Different types of health care worker distress are often conflated. Understanding their distinctions helps customize support and encourages more exact terminology in academic discourse. While it is not necessary to diagn...Different types of health care worker distress are often conflated. Understanding their distinctions helps customize support and encourages more exact terminology in academic discourse. While it is not necessary to diagnose a colleague to support them, it helps to have an awareness of unique struggles. This targeted support can be provided alongside universally caring approaches such as empathetic listening, encouraging professional support, maintaining confidentiality, seeking specialist advice, and destigmatizing mental health issues.
Faculty burnout is a significant issue that negatively impacts the mission of academic medical centers and faculty retention. This article outlines the critical role of faculty affairs leaders in addressing systemic fact...Faculty burnout is a significant issue that negatively impacts the mission of academic medical centers and faculty retention. This article outlines the critical role of faculty affairs leaders in addressing systemic factors that contribute to burnout and enhancing faculty well-being. By leveraging their influence over career lifecycle management, mentorship programs, policy implementation, and climate assessments, faculty affairs leaders can foster a supportive and engaging work environment. The article presents ten practical strategies based on experience and literature to guide faculty affairs leaders in promoting professional fulfillment, reducing burnout, and improving faculty retention. The call to action emphasizes the importance of proactive steps to cultivate a culture of well-being, support, and professional growth within academic medicine.
PROBLEM: The Association of American Medical Colleges (AAMC) has urged actions to promote inclusivity in medical education for historically underrepresented groups. Studies suggest that underrepresentation may be address...PROBLEM: The Association of American Medical Colleges (AAMC) has urged actions to promote inclusivity in medical education for historically underrepresented groups. Studies suggest that underrepresentation may be addressed through structured mentorship and workshops at the pre-medical level and generate interest in less familiar specialties including physical medicine and rehabilitation (PM&R). APPROACH: The authors implemented a novel half-day multi-institutional workshop in spring 2024 featuring physicians and medical students from New York City medical centers. The workshop included structured mentorship and pertinent PM&R-related topics, including disability health and adaptive sports, to which pre-medical students often have limited exposure. Participants were invited to complete pre- and post-workshop surveys to evaluate the workshop's impact. The authors collaborated with pre-health chapters of organizations such as the American Medical Women's Association (AMWA) and the Minority Association of Pre-Medical Students (MAPS) to distribute surveys. OUTCOMES: The pre-workshop survey was completed by 147 pre-medical students, and 81 registered for the workshop. Ultimately, 55 attended the workshop, with 71% completing the post-workshop survey. Most participants had no previous exposure to PM&R (n = 77, 53.5%) and to adaptive sports (n = 116, 80.6%). Furthermore, although 76 (52.8%) had shadowed a physician, only 6 (4.2%) had experience shadowing a PM&R physician. The authors gathered a diverse representation of responses, including those identifying as female (n = 119, 81.0%) and underrepresented in medicine (n = 84, 57.1%). Pre-post comparative analysis showed a statistically significant rise in students' motivation to apply to medical school (P = .018), along with a statistically significant increase in the interest and understanding of PM&R and adaptive sports (P < .001). NEXT STEPS: Future work will focus on developing longitudinal mentorship, improving accessibility through hybrid formats, and expanding the curriculum through interspecialty collaborations to support broader implementation and evaluation.
PURPOSE: The transition to residency is challenging. Educators often believe they could have been greater help if they knew more about trainees before trainee arrival. Thus, many educators have championed use of learner...PURPOSE: The transition to residency is challenging. Educators often believe they could have been greater help if they knew more about trainees before trainee arrival. Thus, many educators have championed use of learner educational handovers. Unfortunately, success has varied, and the literature offers little regarding the cause of misalignment between trainees' needs and educational supports. To redress this issue, the authors explored program directors' (PDs') experiences with struggling residents and information that might have helped. METHOD: The authors used constructivist grounded theory within an interpretivist paradigm. In 2023, they conducted virtual semistructured interviews with PDs from multiple institutions in the Western United States purposively selected to represent family and internal medicine, obstetrics and gynecology, pediatrics, and surgery. The authors elicited 2 specific narratives in which PDs anticipated new residents might struggle and were surprised by residents' struggles. Thematic analysis was used with constant comparison to interpret narratives. RESULTS: Nineteen PDs provided 38 narratives that encapsulated the notion of residents' difficulty adapting to workplaces. To understand struggles, participants looked for clues in applications but had difficulty interpreting available information. Unknown but desired information was common. It was perceived, given system constraints, to be currently unknown (potentially knowable but not routinely gathered by undergraduate programs) or currently unknowable (aspects of performance that may not be detectable until one enters residency). CONCLUSIONS: The findings suggest a novel conceptual model that indicates ways in which information that is ambiguous or currently unknown to postgraduate training programs could be made more accessible. Innovation, however, will be required to determine whether information that is currently deemed unknowable to undergraduate programs can be generated. Such efforts must take into account that PDs consider it difficult to anticipate which residents will struggle in many circumstances, indicating that efforts to implement learner education handovers will need to be systematic.
