PURPOSE: Longitudinal integrated clerkships (LICs) are associated with positive educational and workforce outcomes in the short term, but their influence on long-term career choice remains uncertain. The authors report r...PURPOSE: Longitudinal integrated clerkships (LICs) are associated with positive educational and workforce outcomes in the short term, but their influence on long-term career choice remains uncertain. The authors report results from an LIC-based curricular track at Columbia University designed to recruit medical students into socially oriented careers, including practice in medically underserved settings. METHOD: The authors reviewed educational and workforce outcomes among all physician graduates from Columbia between 2014-2023, comparing participants in the Columbia-Bassett (CB) rural LIC track (N = 96) with those completing the traditional curriculum (N = 1449). The authors assessed outcomes using data from institutional records, government databases, published analyses of the American Medical Association Physician Masterfile, and a cross-sectional survey of alumni completed in 2024. RESULTS: CB participants were similar to peers in age, gender, and socioeconomic status but more likely to report rural background. They scored similarly to peers on U.S. Medical Licensing Exam Step 1 but higher on Step 2 CK and measures of patient-centeredness after LIC completion. Upon graduation, participants were more likely to enter rural or primary care-compatible residencies. At 8-10 years post-graduation, participants were more likely to practice in rural areas (20.8% vs 1.2%, P < .001) and health professional shortage areas (54.2% vs 17.1%, P < .001); a non-significantly higher proportion were also practicing primary care (29.2% vs 14.8%, P = .054). Participation was strongly associated with self-reported rural practice among alumni (adjusted odds ratio 23.4, P = .011) and robust to adjustment for factors including rural upbringing and pre-medical practice interests. CONCLUSIONS: These findings add evidence that LIC-based curricular interventions may produce desirable medical school outcomes in both the short and long term, especially to address workforce disparities in rural and other underserved areas.
PURPOSE: Large language models (LLMs), such as OpenAI's ChatGPT, have demonstrated tutoring benefits in small-scale pilot studies within focused areas of medical education. This study evaluated the large-scale implementa...PURPOSE: Large language models (LLMs), such as OpenAI's ChatGPT, have demonstrated tutoring benefits in small-scale pilot studies within focused areas of medical education. This study evaluated the large-scale implementation of AI-teaching assistants (AI-TAs) within a compulsory medical school course. METHOD: A quasi-experimental observational study with a mixed-methods was conducted to assess the impact of AI-TAs in a compulsory first-year medical school course at the University of Toronto in 2024. The research team developed AI-TAs using OpenAI's ChatGPT-4o and introduced them as a supplementary resource at the course's midpoint. They analyzed exam performance among the students who used AI-TAs (n = 87) and students who did not (n = 206). Additionally, surveys (n = 18) and interviews (n = 10) explored student perceptions of AI-TAs' effectiveness, usability, and impact on learning. RESULTS: Students who would later adopt AI-TAs had significantly lower pre-intervention exam scores than their peers (83.8% vs 88.1%; t(118.8)=-3.82, P<.001). They also more often failed to meet the course's assessment standard pre-intervention (24.1% vs 6.4%). After AI-TA adoption, performance converged for both early users (86.1% vs 86.5%; t(95.63)=-0.35, P=.72) and late adopters (85.6% vs 86.5%; t(26.08)=-0.52, P=.61), with similar proportions falling below the course's standard (4.4-6.4%). Thematic analysis and surveys identified three key advantages of AI-TAs: (1) Reliable and accurate educational support, (2) Efficient application across learning activities, and (3) Improved psychological safety, promoting engagement in active learning. CONCLUSIONS: AI-TAs correlated with improved exam performance, fewer students in academic difficulty, and enhanced student engagement through a psychologically safe learning environment. These findings suggest that AI-TAs can serve as a scalable, cost-effective tool to support struggling students, while complementing traditional instruction.
