PROBLEM: Comics are an emerging medium in medical education for communicating clinical information and patient perspectives. Thus, comics are a promising vehicle for orienting learners to potentially challenging clinical...PROBLEM: Comics are an emerging medium in medical education for communicating clinical information and patient perspectives. Thus, comics are a promising vehicle for orienting learners to potentially challenging clinical experiences like bedside rounding. The authors asked the following research questions: Does use of comics to orient learners to bedside rounding improve learner self-efficacy? Does use of comics improve attending comfort with orienting learners? APPROACH: The authors created a comics-based orientation to bedside rounding grounded in existing literature and faculty input. The comic book depicted a hospital team performing bedside rounds and included scripts and trouble-shooting strategies. The authors randomized faculty along with their teams to use the comic book for orientation or to usual practice, from July 2023 to June 2024. Baseline surveys of learners assessed self-efficacy with bedside rounding and attending comfort with orienting learners to bedside rounding. The authors compared baseline survey data to post-intervention survey data among comics-based orientation recipients versus the control group. OUTCOMES: Twenty-one attendings participated, along with their teams (233 total participants). Response rates were 75% (175/233, baseline survey) and 72% (133/186, post-intervention survey). At baseline, 17% (20/117) of non-resident learners reported feeling comfortable with bedside rounding, and 17% (20/117) reported feeling competent. After the intervention, 78% (29/37) in the comics group reported feeling comfortable, compared to 61% (28/46) among controls, and 73% (27/37) reported feeling competent, compared to 43% (20/46) among controls. Among the attendings in the intervention group, 100% (9/9) felt comfortable orienting learners, compared to 67% (6/9) in the control group. NEXT STEPS: The authors found that a higher proportion of learners reported self-efficacy related to bedside rounding in the groups randomized to the comics intervention versus usual practice. The orientation was feasible to implement. Next steps include assessing whether a comics-based orientation increases uptake of bedside rounding.
The academic promotion process is best navigated from a mindset that emphasizes individual control in reaching the many landmarks along the way. Drawing on the established psychological theories of locus of control and s...The academic promotion process is best navigated from a mindset that emphasizes individual control in reaching the many landmarks along the way. Drawing on the established psychological theories of locus of control and self-efficacy, the authors propose parallels in concepts that faculty members seeking academic promotion should consider. By marking these points on their individual paths, faculty members can control their efforts to achieve academic promotion.
PURPOSE: This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians v...PURPOSE: This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians vs other workers. METHOD: This study used American Medical Association Physician Professional Data to sample US physicians across different specialties between November 2020 and March 2021. Of 7,360 survey respondents, 6,497 (88.3%) completed the SI question. A probability-based sample included 2,508 nonphysician individuals from the US population employed at the time of survey administration, with 2,501 workers (99.7%) completing the SI item. Logistic regression was used to evaluate associations of occupational distress factors, including IWPR, SV, imposter phenomenon, and other factors, with SI before and after adjusting for depression and compare the risk of SI among physicians with other US workers. RESULTS: The study included 6,497 physicians and 2,501 workers in other fields. Adjusting for sex, age, relationship status, parenting status, and depression, each 1-point higher IWPR score (range, 0-10) was associated with 10% increased SI odds (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). Adjusting for the same variables, each 1-point higher SV score (range, 0-10) was associated with 10% lower SI odds (OR, 0.90; 95% CI, 0.85-0.95). The association between imposter phenomenon scores (range, 4-20) and SI was not statistically significant (OR, 1.03; 95% CI, 0.99-1.08). The unadjusted 1-year SI point prevalence was 6.6% (95% CI, 6.0%-7.4%) in physicians vs 5.6% (95% CI, 4.7%-6.6%) among workers in other fields (P = .09). In a multivariable model, workers in other fields with a bachelor's or master's degree had lower SI odds compared with physicians (OR, 0.64; 95% CI, 0.46-0.87). CONCLUSIONS: IWPR and low SV are associated with SI among physicians, independent of depression. Development and evaluation of interventions designed to mitigate these factors in physicians may be warranted.
