The Liaison Committee on Medical Education (LCME) accreditation process presents significant challenges to medical schools in the current educational landscape. Medical schools invest substantial resources in accreditati...The Liaison Committee on Medical Education (LCME) accreditation process presents significant challenges to medical schools in the current educational landscape. Medical schools invest substantial resources in accreditation preparation, often funding consultants and mock site visits, often diverting resources from institutional priorities. Current self-evaluation resources, while meeting Department of Education minimum requirements, inadequately prepare both medical school staff and site surveyors for the complex evaluation process. The accreditation system lacks transparent evaluation methodologies that would ensure consistent application of standards and elements based on institutional contexts. Site surveyors and medical school staff require specialized competencies that are not adequately addressed through existing preparation methods. This has led to the perception that application of standards is inconsistent and results in increased financial burden on medical schools. This commentary proposes implementing rubrics and frame-of-reference training to improve the LCME accreditation process. Drawing from established assessment and program evaluation methodologies that employ transparent standard-setting processes, frame-of-reference training can establish shared mental models for how standards and elements are rated, thereby improving consistency in their application. This approach would provide greater guidance to both medical schools and site surveyors throughout the evaluation process. This adoption could redirect medical school funding from accreditation consultants toward institutional priorities and educational improvements. This systematic approach has the potential to enhance the consistency of accreditation decisions while reducing the financial burden on institutions. Future research should examine outcomes of this proposed framework to evaluate its effectiveness in improving the accreditation process and institutional resource allocation.
PURPOSE: In the context of federal and state policy efforts to address health workforce shortages, this study examines whether US states' Medicaid programs increase the total number of graduate medical education (GME) po...PURPOSE: In the context of federal and state policy efforts to address health workforce shortages, this study examines whether US states' Medicaid programs increase the total number of graduate medical education (GME) positions in primary versus non-primary care physician specialties when increasing financial investment in GME. METHOD: Fixed effects regression estimation was employed to evaluate the association of Medicaid GME payments with residency positions in primary care and non-primary care specialties in 8 years from 1998 to 2022, controlling for changes in poverty rates and health professions regulation. Sensitivity analyses examined this association in the presence of caps on federal direct GME (DGME) reimbursement payments. RESULTS: Per 10,000 population, an additional $1 million of Medicaid GME funding was associated with 0.934 more residents in primary care specialties (95% CI [0.170, 1.697]) and 1.229 more residents in non-primary care specialties (95% CI [0.345, 2.092]). Similar results were obtained in sensitivity analyses that controlled for state-level changes to Medicare DGME caps. CONCLUSIONS: Additional Medicaid GME payments were associated with increases in residency positions, exhibiting similar effects in primary and non-primary care specialties. Additional structures, processes, or policy measures may be needed to optimize Medicaid GME funding as a means of addressing physician workforce shortages in primary care and other high-need areas. Further evaluations of GME financial investment are needed to inform future policy and spending decisions related to health workforce development.
PROBLEM: A core competency of medical education is preparing physicians to effectively navigate challenging clinician-patient relationships. Balint groups are used with residents and practicing physicians to increase int...PROBLEM: A core competency of medical education is preparing physicians to effectively navigate challenging clinician-patient relationships. Balint groups are used with residents and practicing physicians to increase interpersonal skills and reduce burnout but are rarely included in undergraduate medical education. Virtual Balint offerings recruiting medical students from across programs represent a way to increase accessibility. APPROACH: The American Balint Society (ABS) instituted a pilot feasibility project to provide virtual Balint groups for medical students. Students were recruited using informational brochures sent to 155 US allopathic and osteopathic medical schools. 150 students from 26 medical schools were recruited and divided into groups of 10-11, comprised of students from different schools and years of education and led by two experienced ABS credentialed leaders. Each group met monthly four times via Zoom, with new groups initiated each semester from Fall 2023 to Spring 2025. OUTCOMES: Overall, a total of 150 medical students from 26 different medical schools participated, some for several semesters. Following the Fall 2023 and 2024 groups, participants were surveyed. In total, 31 of 83 (37%) responded; results indicated students reported interpersonal skill improvement, particularly in awareness of the interpersonal context, perspective-taking skills, active listening, and an appreciation for their interpersonal impact on their patients. Qualitative responses indicated a desire for Balint groups to be included in their medical education. NEXT STEPS: The ABS intends to continue and expand student virtual Balint groups. The goal is to provide Balint opportunities for students at as many medical schools as possible, while providing leadership training for faculty at those schools and initiating research demonstrating valuable outcomes of Balint education.
