PROBLEM: Documentation of a clinical encounter is a foundational skill required of all physicians; however, there is little standardization in documentation skills teaching. In this Innovation Report, the authors describ...PROBLEM: Documentation of a clinical encounter is a foundational skill required of all physicians; however, there is little standardization in documentation skills teaching. In this Innovation Report, the authors describe a novel patient-centered documentation curriculum and assess the efficacy of the curriculum after implementation. APPROACH: Design of the new patient-centered documentation curriculum included creation of a novel rubric to assess patient-centered language (PCL) in student notes built from the IDEA Assessment Tool as well as the development of new faculty and student workshops. The curriculum was introduced at Harvard Medical School between September 2022 and July 2023. OUTCOMES: History of present illness (HPI), physical examination (PE), and PCL were analyzed at early (September-October), mid (February-March), and late (May-June) time points. At the early time point, the mean (SD) student composite score in the PCL domain was 2.53 (0.04), suggesting students were using PCL in their notes some or all of the time. This score was higher than the scores for the HPI and PE domains (2.16 [0.56] and 2.20 [0.52], respectively). Comparing the early and late time points, students had statistically significant improvements in the PCL domain, with a mean (SD) composite value of 2.87 (0.03) at the late time point (P < .001). Statistically significant mean (SD) improvements from the early to late time points were also observed in the HPI (2.16 [0.56] to 2.76 [0.03], P < .001) and PE (2.20 [0.52] to 2.65 [0.51], P = .02) domains. Students demonstrated improvements in the PCL domain when comparing the early and mid (2.53 to 2.76; P < .001) and mid and late (2.76 to 2.87, P = .047) time points. NEXT STEPS: Next steps include modifying the curriculum to the needs of other medical schools and assessing whether the curriculum has a positive impact when adopted more broadly.
PURPOSE: Medical knowledge is a critical competency for physicians. Assessment of medical knowledge is distinguished between acquisition and application. Studies have demonstrated the association in acquisition throughou...PURPOSE: Medical knowledge is a critical competency for physicians. Assessment of medical knowledge is distinguished between acquisition and application. Studies have demonstrated the association in acquisition throughout training; however, few have assessed the association between acquisition and application to practice. The purpose of this study was to explore the relationship between medical knowledge acquisition and application across a nationally representative data set. METHOD: This was a multi-institutional, multi-specialty retrospective study of data from medical school graduates at seven institutions entering residency training from 2016 to 2018. Medical knowledge acquisition was assessed using scores on United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge. Medical knowledge application was assessed using Accreditation Council for Graduate Medical Education (ACGME) milestone ratings during internship. Mixed-effects regression was used to estimate the predictive association between USMLE performance and ACGME milestones, clustering specialty, and program effects using coefficients reflecting beta estimates. RESULTS: Data were analyzed from 3,430 medical school graduates. Failing USMLE Step 1 was associated with a higher risk of being rated as "not yet level 1" in patient care milestones at mid-year (OR = 4.19, P = .007) while failure of USMLE Step 2 was associated with the same in medical knowledge (OR = 7.56, P = .15). Higher USMLE scores were associated with higher milestone ratings, though the effect size was very small (standard coefficient range .01 - .19). There were no significant associations between USMLE scores and end-of-year milestone ratings for any analyses. CONCLUSIONS: Previous data suggest USMLE scores provide value in identifying future standardized examination (ie, medical knowledge acquisition) performance. These findings demonstrate less compelling evidence using USMLE to predict application of knowledge into practice. USMLE pass/fail status is the most predictive metric of medical knowledge application and may be useful in creating targeted remediation plans.
Non-US citizen international medical graduates (IMGs) enrich the graduate medical education environment in the United States and often fill trainee positions in services and geographic areas of great need. This Last Page...Non-US citizen international medical graduates (IMGs) enrich the graduate medical education environment in the United States and often fill trainee positions in services and geographic areas of great need. This Last Page provides a simple flowchart outlining the J-1 visa application process, aiming to ease navigation for both residency programs and IMG applicants.
Learning analytics involve collecting, analyzing, and visualizing the digital 'footprints' that learners leave behind as they interact with digital learning environments. Learning analytics inform ongoing refinements to...Learning analytics involve collecting, analyzing, and visualizing the digital 'footprints' that learners leave behind as they interact with digital learning environments. Learning analytics inform ongoing refinements to improve educational design and teaching practice. To date, research suggests that educators have not fully capitalized on learning analytics, despite the growing availability of data generated through digital learning platforms, programmatic assessment, and competency-based training. In this article, the authors adapted an established "learning analytics lifecycle" framework to evaluate a representative example of digital learning in HPE: eduCAST, an online, video-based website for orthopaedic surgery training. The framework provided a stepwise approach for exploring the potential of learning analytics in eduCAST, identifying implementation gaps, and developing a transferable list of recommendations for educators in HPE. Demographic and engagement data of 141 registered eduCAST users were analyzed after being collected via website analytics. The findings revealed limitations and opportunities related to: (1) planning for the learning environment and its users, (2) the scope and specificity of available learning analytics data, (3) the purposeful use of data analysis techniques, and (4) the relative absence of educators' data-informed actions. Generic website analytics showed significant limitations: high website traffic did not correspond to meaningful learner engagement, nor did it provide useful data to inform ongoing website refinement. Indeed, these analytics produced more data mysteries than meaningful data stories. Consistent with prior reviews in the HPE literature, this worked example demonstrated that educators appear to make diminishing investments of effort and resources across the learning analytics lifecycle. The authors argue that HPE educators can benefit from using learning analytics frameworks to guide the design, implementation, evaluation, and long-term sustainability of digital learning environments. When thoughtfully collected, analyzed, and interpreted, learning analytics can enhance learners' experiences and outcomes, support educators' professional development, and inform continuous program refinement.