PROBLEM: Inequities in educational infrastructure, faculty availability, and access to continuing professional development contribute to variability in physician preparedness across Thailand, particularly between urban a...PROBLEM: Inequities in educational infrastructure, faculty availability, and access to continuing professional development contribute to variability in physician preparedness across Thailand, particularly between urban and rural settings. Newly graduated physicians are frequently deployed to resource-limited areas with inconsistent access to structured continuing education and specialist supervision. Existing global digital learning platforms are often English-dominant and not aligned with local epidemiology, competency frameworks, or regulatory requirements. These gaps promote reliance on fragmented learning resources and affect workforce readiness. To address these challenges, MDCU MedUMORE was developed as a national digital medical education platform to support equitable access to standardized, contextually relevant learning resources. APPROACH: MDCU MedUMORE was launched in June 2022. The platform integrates multimodal educational resources, including video lectures, interactive modules, infographics, eBooks, simulation-based learning, and live educational events aligned with national competency frameworks and continuing medical education requirements. Instructional design is informed by constructivist, experiential, cognitive load, and social learning principles and operationalized through modular learning pathways, case-based content, and embedded assessment. Content is produced through standardized multidisciplinary workflows with iterative refinement guided by user analytics and feedback. Platform navigation is supported by artificial intelligence-assisted search and content recommendation. OUTCOMES: By the end of 2025, the platform reached nearly 25,000 registered users with approximately 5 million video views across all Thai provinces and neighboring countries. Early data demonstrate high learner satisfaction, post-test knowledge gains in selected modules, and improvements in learner confidence and procedural performance in simulation settings. Broad geographic uptake and increasing interprofessional participation suggest progress toward improving equitable access to continuing medical education. NEXT STEPS: Future priorities include expansion of artificial intelligence-enabled personalization, multilingual regional collaboration, interprofessional education integration, and public health literacy initiatives. Long-term evaluation will focus on knowledge retention, practice behavior change, and patient-level outcomes to determine sustained workforce and health system impact.
PROBLEM: Ethnic and racial diversity is increasing among medical students, with groups that were historically underrepresented in medicine (URiM) now estimated to constitute 21.5% of medical students. However, there is a...PROBLEM: Ethnic and racial diversity is increasing among medical students, with groups that were historically underrepresented in medicine (URiM) now estimated to constitute 21.5% of medical students. However, there is a drop-off in the percentage of URiM students pursuing residencies in surgical specialties. In 2019, only 5.8% of ophthalmology residents surveyed identified themselves as URiM. This has public health implications in that visual impairment and blindness disproportionately affect racial and ethnic minoritized populations in the United States, and URiM physicians practicing in these communities enhance patients' trust in their care, resulting in better utilization of health services, medical adherence, and health outcomes. APPROACH: The Minority Ophthalmology Mentoring Program was created in 2018 by the American Academy of Ophthalmology and Association of University Professors of Ophthalmology to help overcome barriers to ophthalmology careers among URiM students and to strengthen their competitiveness for acceptance into residency positions. Key components include individualized mentorship by practicing ophthalmologists, dedicated educational materials for test preparation, a "match prep boot camp," networking opportunities, and support for research projects and away rotations. OUTCOMES: As of February 2025, 97 participants have matched into 54 ophthalmology residency programs. In 2022 and 2023, match rates for the program participants exceeded the SF Match national average for U.S. students. Participant surveys revealed a high degree of satisfaction with program activities and materials. NEXT STEPS: The program continues to evolve based on ongoing feedback from mentors and mentees and match outcomes data. It was renamed the VISION Mentoring Program 2025 reflecting an expanded reach and commitment to all medical students dedicated to advancing equity and improving access to high-quality eye care in underserved communities. Plans are underway to deepen collaboration with academic and community-based partners and for tracking long-term outcomes beyond residency.
The global health workforce faces a projected shortage of more than 11 million health workers by 2030, with the most severe shortfalls in low- and middle-income countries (LMICs). Traditional training models are resource...The global health workforce faces a projected shortage of more than 11 million health workers by 2030, with the most severe shortfalls in low- and middle-income countries (LMICs). Traditional training models are resource-intensive, rigid, and slow to evolve. These models cannot meet the scale or diversity of workforce needs, nor adapt quickly enough to shifting epidemiology, system demands, or local contexts. Building on previous proposals for shared digital curricula and competency-based ecosystems, this Commentary outlines how the convergence of rapidly growing Open Educational Resources (OER), interoperable digital learning platforms, advances in generative artificial intelligence (AI), and a global governance model creates new opportunities to develop a global, modular, openly licensed curricular ecosystem aligned with regional, national, and global competency frameworks. The authors propose a global initiative to co-create, validate, and disseminate multilingual, adaptable, and competency-aligned training assets across diverse cadres of health workers. Through partnerships among Ministries of Health, academic institutions, professional organizations, and the World Health Organization (WHO), this initiative would strengthen local capacity building, ensure quality and equity, and promote the responsible use of AI in health professions education.