Artificial intelligence (AI) is transforming graduate medical education (GME), yet formal training in its responsible use remains limited. As AI capabilities expand, trainees increasingly adopt these tools informally and...Artificial intelligence (AI) is transforming graduate medical education (GME), yet formal training in its responsible use remains limited. As AI capabilities expand, trainees increasingly adopt these tools informally and without structured oversight, raising urgent questions about how to integrate AI into physician training and teach its responsible use. This article applies Ethan Mollick's Best Available Human (BAH) standard as a principle to guide trainee use of AI. BAH permits AI engagement when its performance meets that of the best human expertise readily available, and offers a simple, flexible rule to help trainees decide when AI can responsibly augment learning and patient care. BAH is adapted for GME by pairing its performance and availability threshold with structured verification and faculty to review to reinforce responsible AI use. The authors apply the BAH principle across three domains central to GME: 1) clinical instruction, 2) diagnostic reasoning, and 3) health record composition. In each domain BAH conditions AI use on availability thresholds, demonstrated performance, and structured verification. Because the BAH principle would function best when trainees possess a foundational understanding of AI tools and their appropriate use, the authors argue that GME programs should formally incorporate established AI competencies into their curricula. These competencies align with the skills needed to master the BAH principle and use AI responsibly. Together they make disciplined, responsible AI use both teachable and feasible within contemporary GME training programs.
Santen SA, Lawson L, Manriquez JAN
… +7 more, Westerveld M, Turner L, Wilson A, Park YS, Holmboe ES, Ryan MS, Medical School Outcomes Milestone Study Group
PURPOSE: Facilitation of competency-based medical education adoption would benefit from alignment between medical school (undergraduate medical education [UME]) and residency (graduate medical education [GME]) assessment...PURPOSE: Facilitation of competency-based medical education adoption would benefit from alignment between medical school (undergraduate medical education [UME]) and residency (graduate medical education [GME]) assessments. This study explores the strength of an a priori alignment of medical school assessments with residency competency domains to guide programmatic assessment and research. METHOD: In fall 2023, the authors (US faculty with UME and GME expertise) used a 2-phase Delphi consensus approach (9 participants in phase 1 and 16 in phase 2) to independently map medical school assessments to the Accreditation Council for Graduate Medical Education competency domains (0, no association; 1, some or moderate association; and 2, strong association). The mean responses were used to create a heatmap of the strength of associations, with a score of 1.5 or higher indicating a meaningful association. Consensus discussion was used to develop a final heatmap of associations. RESULTS: Strong a priori associations emerged for the patient care domain and metrics of clerkship grading, professionalism concerns, clinical skills, and failure to match. Medical knowledge was closely associated with the United States Medical Licensing Examination Step scores and preclinical metrics. Communication and professionalism were associated with professionalism concerns, Gold Humanism Honor Society membership, clerkship grades and rank, clinical skills, Step 2 Clinical Skills failure, and failure to match or Supplemental Offer and Acceptance Program participation. Practice-based learning and improvement and systems-based practice had weaker associations, suggesting these competencies may be less reflected in traditional medical school metrics. However, subcomponents of practice-based learning related to reflection revealed associations with professionalism concerns and match outcomes. CONCLUSIONS: Experts perceived associations between UME and GME assessments in multiple domains, with weaker associations in practice-based learning and systems-based practice. These results offer perspective on how UME outcomes could be associated with GME performance and might be used in programmatic assessment.
This Last Page provides an accessible overview of the definition of reflexive thematic analysis and its phases. It also describes codes, themes, and an example of building themes from codes.This Last Page provides an accessible overview of the definition of reflexive thematic analysis and its phases. It also describes codes, themes, and an example of building themes from codes.
