicine after the 2024 In-Training Examination in October 2024. The survey included questions about EHR use and satisfaction along with multiple other measures, including assessment of burnout with a 2-item screening measure and professional and training satisfaction. High pajama time was defined as an average of 3 hours or more per night on ambulatory EHRs. Bivariate analysis of outcomes by high EHR use and multiple logistic regressions were performed. RESULTS: The survey was administered to 9,731 FM residents who reported being postgraduate year 2 or above. Of the 9,653 residents who answered the EHR questions (response rate, 99.1%), 3,124 (32.3%) reported high pajama time. High pajama time was more common in older, female, underrepresented in medicine, and international medical graduate residents. After these characteristics were controlled for, high pajama time was associated with lower examination scores (odds ratio [OR], 1.28; 95% CI, 1.15-1.41), decreased odds of professional satisfaction (OR, 0.61; 95% CI, 0.55-0.68), training program satisfaction (OR, 0.62; 95% CI, 0.56-0.70), and higher odds of burnout (OR, 1.61; 95% CI, 1.46-1.78). CONCLUSIONS: Nearly one-third of upper-year US FM residents report spending 3 hours or more per day working after hours on ambulatory EHRs. This high pajama time is associated with lower medical knowledge, lower professional satisfaction, and higher burnout. Residency programs should implement strategies at the system and learner levels to reduce after-hours EHR use to prevent long-term negative effects on physician well-being and professional practices.
PROBLEM: Interpretation of large volumes of narrative feedback, collected in a programmatic assessment setting, poses significant challenges for students, mentors, and assessors. This report introduces an innovative tool...PROBLEM: Interpretation of large volumes of narrative feedback, collected in a programmatic assessment setting, poses significant challenges for students, mentors, and assessors. This report introduces an innovative tool designed to provide personalized, real-time interpretations of narrative feedback aligned with predefined learning outcomes. APPROACH: Through collaborative design sessions with key stakeholders, the authors developed and piloted the tool within the master's in medicine program at Maastricht University from February 2022 to May 2024. The tool's algorithm combines topic modeling and sentiment analysis to provide visual representations of feedback data mapped onto predefined competencies and professional activities. OUTCOMES: The innovation was piloted in the master's program in medicine at Maastricht University, the Netherlands, between December 2023 and April 2024. A total of 33 students, approximately 2 years into the 3-year program, and their 20 mentors participated in the pilot. Both mentors and students acknowledged the tool's potential to enhance effective use of narrative feedback data. Students predominantly used the tool to reflect on and self-assess their competency development and set new learning goals, whereas mentors leveraged it to guide and monitor students' learning and provide informed advice to the clinical competency committee on students' competence development. Key benefits included the visualization of feedback data aligned with intended learning outcomes and comprehensive identification of strengths, areas for improvement, and learning gaps. NEXT STEPS: Informed by pilot insights, the tool will be refined and tested in an expanded pilot. The tool's adaptable structure allows integration into diverse educational frameworks, incorporation of domain-specific terms, and deployment within e-portfolios or as a standalone tool. This scalable innovation offers a robust solution for enhancing the interpretation and use of narrative feedback and can be applied globally across a wide range of educational programs that use overarching (eg, competency-based) assessment frameworks.