PURPOSE: Marital status has been associated with the well-being and career decisions of physicians; however, its role during residency remains underexplored, particularly in Japan. This study aimed to examine the associa...PURPOSE: Marital status has been associated with the well-being and career decisions of physicians; however, its role during residency remains underexplored, particularly in Japan. This study aimed to examine the association among marital status, psychological well-being, and intended specialty choice among postgraduate medical residents in Japan, with a focus on sex differences. METHOD: The authors conducted a nationwide cross-sectional survey in January 2023 of postgraduate second-year residents in Japan immediately after the 2022 General Medicine In-training Examination (GM-ITE). Participants completed the survey and provided complete data on their marital status and outcome measures. The primary outcomes included depressive symptoms (assessed using the Patient Health Questionnaire-2), burnout symptoms, job satisfaction, and work-related stress (assessed using the Mini-Z 2.0) as well as gender role attitudes and intended specialty. The authors estimated adjusted prevalence ratios (PRs) using modified Poisson regression with generalized estimating equations. RESULTS: Among 2,721 residents included in the analysis (mean age, 27.7 years; 879 [32.3%] female), 551 (20.2%) were married, of whom 282 (51.2%) had physician spouses. Depressive symptoms were most common among unmarried residents (613/2,170 [28.2%]) and least common among those married to physicians (50/282 [17.7%]; P < .001). In adjusted analyses, being married to a physician was associated with a reduced depressive symptoms prevalence (PR, 0.62; 95% confidence interval [CI], 0.48-0.81) and increased job satisfaction (PR, 1.09; 95% CI, 1.02-1.18). Marital status showed no statistically significant association with burnout symptoms or work-related stress, and no statistically significant specialty preferences differences were observed according to marital status. Female residents, particularly those married to physicians, were more likely to disagree with traditional gender roles than their male counterparts. CONCLUSIONS: Among Japanese medical residents, marriage-particularly to another physician-was associated with fewer depressive symptoms and greater job satisfaction, whereas marital status was not associated with intended specialty choice.
PURPOSE: Narrative feedback commonly involves unidirectional delivery of information from faculty to student. Given the combined formative and summative role of narrative feedback in medical student education, efforts to...PURPOSE: Narrative feedback commonly involves unidirectional delivery of information from faculty to student. Given the combined formative and summative role of narrative feedback in medical student education, efforts to engage students in the creation of narrative feedback are warranted. Such efforts would benefit from understanding how students are impacted by being involved in co-creating narrative feedback. METHOD: As part of an effort to develop a system to empower students to contribute to narrative feedback, this study explored medical students' experience with co-creating narrative feedback with faculty. This system was implemented during an advanced clinical elective in pediatric emergency medicine from July 2023 to December 2024. Initial thematic analysis of semi-structured interviews with all 12 medical students participating in this novel narrative feedback system prompted analysis of the resulting 172 instances of narrative feedback to further inform thematic development. RESULTS: Students described the process of co-creating narrative feedback as impacting both their social and personal feedback experiences, captured by three themes. First, the process engendered higher quality oral as well as narrative feedback. Second, the process helped students solicit feedback while fostering their rapport with faculty, leading to safer feedback relationships. Finally, the process resulted in increased self-direction as students increasingly set goals, planned and assessed their progress in meeting those goals, and engaged in reflection. CONCLUSIONS: Engaging students in co-creating narrative feedback may be a means of improving the impact of feedback both on students' clinical performance and on how they regulate their learning.
From 2014 to 2025, accelerated 3-year MD programs (A3YP) have expanded significantly, such that 20% of allopathic medical schools offer a program to earn the MD degree in three years. While maintaining rigorous and compa...From 2014 to 2025, accelerated 3-year MD programs (A3YP) have expanded significantly, such that 20% of allopathic medical schools offer a program to earn the MD degree in three years. While maintaining rigorous and comparable educational standards as traditional 4-year programs, A3YPs aim to address physician workforce shortages, reduce student debt, and provide individualized education pathways into specific specialties. Among the thirty-two A3YPs in existence, twenty-two medical schools have graduated 1141 students to date, with numbers increasing annually. Nineteen programs are linked to a residency program, though six of these programs consistently match students outside their linked program. As more medical schools implement A3YPs and an increasing number of graduates enter the National Residency Matching Program (NRMP), residency program directors will encounter A3YP applicants more frequently. The proliferation of A3YPs presents both challenges and opportunities for residency program directors in evaluating applicants. Despite the differences in their applications, including limited extracurricular activities and time for visiting rotations, these applicants have been found to perform similarly in standardized testing and residency milestones, and have similar well-being and satisfaction as traditional students. This perspective outlines key considerations for PDs and provides a foundation for contextually evaluating the increasing numbers of these applicants graduating from A3YPs.