PURPOSE: Theory enables medical education scholars to move beyond local problems to understand broader phenomena and build cumulative knowledge. Yet many scholars struggle to use theory in their educational endeavors. Wh...PURPOSE: Theory enables medical education scholars to move beyond local problems to understand broader phenomena and build cumulative knowledge. Yet many scholars struggle to use theory in their educational endeavors. While the medical education literature offers resources and mentors provide guidance, the field lacks insight into specific mentoring processes for theory use. This study aimed to illuminate processes by which experienced mentors help mentees use theory in medical education scholarship. METHOD: Using constructivist grounded theory, the authors conducted semi-structured interviews in 2021, 2024, and 2025, with faculty from diverse disciplinary and geographic backgrounds with experience mentoring others in medical education scholarship. Through iterative data collection, coding, and discussion, we developed The Abstracting-Contextualizing Model (ACM) of Mentoring for Theory Use in Medical Education, which was supported by multiple sources of evidence and remained stable with additional data. RESULTS: Based on interviews with 20 mentors, the authors defined three core elements: problems (local issues), phenomena (generalizable abstractions), and theories (tools for understanding). Mentors identified understanding phenomena as the central goal of scholarship, with these core elements serving as entry points. Mentors employed general strategies including preparatory approaches (metaphors, role modeling, sharing exemplar articles, facilitating application exercises) and helping mentees avoid common errors. Based on mentees' starting points, mentors strategically selected between two complementary approaches: Abstracting (guiding from problems or phenomena toward theories) for mentees beginning with local issues, and Contextualizing (grounding theoretical knowledge in educational practice) for mentees starting with particular theories or disciplinary expertise. CONCLUSIONS: The ACM addresses a gap at the intersection of theory, research skills, faculty development, and mentoring literatures. It demonstrates how mentors employ sophisticated, adaptive, and task-specific strategies to guide scholars toward understanding phenomena based on their individual starting points. This work offers practical implications for mentees, mentors, institutions, and the field.
PURPOSE: Faculty development (FD) is a strategic priority in health professions education, yet its impact in low- and middle-income countries (LMICs) is often limited by contextual and cultural factors. This study explor...PURPOSE: Faculty development (FD) is a strategic priority in health professions education, yet its impact in low- and middle-income countries (LMICs) is often limited by contextual and cultural factors. This study explored how Vietnamese health professions faculty engaged with and applied learning from a cross-cultural, interprofessional FD certificate program. METHOD: Using a qualitative approach informed by a constructivist paradigm, the authors conducted semistructured interviews with 10 faculty from a single academic institution in Vietnam who completed a nine-month international FD program. Interviews, conducted from December 2024-February 2025, were audio-recorded, transcribed verbatim, and thematically analyzed following Braun and Clarke's six phases; coding was conducted in pairs with regular reconciliation meetings. Cultural Historical Activity Theory (CHAT) served as an interpretive lens to analyze systemic tensions. RESULTS: Three interrelated themes characterized participant experiences. First, cultural norms of hierarchy and conflict avoidance, compounded by language barriers and time zone differences, limited open dialogue and learner engagement. Second, contextual barriers, including heavy clinical workloads, structural constraints, and a lack of locally relevant case examples, impeded the translation of educational theory to practice. Third, while interprofessional education (IPE) broadened participants' perspectives, its implementation was limited by role ambiguity between health professions, insufficient institutional support, and a lack of local IPE expertise. Viewed through CHAT, these findings highlight three key tensions: between cultural rules and the learning community; between program instruments (curriculum and pedagogical approaches) and the object of improving teaching capacity; and between the interprofessional learners and the object of applying new teaching practices in local contexts. CONCLUSIONS: Cross-cultural and interprofessional FD can foster significant professional growth, but its sustainability in LMIC contexts requires system-level alignment. To enhance relevance and impact, programs should embed cultural humility and psychological safety, co-design locally relevant content, and use layered learning designs that balance interprofessional breadth with profession-specific depth.
PURPOSE: The United States is facing a primary care workforce crisis that is impacting the overall health of the population. The University of Washington School of Medicine's Rural Underserved Opportunities Program (RUOP...PURPOSE: The United States is facing a primary care workforce crisis that is impacting the overall health of the population. The University of Washington School of Medicine's Rural Underserved Opportunities Program (RUOP) is a 4-week primary care preclerkship rotation. This study examined whether early and immersive exposure to primary care is independently associated with a career choice in primary care overall and family medicine as a distinct specialty. METHOD: This retrospective cohort study included 2,234 students who matriculated at the University of Washington School of Medicine between 2003 and 2015. Program records were linked to American Medical College Application Service data, a matriculation career-preference survey, and the American Medical Association Physician Masterfile. The outcomes were practice in primary care (family medicine, internal medicine, and pediatrics) and family medicine; the exposure was RUOP participation. Covariates included age; sex; parental educational level; rural upbringing; Washington, Wyoming, Alaska, Montana, or Idaho origin; and 17 baseline specialty or practice setting interests. Multivariable logistic regression generated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Of the 2,234 graduates, 1,104 (49.4%) completed RUOP. Among RUOP participants, 533 (48.2%) were practicing primary care compared with 328 of the 1,130 non-RUOP graduates (29.3%). In multivariate regression, RUOP participation was associated with higher odds of practicing primary care (OR, 1.39; 95% CI, 1.10-1.76; P = .01) and family medicine practice (OR, 1.54; 95% CI, 1.11-2.14; P = .01). CONCLUSIONS: RUOP was associated with higher odds of practicing both primary care and family medicine. Although confounding factors cannot be entirely excluded, these findings suggest that short, preclerkship primary care immersions may support students' trajectories toward primary care careers. Medical schools aiming to strengthen the primary care pathway should consider incorporating similar experiences into their curricula.