Hospital discharge is a complex and error-prone process for internal medicine patients which requires making nuanced management decisions, collaborating with multiple stakeholders, integrating patient preferences, and ad...Hospital discharge is a complex and error-prone process for internal medicine patients which requires making nuanced management decisions, collaborating with multiple stakeholders, integrating patient preferences, and addressing structural barriers to care. To date, educational innovations targeting the discharge process have focused on interprofessional collaboration, patient communication, written discharge summaries, and competency-based assessment tools. The authors argue that formulating and communicating a discharge plan is a critical 'management moment' for trainees and that providing supervision and feedback on this process is an important responsibility for inpatient attending physicians. A critical gap in hospital discharge education is discharge plan formulation-a key competency that is undertaught and variably supervised for internal medicine trainees. To address this gap, in 2025 the authors developed the SAFE-DC (Summary, Active Issues, Follow-Up, Exit, Drugs and Devices, Counseling) communication tool, which is designed for attending physicians to implement as an oral presentation format that guides internal medicine trainees in formulating and communicating discharge plans during attending rounds. Attendings can use the tool to supervise trainee management reasoning, ensure completion of all necessary discharge tasks, and provide structured, real-time feedback to trainees on their discharge management plans. In this Scholarly Perspective, we describe the SAFE-DC communication tool, illustrate its implementation and use on internal medicine teams, and share key lessons learned for clinician educators.
PURPOSE: Patient-physician language concordance improves health outcomes for the growing US population with non-English language preferences. Some graduate medical education specialties offer educational opportunities fo...PURPOSE: Patient-physician language concordance improves health outcomes for the growing US population with non-English language preferences. Some graduate medical education specialties offer educational opportunities for their residents to improve skills in a non-English language relevant to their population. However, these efforts are typically program-specific, and the language proficiency of resident physicians by specialty has not been previously evaluated on a national scale. In this study, the authors sought to examine the language skills of first-year resident physicians across Accreditation Council for Graduate Medical Education (ACGME) specialties. METHOD: This study describes the language skills of first-year resident physicians within 36 specialties from academic years 2013-2014 to 2023-2024. Data were obtained from the Association of American Medical Colleges (AAMC)'s Electronic Residency Application Service and the ACGME. Data analysis included descriptive statistics and chi-square testing. RESULTS: Of 303,539 first-year resident physicians with an AAMC ID from 2013 to 2024, 288,933 (95.2%) had available language data. Most residents (71.6%) reported a non-English language at any level across 36 specialties. Over the study period, reported advanced/native multilingualism increased by 11.6 percentage points, while novice/intermediate language skills declined by a comparable amount. Medical specialties had a higher proportion of advanced/native multilingual residents (34.8%) compared to hospital-based and surgical specialties (27.0% and 26.7%, respectively, P < .001). Spanish was the most prevalent advanced/native language in 34 of the 36 specialties. CONCLUSIONS: First-year resident physician multilingualism is common, with marked variations in languages and proficiency levels across specialties. Graduate medical education programs and specialty societies may consider evaluating their specialists' language skills when considering strategies to improve health care for populations in need. Such language data may be used to inform the development of specialty-specific medical language curricula and individualized resources according to trainee language proficiency and patient population language preferences.
PURPOSE: Coaching is an emerging pedagogical strategy in health professions education, aimed at enhancing learners' growth and competency through self-reflection, self-regulated learning, and lifelong learning skills. Co...PURPOSE: Coaching is an emerging pedagogical strategy in health professions education, aimed at enhancing learners' growth and competency through self-reflection, self-regulated learning, and lifelong learning skills. Coaching programs are resource-intensive due to the training and support required for clinician educators. Through the lens of actor-oriented transfer theory, this study seeks to understand the broader value of coaching programs beyond benefits for learners by investigating how medical student coaches apply coaching skills beyond their direct coaching relationships and the impacts of this skill transfer. METHOD: Using a qualitative interpretivist approach, individual semi-structured interviews were conducted with 11 medical student coaches at UCSF School of Medicine in 2024-2025. The interviews, guided by literature on coaching and actor-oriented transfer, were analyzed inductively using template analysis. RESULTS: Participants described applying coaching skills in various clinical, educational, administrative, leadership, and personal contexts in ways that benefit learners, colleagues, patients, family, and themselves. Themes address 1) the transfer process of coaching skills (transfer is guided by experience, integrating skills with prior values, and identifying similarities in new situations, 2) positive impacts of transfer experience on the coach (skill building and identity formation), and 3) positive impacts on the learning environment and organizational culture (improving faculty empathy with learners, applying relationship-centered skills broadly, and building a culture of inclusive educators and leaders). CONCLUSIONS: This study shows how medical student coaches can have positive benefits beyond their formal coaching relationships by applying various coaching skills across professional and personal contexts. Actor-oriented transfer provided a framework to understand when and how these skills are applied. The study highlights the positive effects of transfer on faculty coaches, the learning environment, and organizational culture, supporting the benefits of coaching programs in medical education.