Competency-based medical education (CBME) aims to modernize postgraduate training through developmental, learner--centered assessment. However, many residents still experience the process as procedural and detached from...Competency-based medical education (CBME) aims to modernize postgraduate training through developmental, learner--centered assessment. However, many residents still experience the process as procedural and detached from meaningful growth. Using self-determination theory, the authors examine how current CBME practices often undermine residents' needs for autonomy, competence, and relatedness, producing superficial compliance rather than internalization and authentic commitment. Beyond structural critique, they highlight agentic engagement-residents' proactive efforts to "pull" autonomy support and shape feedback-as an underused but essential lever for revitalizing CBME. Field notes and entrustable professional activities can serve as coaching tools rather than bureaucratic artifacts but only if situated within autonomy-supportive dialogue, trusting relationships, and competence-oriented feedback. Drawing from self-determination theory research, the authors outline evidence-based, need-supportive strategies for embedding CBME practices into routine workflows. Collectively, the recommendations offer educators a pragmatic guide for aligning assessment culture with resident motivation, professional identity formation, and well-being. Without motivational alignment, CBME risks remaining an exercise in form over substance.
PROBLEM: Theory-informed and evidence-based educational offerings promote student learning and equity but are time-consuming and require health professions educators to have content expertise in inclusive instructional d...PROBLEM: Theory-informed and evidence-based educational offerings promote student learning and equity but are time-consuming and require health professions educators to have content expertise in inclusive instructional design. While -generative AI (GAI) offers the potential to overcome these barriers, educators must learn to effectively leverage GAI tools for evidence-based instructional design. In this work, the authors piloted and evaluated a 2-part experiential learning activity to equip educators to effectively engage with GAI for instructional design purposes. APPROACH: The authors implemented the GAI innovation in the graduate-level "Teaching 100" course (enrollment n = 27) at Harvard Medical School September-November 2023. Educators used GAI to annotate their lesson plans to identify application of, and opportunities to incorporate, evidence-based principles of teaching and learning. The 2-part assignment provided scaffolded instruction on prompt engineering and engaged learners in metacognitive reflection on AI-generated content. The authors evaluated the effectiveness of the GAI innovation according to the Kirkpatrick Model: descriptive analysis of self--reflections evaluated educators' subjective experience (Level 1) and planned behavioral changes (Level 3), while quantification of prompt quality pre-/post-instruction measured educators' learning (Level 2). OUTCOMES: Among educators who completed the 2-part assignment (n = 17/27, 62% completion rate), the quality of -educator-generated AI prompts improved following instruction in prompt engineering: pre-instruction 1.4 (1.2) (mean [SD]) vs post-instruction 4.0 (0.8). The difference in means (2.6 points) was statistically significant (P < .0001, 95% CI [1.9, 3.3]). Metacognitive reflections revealed specific actions educators planned to pursue to implement GAI feedback to improve their instructional design. Educators reported that AI-based assignments enhanced their learning. NEXT STEPS: The authors are developing a stand-alone, interactive GAI tool to be broadly deployed as a faculty development instructional design resource. This future work will yield a scalable solution to the challenge of developing AI literacy among health professions educators to leverage GAI for theory-informed and evidence-based instructional design.