Academic medicine faces increasingly complex challenges-and the design thinking (DT) method offers a framework that not only uncovers root causes and generates innovative solutions but also strengthens faculty leadership...Academic medicine faces increasingly complex challenges-and the design thinking (DT) method offers a framework that not only uncovers root causes and generates innovative solutions but also strengthens faculty leadership skills along the way. This Last Page illustrates how each stage of the DT process develops skills such as collaboration, critical thinking, and adaptability while driving meaningful institutional change.
From idea generation to publication, artificial intelligence (AI)-enhanced tools are transforming how scholars write, revise, and publish. This Last Page serves as a guide map to the academic writing process and identifi...From idea generation to publication, artificial intelligence (AI)-enhanced tools are transforming how scholars write, revise, and publish. This Last Page serves as a guide map to the academic writing process and identifies AI-enhanced scholarly tools designed to support each stage of the process.
In response to student and institutional feedback, the authors created an educational infographic and resource to address academic anxiety. This infographic incorporates evidence-based strategies to provide psychoeducati...In response to student and institutional feedback, the authors created an educational infographic and resource to address academic anxiety. This infographic incorporates evidence-based strategies to provide psychoeducation and practical approaches for coping with academic anxiety.
Commencement ceremonies are opportunities to survey the road covered along the lifelong journey of education, both reflecting on important intervals and imagining the future. This AM Last Page features an approach to con...Commencement ceremonies are opportunities to survey the road covered along the lifelong journey of education, both reflecting on important intervals and imagining the future. This AM Last Page features an approach to convey an effective commencement message, which includes lessons learned through a 45-year career in higher education and academic medicine and participation in over 50 commencement ceremonies.
PROBLEM: With evolving accreditation requirements, competing demands of medical students, and the national trend toward shortening the preclerkship curriculum, management of workload hours for preclerkship medical studen...PROBLEM: With evolving accreditation requirements, competing demands of medical students, and the national trend toward shortening the preclerkship curriculum, management of workload hours for preclerkship medical students is essential. Although many medical schools have established policies outlining student workload expectations in the preclerkship curriculum, the mechanisms to ensure adherence to these policies are often less well defined. APPROACH: In 2019, the University of Cincinnati College of Medicine (UCCOM) established a scheduling workgroup, the Student Workload Advisory Group (SWAG), which evolved into a collaborative effort to monitor and manage workload. SWAG created a workload calculator that could be applied to all preclerkship courses to monitor workload hours among medical students during academic years 2021 to 2022 through 2024 to 2025. OUTCOMES: Within the first year of formal monitoring, there were 27 instances in which student workload exceeded that defined in the workload policy. SWAG identified explicit and hidden workload exceedances. Explicit workload exceedances included requirements that can be captured on a course calendar, whereas hidden workload exceedances emerged after implementation of an assignment audit self-report tool. Multiple revisions to the workload policy were incorporated to ensure scheduled activities reflected the time needed to complete the activities, which led to a reduction in workload policy exceedances. More success was seen with a proactive approach that facilitates collaboration between SWAG and course directors to anticipate and address potential workload concerns before they occur. NEXT STEPS: The creation of a formal body consisting of faculty, staff, and students to monitor workload combined with a proactive monitoring plan to enforce workload policies represents a reproducible framework for other institutions seeking to create and/or enforce workload policies. The next step at UCCOM is to incorporate formal workload monitoring into clinical phases of the curriculum to monitor workload hours outside enforced duty hours to improve student wellness.