PURPOSE: Gossip has been found to influence feedback, but the interplay between gossip and feedback is unclear. Given the importance of feedback for resident development, the education community needs to better understan...PURPOSE: Gossip has been found to influence feedback, but the interplay between gossip and feedback is unclear. Given the importance of feedback for resident development, the education community needs to better understand how gossip and feedback are connected, and the implications of that relationship. For purposes of this study, the authors used an established definition of gossip as "evaluative talk about a person who is not present." METHOD: The authors used constructivist grounded theory to iteratively conduct and analyze semi-structured interviews from November 2024 to April 2025 with 16 resident participants from 7 programs, including pediatric, obstetrics-gynecology, internal medicine, and psychiatry programs, in the United States and the Netherlands. Interview questions focused on the experience of gossip in residency and the interplay between gossip and feedback. RESULTS: The analysis revealed that gossip and feedback relate to each other in 4 distinct ways, particularly when there are barriers to feedback. "Gossip catalyzes feedback," encouraging its delivery, whether explicitly or subconsciously. "Gossip replaces feedback" when giving critical feedback is challenging or when there is no forum for feedback. Sometimes, "gossip is feedback" given that feedback systems share elements with gossip conversations, such as when feedback conversations are indirect or the feedback provider maintains anonymity. Finally, "gossip follows feedback" when it helps trainees process the emotional experience of receiving challenging feedback and guards against peers receiving similar feedback. CONCLUSIONS: The authors theorize gossip as a mechanism for navigating formal feedback systems in practice. Gossip, as much as it is commentary about individuals, is metacommentary on our systems of feedback. The authors call on educators to understand when gossip is used in feedback as a means to further understand barriers to formal feedback. Educators grappling with their feedback systems without considering gossip are missing the looming third party.
PURPOSE: Consensus recommendations and harmonized guidelines for reporting quantitative research in health professions education (HPE) research are lacking. This study synthesizes available quantitative reporting recomme...PURPOSE: Consensus recommendations and harmonized guidelines for reporting quantitative research in health professions education (HPE) research are lacking. This study synthesizes available quantitative reporting recommendations and guidelines to present a harmonized framework and derive quantitative standards for reporting HPE research. METHOD: The authors identified existing standards, recommendations, and guidelines from peer-reviewed scientific journals in medicine, education, and social sciences by searching PubMed, Web of Science, and Google from August 2006 through April 2025. The authors also requested input from experts in HPE (scholars and journal editors) via electronic communication over 6 months (November 2024 to April 2025). The articles identified were then used to synthesize and generate an initial list of standards for reporting quantitative research in HPE. Two authors reviewed each article to rate its alignment with HPE research. All authors independently evaluated the full list of standards and discussed them as a group for their relevance and alignment for reporting in HPE; all authors also made recommendations for each standard (to report as is, report but modify, or drop). The group subsequently reviewed and collectively reached consensus on the final set of quantitative reporting standards. RESULTS: The authors reviewed a total of 34 articles, with 19 identified as having alignment with HPE quantitative research standards. Mean interrater agreement among author pairs was 98% (kappa = .96). Authors initially generated 40 reporting standards, of which 18 (45%) were modified and 1 (3%) was identified to be dropped. The final set of quantitative guidelines consisted of 39 standards, with each standard nested in one of 28 topic areas. CONCLUSIONS: The quantitative reporting standards identified in this study provide guidance to ensure rigor in reporting expectations for HPE research. These standards may also facilitate critical appraisal of articles and enhance the quality and impact of quantitative HPE research.
Developmental evaluation is an approach to capture the nuances of change when introduced into a context-often overlooked nuances that require real-time attention for change to be long-lasting. This AM Last Page bridges p...Developmental evaluation is an approach to capture the nuances of change when introduced into a context-often overlooked nuances that require real-time attention for change to be long-lasting. This AM Last Page bridges philosophy with a 5-step approach to undertaking developmental evaluation in complex contexts.