PURPOSE: Management reasoning, the process of making decisions about patient treatment, testing, and resource allocation, remains inadequately addressed in medical education. This qualitative study explored how graduate...PURPOSE: Management reasoning, the process of making decisions about patient treatment, testing, and resource allocation, remains inadequately addressed in medical education. This qualitative study explored how graduate medical trainees develop management reasoning during medical school and residency. METHOD: Between February and June 2024, focus groups were conducted with residents representing postgraduate years 2 to 4 from internal medicine, pediatrics, family medicine, and medicine-pediatrics at 2 US academic institutions. Using dual process theory and situated cognition theory as sensitizing concepts, focus groups explored trainees' experiences and perceptions of management reasoning learning and factors that shape their development. Reflexive thematic analysis was used to identify themes. RESULTS: Four focus groups with 28 residents yielded 4 themes characterizing the development of management reasoning: learning formats, factors supportive of learning, barriers to learning, and developmental trajectories. Residents developed management reasoning through experiential learning activities, such as actively managing patients, observing management practices by senior trainees and faculty clinicians, and interacting with patients, consultants, and peers. In contrast, structured educational activities typically emphasized diagnostic reasoning. Supportive factors contributing to management reasoning included verbalization of reasoning processes, opportunities for ownership, case repetition and variability within the clinical learning environment, individual learner characteristics such as preexisting knowledge base, and practices such as vulnerability and reflection. Barriers included minimized responsibility, lack of patient continuity or follow-up, hierarchy, and extrinsic cognitive load. Trainees described progression from rigid, guideline-dependent approaches toward more nuanced, patient-centered reasoning. CONCLUSIONS: This study provides empirical evidence on how graduate medical trainees develop management reasoning along with actionable recommendations for educators to support this development. Findings highlight the need to intentionally design clinical environments to promote graduated autonomy and verbalization of reasoning by senior clinicians. Addressing identified barriers and maximizing supportive factors will help ensure that future clinicians can navigate the complexities of patient-centered management decisions.
In 2022, the MD-PhD Competencies Development Workgroup, a subgroup of the Association of American Medical Colleges Group on Research, Education, and Training, initiated a project to define essential competencies for trai...In 2022, the MD-PhD Competencies Development Workgroup, a subgroup of the Association of American Medical Colleges Group on Research, Education, and Training, initiated a project to define essential competencies for training physician-scientists, with a focus on MD-PhD education programs. The primary objective was to develop a comprehensive toolkit containing well-defined competencies and milestone-based tools to guide the education of individuals in MD-PhD combined degree programs. It is intended to augment, not duplicate, existing MD and/or PhD competency rubrics. A systematic approach was adopted in creating the toolkit, which included opportunities for the physician-scientist training community to con-tribute their collective experience and knowledge. This article describes the toolkit and its 3 main components: (1) 14 competencies grouped in 4 core domains, (2) a milestone-based assessment tool to track learner progress, and (3) guidelines for implementing the toolkit. This framework can be used to align expectations for learners and mentors, assess learner development, facilitate mentor-mentee conversations, adjust individualized learning goals, and self-identify curricular strengths and gaps. The toolkit can serve as a valuable resource for program directors, faculty mentors, and learners, empowering them to collaboratively shape the next generation of physician-scientists, bridging the worlds of medicine and research.
PURPOSE: Early career attrition, defined as attrition within the first 10 years of a physician's practice, is a significant concern for health care professionals and policymakers because it contributes to the growing phy...PURPOSE: Early career attrition, defined as attrition within the first 10 years of a physician's practice, is a significant concern for health care professionals and policymakers because it contributes to the growing physician shortage. Previous studies examined attrition within single specialties or institutions, but comparisons between surgical and nonsurgical fields remain limited. This study aims to determine early-career attrition rates among the 5 surgical and nonsurgical specialties with the largest physician population and investigate predictors influencing departure from clinical practice. METHOD: This study analyzed the Centers for Medicare and Medicaid Services' Physician Compare National Downloadable Files from 2014 through 2023 to identify physicians in the first 10 years of their career in 2014 who left practice between the third quarters of 2014 and 2015 and did not return. Those who remained absent in subsequent years, excluding clinically active physicians who opted out of Medicare, were considered early attrition cases. The study population included physicians from the 5 most common surgical and nonsurgical specialties based on practicing physician count. Logistic regression models evaluated attrition rates while adjusting for surgical status, gender, region, Area Deprivation Index, and Rural-Urban Commuting Area codes. RESULTS: Among 94,638 early-career physicians across 10 specialties, 1164 (1.2%) experienced early career attrition. After adjusting for physician demographic variables, psychiatrists had significantly higher adjusted odds of early career attrition than all other nonsurgical specialties and obstetricians/gynecologists had significantly higher adjusted odds of early career attrition than all surgical specialties except for general surgery. Among all early career physicians, females, surgical specialists, and those practicing in areas with lower Area Deprivation Index had significantly greater adjusted odds of experiencing early career attrition. CONCLUSIONS: These findings highlight the need to determine reasons behind specialty-specific differences and implement targeted interventions aimed at improving physician retention to ensure current physicians do not contribute to the growing physician shortage.