To expand the tripartite mission to advance health equity, academic medical centers (AMCs) need to look outside their walls. In 2018, Stanford's primary care division launched the Community Partnership Program (CPP) betw...To expand the tripartite mission to advance health equity, academic medical centers (AMCs) need to look outside their walls. In 2018, Stanford's primary care division launched the Community Partnership Program (CPP) between their AMC and local safety-net community health centers (CHCs) to support the goals of meaningful community engagement and addressing local clinic capacity needs. The CPP embeds Stanford physician faculty in local CHCs through service agreements. This study aimed to characterize the experiences of CHC leaders and faculty involved in the CPP to better understand barriers and facilitators to program implementation and assess its success as a community-responsive partnership. Stanford's CPP faculty (n = 9/15) and representative CHC leadership (n = 9/11) from five partner CHCs participated in the study. The National Academy of Medicine's Assessing Community Engagement Conceptual Model guided an explanatory mixed methods study: cross-sectional survey followed by semi-structured interviews. A modified Enage for Equity Community Engagement Survey identified high- and low-scoring variables (Likert scale:1-strongly disagree/never to 5-strongly agree/always). Qualitative assessment explored facilitators and barriers to program implementation and success. Overwhelmingly, both CHC leaders and faculty (n = 18) highlighted the CPP's positive role in making their work meaningful (4.78 (0.5)) and trusting the partners they work with (4.50 (0.5)). Sufficient time (3.61 (1.0)) and financial support (3.33 (1.4)) to engage in the CPP were the lowest scoring variables. Qualitative results highlighted the importance of communication, trust, and institutional buy-in, the value of community-academic bridges, increased access to clinical care, development of community-aligned solutions, and the partnership's positive impact on well-being. A model of community-academic partnership with primary care faculty embedded in safety-net CHCs can be successful from both AMC and CHC perspectives. These findings offer pragmatic lessons that can support other AMCs in building their own capacity for equity-focused collaboration grounded in community-engaged principles.
PURPOSE: Although differing undergraduate medical education (UME) and graduate medical education (GME) assessment frameworks contribute to transition discontinuity, incorporating Accreditation Council for Graduate Medica...PURPOSE: Although differing undergraduate medical education (UME) and graduate medical education (GME) assessment frameworks contribute to transition discontinuity, incorporating Accreditation Council for Graduate Medical Education (ACGME) postgraduate year 1 (PGY-1) milestone data into UME program evaluation may improve continuity. This analysis examined whether UME clinical competency committee (CCC) ratings are associated with PGY-1 milestone performance across specialties within a single institution that uses CCC procedures to support decision-making toward continuous assessment system improvement. METHOD: This retrospective quality improvement initiative collected and analyzed data from Northwestern University Feinberg School of Medicine students in the 2022 and 2023 graduating classes in fall 2024. UME assessment domains were mapped to milestones by specialty, creating PGY-1 milestone ratings aligned with entrustable professional activities (EPAs). Ratings for 2 competencies and 6 EPAs were compared with EPA-aligned milestone ratings and mean learner ratings by ACGME competency domain using mixed-effects regression analyses. Associations were analyzed for all specialties, medical specialties only, and surgical specialties only. RESULTS: A total of 232 graduates across 18 specialties were included. Regression analyses indicated that the UME EPA 6 (oral presentation) rating was most significantly associated with mean competency ratings across multiple GME domains, including patient care (β = 0.52, P < .001), systems-based practice (β = 0.37, P < .001), and professionalism (β = 0.45, P < .001), and was significantly associated with medical specialties' mean competency ratings, including patient care (β = 0.66, P < .001), medical knowledge (β = 0.44, P = .01), and systems-based practice (β = 0.45, P = .01). No associations were found for professionalism or communication skills. CONCLUSIONS: The numerous associations between UME CCC ratings and GME end-of-PGY-1 milestone data, particularly those for medical specialties, indicate that introduction of competency-based processes within UME and harmonization of milestones within GME are lessening the continuity gap.
As Academic Medicine celebrates a century of contributions to medical education, it is worth examining the questions that drove the inaugural issues of the journal and what lessons these may provide today. Although 1926...As Academic Medicine celebrates a century of contributions to medical education, it is worth examining the questions that drove the inaugural issues of the journal and what lessons these may provide today. Although 1926 was a year adjacent to many global shocks that influenced medicine, the journal was keenly focused on the 1910 Flexner Report and the existential reforms being implemented across medical schools. The reports in these issues provide insights on a community grappling with disruption. These first authors helped reshape medical education in the United States; the effects of many of the changes they proposed or studied 100 years ago can still be seen in medical education and/or practice. Today, with the rapid acceleration of generative artificial intelligence (AI), medical education and health care delivery face disruption at a scale analogous to or even greater than that encountered in the aftermath of the adoption of the Flexner Report recommendations. In 1926 and 1927, several themes emerged including discussions on integrating new technologies, exploring of biases, and consensus building and articulating values around what is required for a student to enter medical training and what the curriculum should deliver to matriculants. Insights around these themes helped to direct the academic medicine community as new expectations for medical education and the role of physicians were emerging. Change, especially disruptive change, presents both opportunity and risk. The inaugural issues of the journal demonstrate the value of creating a community of informed stakeholders that can debate, generate data, and share experiences. The journal remains critical in 2026 for developing and supporting medical educators, students, and trainees and the patients they serve. The relevance of Academic Medicine, particularly in articulating values, exploring biases, and building consensus will likely only increase through the transformative disruptions that are inevitable over the next 100 years.