The academic faculty promotion and tenure process for medical school faculty is a critical and high-stakes endeavor, yet the traditional narrative letter of recommendation (LOR) format is often hindered by vague criteria...The academic faculty promotion and tenure process for medical school faculty is a critical and high-stakes endeavor, yet the traditional narrative letter of recommendation (LOR) format is often hindered by vague criteria, bias, and subjectivity. When examined through the Standards for Educational and Psychological Testing framework, the LOR format is vulnerable to limitations in validity, reliability, and fairness. The LOR format also shows vulnerability to methodological biases (eg, selection bias, content inconsistency), cognitive biases (eg, leniency bias, halo effect, confirmation bias), and structural inequities (eg, gender, racial/ethnic, and prestige biases). Additionally, the LOR writing process imposes considerable resource demands that divert faculty time from core academic missions. In this Scholarly Perspective, the authors propose a structured LOR format that integrates standardized structured assessments with guided prompt components focused on the candidate's key contributions across 3 dimensions: primary domain of impact, broadest scope of impact, and significance of contribution. This approach aligns with competency-based assessment principles that have transformed other areas of medical education, shifting evaluation from impressionistic judgments toward evidence of specific achievements against defined benchmarks. While acknowledging institution-specific needs and implementation challenges, this proposed structured LOR format offers a potentially more valid, reliable, and equitable approach that institutions can adapt to their specific values and promotion criteria.
PROBLEM: To advance health equity, residents need preparation to address structural contributors to disparities and mitigate bias in clinical decision-making. Experiential learning around health equity, however, is lacki...PROBLEM: To advance health equity, residents need preparation to address structural contributors to disparities and mitigate bias in clinical decision-making. Experiential learning around health equity, however, is lacking, and specialty-specific interventions often fail to reflect the interdisciplinary nature of clinical practice. This report describes an institution-wide longitudinal simulation-based health equity educational intervention for first-year residents, comprising experiential education on structural determinants of health (SDOH) and spaced reflection opportunities. APPROACH: In 2024, first-year residents from all specialties at one academic medical center participated in two simulated encounters with standardized patients (SPs), followed by SP feedback, individual narrative reflection, and group debriefing, which leveraged visual arts-based exercises to generate dialogue. Three to six months later, residents reviewed recordings of their encounters and completed a semi-structured metacognitive activity. Surveys conducted before, immediately after, and 3-6 months after the simulations captured self-reported impacts on decision-making and communication in clinical encounters, understanding SDOH, and performance on the Multidimensional Cultural Humility Scale, which measures dimensions of intercultural interactions (e.g. openness, self-awareness). OUTCOMES: Of 235 eligible residents, 216 participated. One hundred sixty-four, 116, and 130 consented to have their pre-, immediate post-, and interval- (3-6 months post) responses included for analysis. 99.1% (115) found programming quality to be high. Immediately after simulation experiences, there was a statistically significant improvement in participants' cultural humility and confidence in addressing stigmatizing language, bias, and SDOH during patient encounters; communicating with diverse patients; and advocating for patients. At interval follow-up, most improvements were sustained; nearly 70% (89) found the experience had impacted their patient interactions. NEXT STEPS: Next steps include offering advanced iterations of this experience to senior residents. Other institutions may replicate this activity with cases tailored to site-specific patient populations to give learners opportunities to practice equity-focused skills and signal organizational commitment to meeting their patient populations' needs.