PROBLEM: Accelerated pathway programs graduate students in three, rather than four, years. While these programs help address physician workforce shortage and student debt, they have not implemented rigorous assessment fr...PROBLEM: Accelerated pathway programs graduate students in three, rather than four, years. While these programs help address physician workforce shortage and student debt, they have not implemented rigorous assessment frameworks aligned with Competency-Based Medical Education (CBME) training to ensure students are ready to graduate one year early. This report describes an accelerated pathway program using a CBME framework to transition students into graduate medical education programs when they are deemed competent. APPROACH: Starting in 2018, the Virginia Commonwealth University School of Medicine (VCU-SOM), developed an accelerated and competency-based graduation (CBG) program focusing on competency as the standard for graduation. Students apply to the CBG program in their second year, with selection based on academic performance, program commitment, and mutual interest with the affiliated residency. Except for reduced post-clerkship elective time, students complete the same curriculum as non-CBG peers. Progress during the clinical year is evaluated by the CBG Clinical Competency Committee (CCC) to ensure students meet required milestones for advancement and eligibility for accelerated graduation. OUTCOMES: As of 2024, 20/33 (61%) CBG students graduated in 3 years, while the remainder (13/33; 39%) transitioned back to the standard program. CCC analysis showed increasing competency ratings, with nearly 100% achieving 'competent' or 'on track' in core domains. Some assessment areas showed lower competency, identifying targets for improvement. Program directors report that all CBG graduates are progressing appropriately through residency milestones, with no significant concerns about performance or burnout. NEXT STEPS: The CBG program offers a competency-based, time-variable pathway (CBTV) from medical school to residency, utilizing a CCC and designed to support both early and traditional progression based on achievement of competency. Future steps include adapting to the removal of Step 1 scores as a selection tool, ensuring adequate Entrustable Professional Activities (EPA) data for decision-making, and expanding participation across additional specialties.
PURPOSE: Faculty supervisor modification of trainee approaches to clinical encounters represents a chance for trainees to learn what is different about their conceptualization of the case that merits change. In addition...PURPOSE: Faculty supervisor modification of trainee approaches to clinical encounters represents a chance for trainees to learn what is different about their conceptualization of the case that merits change. In addition to identifying errors or gaps in knowledge on the trainee's part, these changes can highlight meaningful variation in clinical approaches. However, little is known about if and how trainees arrive at this understanding. This study explores how trainees make sense of supervisor changes to their proposed clinical approaches. METHOD: Semistructured interviews with senior emergency medicine trainees from 3 academic institutions were performed between May 2024 and January 2025. Content was analyzed using a constructivist grounded theory approach with meaningful variation as a sensitizing framework to generate a model of how trainees understand supervisor changes to their clinical approaches. RESULTS: Sixteen trainees in their final year of emergency medicine residency participated. Trainees saw changes as learning opportunities. However, trainee descriptions often revolved around preemptively modifying their approach to match the anticipated supervisor approach, thus avoiding changes altogether because trainees experienced discussing changes with supervisors as antagonistic and burdensome. When trainees did experience a change, they distinguished changes as clinical or stylistic (practitioner or context based). Perceiving the former to signal what they should do and the latter what they could do, trainees demonstrated greater investment in understanding clinical vs stylistic changes. Trainees frequently described attributing the reason for the change to 1 of these 2 domains on their own without supervisor input and only occasionally asking their supervisor. CONCLUSIONS: Trainees perceived value in understanding changes to their approaches but frequently did not engage supervisors in their meaning-making and sometimes preemptively avoided changes altogether. Such missed opportunities for exposure to meaningful variation suggest opportunities for educators and training systems to increase the frequency and decrease the perceived hostility of these conversations.
PURPOSE: This study evaluated differences in expected and observed proportions of activities, average Step 2 scores, and abstracts, publications, and presentations since the adoption of a 10-experience maximum for reside...PURPOSE: This study evaluated differences in expected and observed proportions of activities, average Step 2 scores, and abstracts, publications, and presentations since the adoption of a 10-experience maximum for residency applications and pass/fail Step 1 grading. METHOD: The authors queried National Resident Matching Program data for MD senior applicants from 2016 to 2024 across 22 specialties. Data included average Step 2 scores; research, work, and volunteer experiences; and number of research products for matched and unmatched students by specialty. Repeated-measures multilevel models were used to estimate the difference in observed outcome in 2024 and expected outcome based on trends from 2016 to 2022. The difference in the 2024 predicted and observed values was the estimated effects of pass/fail Step 1 grading and 10-experience maximum. RESULTS: A total of 91,992 applicants were included in this analysis. In 2024, residency applicants reported higher average Step 2 scores (average observed, 249.62; average predicted, 248.48; b = 1.21; 95% CI, 0.39-2.03; P = .003) and higher average number of research outputs (average observed, 10.30; average predicted, 9.21; b = 1.10; 95% CI, 0.61-1.59; P < .001) than predicted. The proportion of reported research experiences was significantly higher than expected (observed, 0.360; model predicted, 0.254; odds ratio [OR], 1.67; 95% CI, 1.58-1.75), whereas reported work (observed, 0.445; model predicted, 0.506; OR, 0.85; 95% CI, 0.80-0.89) and volunteer (observed, 0.194; model predicted, 0.221; OR, 0.73; 95% CI, 0.69-0.76) experiences were significantly lower than expected (P < .001 for all). CONCLUSIONS: These results suggest potential downstream effects of the Step 1 shift to pass/fail and the imposition of a 10-experience limit on residency applications with an increase in scholarly output but a decrease in volunteer and work experiences. These findings challenge medical education leadership to evaluate whether these potential changes align with desired applicant qualities.