PURPOSE: There is a longstanding and well documented shortage and maldistribution of rural physicians in the United States. Students from rural backgrounds are underrepresented in U.S. medical schools and rural practice...PURPOSE: There is a longstanding and well documented shortage and maldistribution of rural physicians in the United States. Students from rural backgrounds are underrepresented in U.S. medical schools and rural practice interest declines collectively for students between matriculation and graduation. Understanding characteristics of institutions that sustain rural interest will inform strategies to support medical students' rural career goals. METHOD: The authors collected rural practice intent for a three-year cohort of all U.S. medical students using the Matriculating Student Questionnaire (MSQ: 2013-2015) and Graduation Questionnaire (GQ: 2017-2019). Authors analyzed students' change in rural intent from matriculation to graduation among all schools individually by calculating, for each 3-year cohort, proportions of students expressing rural interest on the MSQ (or GQ) divided by the total number of students completing the MSQ (or GQ) and displaying this data graphically. Authors also explored characteristics of those schools that matriculated and sustained a high proportion of students with rural interest. RESULTS: Student cohorts at almost all medical schools became less interested in rural practice during their medical education. The mean of the average percentages of students with rural practice intent for all schools declined from matriculation (9.1%, SD 7.1) to graduation (7.7%, SD 5.9; P < .001). Twenty-five schools matriculated or graduated a high proportion of students interested in rural practice. Those schools with the strongest maintenance of rural interest had large rural cohorts, admissions preference for rural students, and defined rural programs. CONCLUSIONS: The decline in rural practice interest during medical school, combined with underrepresentation of rural medical students, exacerbates the U.S. rural physician workforce shortage. Medical schools admitting students interested in rural practice should target strategies to foster this interest throughout training, including building cohorts of students of rural origin within medical school classes and providing opportunities for rural training through defined rural programs.
PURPOSE: MD/PhD or DO/PhD ("dual degree") holders represent approximately 3% of graduating medical students annually. Graduates from this pipeline have a higher likelihood of successfully obtaining research independence...PURPOSE: MD/PhD or DO/PhD ("dual degree") holders represent approximately 3% of graduating medical students annually. Graduates from this pipeline have a higher likelihood of successfully obtaining research independence than single degree peers. Despite the long-term success, there is substantial concern in the physician-scientist community that the pipeline for these trainees is at risk. While career alignment in dual degree graduates has been previously assessed, data is limited on students. This study evaluates program leadership perceptions of student resources, mental health, reasons for non-completion, and next steps. METHOD: This cross-sectional study was administered March 2024 to June 2024 via electronic survey sent to dual degree program leadership across the U.S. This survey queried quantity and reasons for degree non-completion; created a curated list of student support resources; and assessed program leadership responses to admissions of student addiction and/or suicidality. Leadership was invited to share voluntary, free-text responses for additional context. RESULTS: The response rate was 57% (61/107). There was no difference between responders and non-responders when comparing MSTP status, dual degree cohort size, and/or medical school size. Financial assistance was common amongst dual degree programs (58/61; 95%), while pregnancy (26/61; 43%) or parenting (21/61; 34%) resources were less common. Nearly 87% (53/61) of programs experienced at least 1 degree non-completion in the past 10 years, with the most common reason cited as "change in priorities" (32/42; 76%), and the second most common reason being "mental health" (13/42; 31%). CONCLUSIONS: Change in priorities was the primary driver of student attrition, followed by mental health. Factors confounded with mental health included negative research experiences and struggles with academic performance. Dual degree program leadership stated firm commitment to improving mental health and wellness as requested by students, and suggested a focus on screening for appropriate student expectations for a research focused career.
The field of academic medicine, through its tripartite mission, has for decades driven scientific achievement, translated biomedical research into improved clinical outcomes, and educated the next generation of researche...The field of academic medicine, through its tripartite mission, has for decades driven scientific achievement, translated biomedical research into improved clinical outcomes, and educated the next generation of researchers and medical practitioners. Throughout its history, it has remained resilient in the face of changing political and funding environments and evolving attitudes toward science and medicine. However, rarely has academic medicine confronted changes as abrupt and destabilizing as those unfolding today. To successfully navigate this moment and preserve its essential mission of advancing research, patient care, and medical training, we propose a roadmap for leadership at academic medical centers. First, stand firm in the face of political and policy pressures, defend core principles, and remain committed to the mission. Second, build strong financial stewardship through increased operational efficiency, prioritize mission-critical programs, core academic functions and consolidate non-aligned activities. Third, remodel research and education and innovate with artificial intelligence. Fourth, strengthen commitment to the workforce, and prioritize support for vulnerable early-career trainees and faculty. Finally, align research and clinical priorities with public priorities to strengthen the social compact between medicine and the communities it serves and increase public trust.