PROBLEM: Increasing emphasis on research productivity for residency applications has intensified pressures on medical students in recent years. Students, although eager to participate in research early on in medical scho...PROBLEM: Increasing emphasis on research productivity for residency applications has intensified pressures on medical students in recent years. Students, although eager to participate in research early on in medical school, may struggle to independently design research projects. This can result in an overreliance on faculty mentors and departmental support, as well as academic dishonesty in research and publishing. APPROACH: The structured research group was initiated in August 2019 to foster student-led projects while supporting faculty mentorship. The framework includes an onboarding process to guide project formulation, regular group meetings for collaboration, and leadership roles to empower students. This adaptable model prioritizes fostering research innovation, mentorship, and ethical collaboration. OUTCOMES: Since the group's inception through September 2025, faculty-supported, student-led projects have increased, fostering a collaborative environment among faculty, residents, and medical students. Alumni have highlighted the group's structure as a unique strength, contributing to the department's research culture without significantly adding to faculty workload. Other institutions have expressed interest in implementing similar models within their own programs. NEXT STEPS: Future efforts will focus on monitoring research output, mentorship dynamics, and student engagement to guide iterative improvements. The group also aims to support broader adoption of this model while fostering inclusion across varying levels of research experience.
PURPOSE: Medical education has embraced Dweck's theory of a growth mindset because it reflects a commitment to developmental progression. The benefits of a growth mindset can be difficult to realize within medicine's pro...PURPOSE: Medical education has embraced Dweck's theory of a growth mindset because it reflects a commitment to developmental progression. The benefits of a growth mindset can be difficult to realize within medicine's professional culture, which may constrain its adoption and expression. To date, strategies to nurture a growth mindset have been directed toward changing the behavior of individual learners, which is insufficient. Preceptor behaviors shape the learning culture, but their influence on learner attitudes toward the learning process is unexplored. METHOD: The authors conducted a qualitative study using constructivist grounded theory methodology. Seventeen learners from Western University were interviewed in 2023. An iterative process was employed whereby data collection and analysis took place concurrently. Dweck's theory of mindset was used as a sensitizing concept. Open coding was followed by more focused coding, and ideas both within and across categories were compared to inform generation of theory. A reflexivity lens was applied throughout. RESULTS: Learners are constantly interpreting signals and using them to form impressions about their preceptors' value systems. These signals are conveyed in a preceptor's behavior, and learners often adapt their learning behaviors accordingly. When a preceptor is perceived primarily to value learner growth, learners will adopt behaviors in line with a growth mindset. When a preceptor is perceived primarily to value displays of competence over growth, learners may adopt behaviors in line with a fixed mindset. Furthermore, in the absence of growth-valuing signals, learners tend to default to impression management and may exhibit behaviors in keeping with a fixed mindset. CONCLUSIONS: This study offers an important new dimension to our understanding of the dynamic nature of mindsets: that learner mindsets may be preceptor-responsive, shifting in response to perceptions about preceptors' values. These new insights can inform future efforts to foster a growth mindset within medicine's professional culture.Teaser text: This study explores how learners' mindsets are influenced by preceptor attitudes and behaviors relevant to the learning process and offers an important new dimension to our understanding of the dynamic nature of mindsets: that learner mindsets may be preceptor-responsive, shifting in response to perceptions about preceptors' values.