PURPOSE: Preceptorship is a key component of medical student clinical experience. Demand for clinical preceptors is increasing. An updated understanding of why preceptors continue or discontinue these roles, particularly...PURPOSE: Preceptorship is a key component of medical student clinical experience. Demand for clinical preceptors is increasing. An updated understanding of why preceptors continue or discontinue these roles, particularly in pre-clerkship settings, is needed to optimize recruitment and retention. To inform recruitment and retention of pre-clerkship preceptors at a large public medical school, the authors examined preceptor motivations for precepting, reasons for leaving, and factors influencing a successful preceptorship. METHOD: The authors conducted an explanatory sequential mixed-methods study (survey followed by semi-structured interviews) between September 2024 and December 2024. Participants were current and former pre-clerkship preceptors from 57 clinical sites across 22 organizations in academic and community clinical settings. Rapid qualitative methods using templated summaries and matrix analysis were applied to identify major themes. RESULTS: A total of 202 current and former pre-clerkship medical student preceptors participated in surveys characterizing their experiences: 158 current preceptors (including 36 planning to stop) and 44 former preceptors with a 70% response rate. Most preceptors cited a love of teaching as their primary motivation. Thematic analysis identified three themes: (1) Preceptors chose to precept because they love teaching-when they leave it is often related to life and work-related factors; (2) Heavy clinical workload was a barrier to a good preceptorship experience; (3) The importance of guidance flexibility, and supportive structures for preceptors. CONCLUSIONS: Pre-clerkship preceptors are primarily motivated by a passion for teaching, but personal and professional pressures contribute to attrition. Addressing clinical workload and providing flexible, supportive program structures may improve preceptor retention.
This commentary reflects on the role that Academic Medicine, as a journal, has played in being a catalytic force in the transformation of the professional role of clinician-educators. The clinician-educator has emerged f...This commentary reflects on the role that Academic Medicine, as a journal, has played in being a catalytic force in the transformation of the professional role of clinician-educators. The clinician-educator has emerged from a marginal position within academic medicine to a recognized and essential core faculty role. Academic Medicine has published work that articulated the structural barriers to integrating clinician-educators into academic medical centers. The journal has also served as a platform for naming, examining, and addressing the challenges faced by this group. Early scholarship in this area discussed tensions related to recognition, promotion, career development, and professional identity formation. This work has helped to reframe these issues as organizational and systemic rather than individual faculty shortcomings. As the literature evolved, Academic Medicine emphasized solutions, including playing a role in reimagining promotion systems, using its platform to articulate broader definitions of scholarship. Previous work has highlighted disparities in advancement and recognition and created space to discuss communities of practice, collaboration, and the collective work of educating clinicians. The growth of the clinician-educator path is also reflected in the creation of faculty development programs, dedicated training tracks, and educational academies, all while other specialty and medical education journals have also expanded conversations about promotion, career advancement, and educational scholarship across disciplines. This journal has been a venue to clearly highlight clinician-educators as central to the academic mission. The trajectory from marginalization to leadership for the clinician-educator reflects a sustained contribution that continues to evolve in response to emerging challenges, such as competency-based education and technological change. Academic Medicine has functioned as both a mirror and an engine of progress, helping clinician-educators move from the margins of academic medicine to a position of influence and importance.
Public Law 119-21, commonly referred to as the One Big Beautiful Bill Act (OBBBA), enacted on July 4, 2025, represents the most sweeping federal higher education reform in more than a decade. This legislation restructure...Public Law 119-21, commonly referred to as the One Big Beautiful Bill Act (OBBBA), enacted on July 4, 2025, represents the most sweeping federal higher education reform in more than a decade. This legislation restructures federal student loan programs, eliminates subsidized and Grad PLUS loans, consolidates repayment options, and introduces new institutional accountability metrics tied to graduate earnings. Although these provisions are intended to curb federal spending and improve return on investment for students, they carry significant implications for graduate and professional education-particularly in medicine, pharmacy, dentistry, and other health professions where the cost of attendance routinely exceeds $200,000. This article offers an analysis of the major provisions of OBBBA and their expected effects on institutional finances, student access, and educational design. The article highlights the emerging gap between federal loan limits and the full cost of attendance, raising concerns about opportunity for students interested in health professions education and impact of OBBBA on the workforce pipeline. In response, the authors outline several strategic actions for institutional leaders, including the development of internal loan replacement programs, implementation of accelerated and competency-based degree pathways, and the use of cost-of-quality frameworks to assess and improve curricular efficiency. The new policy environment demands a recalibration of how institutions structure, price, and deliver health professional education. Collectively, these considerations underscore the need for coordinated, context-sensitive responses to preserve access and educational quality under a constrained financing environment.