PURPOSE: Increasing student costs and financial burden of medical education necessitate an exploration of economically viable alternatives. Accelerated 3-year MD programs (A3YPs) are a promising solution, offering shorte...PURPOSE: Increasing student costs and financial burden of medical education necessitate an exploration of economically viable alternatives. Accelerated 3-year MD programs (A3YPs) are a promising solution, offering shorter training and potentially lower debt. This study calculated the additional financial value and potential debt savings inherent in A3YPs vs traditional 4-year MD programs (4YPs), focusing on net present value (NPV) (ie, current worth of future cash flows). METHOD: The authors used NPV analysis to evaluate the differential financial investment and expected future cash flows for A3YP students graduating from eight US medical schools in 2022 compared with 4YP graduates. The analysis considered tuition costs, residency and practicing physician salaries, and medical educational debt as the basis for the financial calculations. The analysis extended from the first year of medical school in 2020 through 1 year of postresidency practice in 2026, assuming contiguous training with no gaps and no fellowship training, including 7 years for the A3YP timeline. RESULTS: Sixty-six students graduated from A3YPs from the eight participating schools in 2022 (range, 3-17 graduates per school; mean, 8 graduates). The NPV for A3YP graduates was $240,349 higher per graduate compared with 4YP graduates. The most significant contribution to this higher NPV was the additional year of physician-level salary received by A3YP graduates. Additional contributions included savings from avoiding a fourth year of tuition and lower loan repayment costs due to decreased medical educational debt for A3YP graduates. CONCLUSIONS: This study offers a novel contribution to the ongoing discourse regarding the financial implications of medical education by providing a comprehensive NPV analysis comparing A3YPs with traditional 4YPs. A3YPs offer considerable financial advantages over 4YPs, which has implications for reducing medical student indebtedness and potentially addressing physician workforce shortages. Further research is necessary to explore the specific impacts on individual schools and specialties.
PURPOSE: Morning report (MR), a tradition in internal medicine residency programs, is widely used across the United States and increasingly used by other specialties. However, limited data exist regarding learner-level-s...PURPOSE: Morning report (MR), a tradition in internal medicine residency programs, is widely used across the United States and increasingly used by other specialties. However, limited data exist regarding learner-level-specific considerations. The authors conducted a scoping review to characterize current knowledge regarding learner-level MR content, structure, gaps, and outcomes. METHOD: The authors searched 3 databases on June 17, 2025, for English-language peer-reviewed articles that described MR in graduate medical education. Included studies featured case-based educational activities that enhanced trainees' clinical skills from history-taking to management, targeted resident learners, and mentioned the participants' composition (ie, interns or first-year residents only or senior residents [second year and beyond] only). Data were extracted and analyzed using content analysis. RESULTS: Of 2,287 articles identified, 36 met the inclusion criteria. Twenty-three articles (64%) addressed first-year-related sessions, whereas 32 (89%) covered senior resident-related sessions. Common study objectives included intern (7 [19%]) or senior (11 [31%]) perception or attitudes toward MR. Structural themes included intern (11 [31%]) or senior (13 [36%]) session time limits. Few studies evaluated outcomes incorporating theoretical models or validated tools. Literature differed where intern sessions gravitated toward fundamental history-gathering, differential diagnosis generation, and adapting to the rapidly changing responsibilities of intern year, whereas senior-only sessions focused on more advanced cases and evidence-based medicine. Key gaps included limited incorporation of adult learning theory, minimal facilitator development, ways to evaluate sessions, and content or structural redesign. CONCLUSIONS: Despite its fundamental and widespread use, MR's educational design has remained largely unchanged during the past 3 decades and remains poorly aligned with adult learning theory or rigorous evaluation. This review highlights the need for more studies to reevaluate MR through learner-specific design, incorporation of modern learning theories, and validated outcomes to ensure it continues to meet the evolving needs of trainees.