PROBLEM: Clinical decision-making for persons with multiple chronic conditions is a challenge because of uncertain benefits and harms of many treatments and variability in what health outcomes are most important to patie...PROBLEM: Clinical decision-making for persons with multiple chronic conditions is a challenge because of uncertain benefits and harms of many treatments and variability in what health outcomes are most important to patients. Patient Priorities Care (PPC) is an evidence-based approach to aligning decision-making for persons with multiple chronic conditions with their own health priorities. Curricula for health professional trainees in the PPC approach would equip them with the skills necessary to optimize care for this complex population. However, given the time limitations during medical training, program leadership must prioritize competency-based medical education. The authors determined alignment of internal medicine (IM) resident and family medicine (FM) resident Accreditation Council for Graduate Medical Education (ACGME) milestones with core PPC skills. APPROACH: From June 2023 through December 2023, PPC at 3 academic institutions examined ACGME milestones for IM and FM residents and identified milestones that overlap with core PPC skills. Then from June 2024 through December 2024, US Program Directors within IM (S.S.) and FM (M.M.B.) reviewed the findings. OUTCOMES: The 8 core skills of PPC align with 13 of the 21 IM ACGME milestones and 10 of the 19 FM ACGME milestones. PPC addresses ACGME IM/FM milestones in patient care, medical knowledge, systems-based practice, practice-based learning and improvement, and interpersonal and communication skills. A pilot PPC curriculum with IM residents demonstrated increased confidence in several core PPC skills. NEXT STEPS: After demonstrating milestone alignment, authors are developing educational materials for use in various clinical and educational settings with trainees and also practicing health professionals. Tools to assess skills will be created to guide medical educators who implement the PPC trainings. Following that, authors will work with key stakeholders including IM and FM residents, program directors, and geriatrician clinician-educators to assess the feasibility of implementing a PPC curriculum throughout residency training.
PURPOSE: Shared decision-making (SDM) is a vital component of patient-centered care. This study aims to identify key themes relevant to medical student experience with an SDM curriculum, as well as their depth of engagem...PURPOSE: Shared decision-making (SDM) is a vital component of patient-centered care. This study aims to identify key themes relevant to medical student experience with an SDM curriculum, as well as their depth of engagement with the patient perspective. METHOD: Beginning in 2022, medical students at the University of Colorado participated in an SDM curriculum incorporated into a longitudinal integrated clerkship, including a written reflection about their experience with a patient SDM clinical encounter. Reflection pieces were evaluated with both thematic and narrative analysis methods. Written works were coded using interpretive phenomenological analysis to evaluate for emergent qualitative themes surrounding the participants' learned experiences during exposure to the curriculum. Separately, structural narrative analysis of the reflection pieces examined engagement, depth, and meaning making. RESULTS: Fifty-one students completed this SDM curriculum between 2022 and 2024. Thematic analysis of their written reflections revealed 4 primary themes: Communication and Comprehension, Patient Autonomy, Empathy, and Professional Identity Formation. Students emphasized clear communication, respect for patient values, and the emotional dimensions of SDM as elements they observed. Narrative analysis showed significant variations in dimensions of the written reflections including the richness of contextual details, specificity of witnessing, and exploration of multiple perspectives. Reflective pieces also demonstrated variable degrees of critical reflection on personal growth and future-oriented professional insights. Certain elements were notably shared between narrative elements present in deep reflections and skills important for SDM, including framing the situation, attention to details and nonverbal cues, exploration of multiple perspectives, and personal reflection. CONCLUSIONS: SDM is a complex process that involves clear communication, empathy, and respect for autonomy. Narrative elements that create engaging written works are also important to SDM performance, including patient perspective-taking. As medical students undergo professional identity formation, an SDM curriculum engaging the patient perspective may promote a humanistic approach to clinical practice.