Social determinants of health (SDH) are nonmedical factors that influence health outcomes. This AM Last Page provides a framework utilizing Miller's pyramid that curriculum designers can use to create assessments of lear...Social determinants of health (SDH) are nonmedical factors that influence health outcomes. This AM Last Page provides a framework utilizing Miller's pyramid that curriculum designers can use to create assessments of learners' abilities to recognize and mitigate SDHs in patients.
Physicians who care for seriously ill family members inhabit a complex dual role that challenges conventional ideas of professional identity, boundaries, and resilience. Despite its growing relevance, this experience rem...Physicians who care for seriously ill family members inhabit a complex dual role that challenges conventional ideas of professional identity, boundaries, and resilience. Despite its growing relevance, this experience remains underrecognized in academic medicine. This article synthesizes emerging literature to examine physician-family caregiving as a distinct and consequential phenomenon with implications for physician well-being, workforce sustainability, and ethical practice. The article explores six key domains: personal and professional burden; ethical and boundary challenges; variability by age, relationship, diagnosis, and sociocultural factors; systemic and institutional barriers; the paradoxical potential for benefit; and enduring effects and research gaps, which collectively frame comprehensive recommendations for addressing this important issue. Physician-caregivers often face intensified mental, physical, and occupational strain. These burdens, frequently invisible to institutions, contribute to burnout, diminished productivity, and role conflict, especially among women and underrepresented groups. Ethical dilemmas emerge when professional standards conflict with familial responsibilities, and navigating these challenges can alter communication and clinical decision-making. However, most health systems lack formal mechanisms to identify or support physician-caregivers. Evidence-based interventions such as mindfulness therapies, caregiver assessments, and flexible work policies are seldom implemented. The article offers a multi-level response to support physician caregivers including psychosocial support, institutional reform, educational innovation, and equity-focused policies. Reframing caregiving as a shared professional concern, rather than a private burden, can improve physician health, patient care, and workforce stability. In an era of growing caregiving demands and physician shortages, supporting physician-caregivers is both a moral obligation and a strategic imperative.
PURPOSE: Workplace-based assessments (WBAs) of surgical trainees historically demonstrate poor alignment between faculty and learner perception of clinical encounters. Given trainee perception of receiving low autonomy i...PURPOSE: Workplace-based assessments (WBAs) of surgical trainees historically demonstrate poor alignment between faculty and learner perception of clinical encounters. Given trainee perception of receiving low autonomy is associated with higher rates of burnout, depression, and attrition, it is important to better align faculty and trainee perceptions of clinical experiences. This study aims to evaluate validity evidence data, including response process, internal structure, and consequences, of vascular surgery Entrustable Professional Activities assessments (EPAs) using national pilot implementation data. METHOD: A multi-institutional pilot implementation of vascular surgery EPAs was open to residencies and fellowships from April-June of 2024. Participating programs collected assessments of entrustment for clinical encounters. Faculty and trainee assessments were paired and descriptive statistics were conducted. A linear mixed-effects model was conducted to examine factors associated with alignment. Intraclass correlation (ICC) was calculated between trainee and faculty assessments. A random effects model was applied to demonstrate sources of variance in entrustment ratings. Linear mixed effects models were applied to examine encounter and demographic differences in faculty assessed and trainee self-assessed entrustment scores. RESULTS: Twenty-nine programs contributed 1,620 paired assessments (n = 79 trainees, n = 87 faculty). There were no differences in absolute alignment by demographics or phase of care. ICC for all EPAs combined was 0.76). Variance in entrustment ratings was attributed primarily to the interaction between EPA and trainee (31%), suggesting EPA assessments were able to discriminate proficiency within trainees across EPAs. Entrustment ratings were not different when considering demographic variables. CONCLUSIONS: In this retrospective analysis of national EPA pilot implementation data of residents, fellows, and faculty, strong response process and internal structure validity evidence was established. Shortcomings of other WBAs used in surgical training, such as poor alignment between faculty and trainee perceptions of an encounter, were not evident with the use of behaviorally-anchored EPA assessments.