Transforming remediation for competency-based medical education.

We care about the future experiences of all health professions trainees as competency-based medical education evolves. It is an exciting new era with many possibilities for progress in learning and competency development. Yet we are concerned that remediation remains a troubled and stigmatized detour from routine learning that can persist as a feared off-ramp from competency development rather than a central avenue for improvement and competency achievement.

Viewing Readiness-for-Residency through Binoculars: Mapping Competency-Based Assessments to the AAMC's 13 Core Entrustable Professional Activities (EPAs).

: The construct being assessed is readiness-for-residency of graduating medical students, as measured through two assessment frameworks. : Readiness-for-residency of near-graduate medical students should be but is not consistently assessed. To address this, the Association of American Medical Colleges (AAMC), in 2014, identified and described 13 core Entrustable Professional Activities (EPAs), which are tasks that all residents should be able to perform unsupervised upon entering residency.

REACH: A Required Curriculum to Foster the Well-Being of Medical Students.

Problem: The extent of medical student unwellness is well documented. Learner distress may impact patient care, workforce adequacy, and learners' performance and personal health. The authors describe the philosophy, structure, and content of the novel REACH (Recognize, Empathize, Allow, Care, Hold each other up) curriculum and provide a preliminary evaluation.

From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities.

Research is needed to improve understanding of work-life integration issues in academic medicine and to guide the implementation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS), a national initiative offering financial support to physician-scientists facing caregiving challenges. In 2018, as part of a prospective program evaluation, the authors conducted a qualitative study to examine FRCS program participants' initial impressions, solicit descriptions of their career and caregiving experiences, and inquire how such factors might influence their professional advancement. The authors invited all 33 awardees who had been granted FRCS funding in the first year of the program to participate in the study, of whom 28 agreed to complete an interview.

Defining and Adopting Clinical Performance Measures in Graduate Medical Education: Where Are We Now and Where Are We Going?

Assessment and evaluation of trainees' clinical performance measures is needed to ensure safe, high-quality patient care. These measures also aid in the development of reflective, high-performing clinicians and hold graduate medical education (GME) accountable to the public. Although clinical performance measures hold great potential, challenges of defining, extracting, and measuring clinical performance in this way hinder their use for educational and quality improvement purposes.

Situating Remediation: Accommodating Success and Failure in Medical Education Systems.

There has been a widespread shift to competency-based medical education (CBME) in the United States and Canada. Much of the CBME discourse has focused on the successful learner, with relatively little attention paid to what happens in CBME systems when learners stumble or fail. Emerging issues, such as the well-documented problem of "failure to fail" and concerns about litigious learners, have highlighted a need for well-defined and integrated frameworks to support and guide strategic approaches to the remediation of struggling medical learners.

Professionalism Training For Surgical Residents: Documenting the Advantages of a Professionalism Curriculum.

Objectives: Professionalism education is a vital component of surgical training. This research attempts to determine whether an annual, year-long professionalism curriculum in a large surgical residency can effectively change professionalism attitudes.

Summary Of Background Data: The ACGME mandated 6 competencies in 2003.

Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: a qualitative study.

Background: Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit.

Twelve tips for improving the effectiveness of web-based multimedia instruction for clinical learners.

Using educational technology does not necessarily make medical education more effective. There are many different kinds of technology available to the contemporary medical teacher and what constitutes effective use may depend on the technology, the learning situation and many other factors. Web-based multimedia instruction (WBMI) provides learners with self-directed independent learning opportunities based on didactic material enhanced with multimedia features such as video and animations.

Context matters: emergent variability in an effectiveness trial of online teaching modules.

Context: Conducting research in real life settings (effectiveness studies) can introduce many confounding factors. Efficacy studies seek to control for researcher bias and data quality rather than considering how the efficacy of an intervention is changed by the contexts in which it is used. Relatively little is known about the impact of context on educational interventions, in particular on multimedia learning.

The cognitive impact of interactive design features for learning complex materials in medical education.

To identify the most effective way for medical students to interact with a browser-based learning module on the symptoms and neurological underpinnings of stroke syndromes, this study manipulated the way in which subjects interacted with a graphical model of the brain and examined the impact of functional changes on learning outcomes. It was hypothesized that behavioral interactions that were behaviorally more engaging and which required deeper consideration of the model would result in heightened cognitive interaction and better learning than those whose manipulation required less deliberate behavioral and cognitive processing. One hundred forty four students were randomly assigned to four conditions whose model controls incorporated features that required different levels of behavioral and cognitive interaction: Movie (low behavioral/low cognitive, = 40), Slider (high behavioral/low cognitive, = 36), Click (low behavioral/high cognitive, = 30), and Drag (high behavioral/high cognitive, = 38).

When surgeons decide to become surgeons: new opportunities for surgical education.

Background: When surgeons decide to become surgeons has important implications. If the decision is made prior to or early in medical school, surgical education can be more focused on surgical diseases and resident skills.

Methods: To determine when surgeons - compared with their nonsurgical colleagues - decide on their medical path, residents in surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and emergency medicine were surveyed.

The impact of primary care resident physician training on patient weight loss at 12 months.

Objective: It is unclear whether training physicians to counsel obese patients leads to weight loss. This study assessed whether a 5-h multimodal longitudinal obesity curriculum for residents on the basis of the 5As (assess, advise, agree, assist, and arrange) was associated with weight loss in their obese patients.

Design And Methods: Twenty-three primary care internal medicine residents were assigned by rotation schedule to intervention (curriculum) or control groups.

Medical students as human subjects in educational research.

Introduction: Special concerns often arise when medical students are themselves the subjects of education research. A recently completed large, multi-center randomized controlled trial of computer-assisted learning modules for surgical clerks provided the opportunity to explore the perceived level of risk of studies where medical students serve as human subjects by reporting on: 1) the response of Institutional Review Boards (IRBs) at seven institutions to the same study protocol; and 2) the thoughts and feelings of students across study sites about being research subjects.

Methods: From July 2009 to August 2010, all third-year medical students at seven collaborating institutions were eligible to participate.

Engaging health professional students in substance abuse research: development and early evaluation of the SARET program.

Objective: There is a need to build the ranks of health care professionals engaged in substance abuse (SA)-focused clinical research. The authors simultaneously developed and evaluated SARET, the Substance Abuse Research Education and Training program. The fundamental goal of this interprofessional program is to stimulate medical, dental, and nursing student interest and experience in SA research.

Assessment of medical student clinical reasoning by "lay" vs physician raters: inter-rater reliability using a scoring guide in a multidisciplinary objective structured clinical examination.

Background: To determine whether a "lay" rater could assess clinical reasoning, interrater reliability was measured between physician and lay raters of patient notes written by medical students as part of an 8-station objective structured clinical examination.

Methods: Seventy-five notes were rated on core elements of clinical reasoning by physician and lay raters independently, using a scoring guide developed by physician consensus. Twenty-five notes were rerated by a 2nd physician rater as an expert control.