U.S. physician burnout and the proletarianization of U.S. doctors: A theoretical reframing.

We delve into the escalating issue of U.S. physician burnout, arguing its roots lie in the proletarianization of the U.

The fundamentals of Artificial Intelligence in medical education research: AMEE Guide No. 156.

The use of Artificial Intelligence (AI) in medical education has the potential to facilitate complicated tasks and improve efficiency. For example, AI could help automate assessment of written responses, or provide feedback on medical image interpretations with excellent reliability. While applications of AI in learning, instruction, and assessment are growing, further exploration is still required.

An Examination of the Associations Among USMLE Step 3 Scores and the Likelihood of Disciplinary Action in Practice.

Purpose: As the last examination in the United States Medical Licensing Examination (USMLE) sequence, Step 3 provides a safeguard before physicians enter into unsupervised practice. There is, however, little validity research focusing on Step 3 scores beyond examining its associations with other educational and professional assessments thought to cover similar content. This study examines the associations between Step 3 scores and subsequent receipt of disciplinary action taken by state medical boards for problematic behavior in practice.

Medical Student Experiences With Electronic Health Records Nationally: A Longitudinal Analysis Including School-Level Effects.

Purpose: Increasingly, medical school graduates have been expected to be competent in the knowledge and skills associated with effective electronic health record (EHR) use. Yet little is known about how student experiences with EHRs have changed over time or how these trends vary by medical school. This study examined shifts in U.

Multiple United States Medical Licensing Examination Attempts and the Estimated Risk of Disciplinary Actions Among Graduates of U.S. and Canadian Medical Schools.

Purpose: The United States Medical Licensing Examination (USMLE) recently announced 2 policy changes: shifting from numeric score reporting on the Step 1 examination to pass/fail reporting and limiting examinees to 4 attempts for each Step component. In light of these policies, exam measures other than scores, such as the number of examination attempts, are of interest. Attempt limit policies are intended to ensure minimum standards of physician competency, yet little research has explored how Step attempts relate to physician practice outcomes.

Exploring the Association Between USMLE Scores and ACGME Milestone Ratings: A Validity Study Using National Data From Emergency Medicine.

Purpose: The United States Medical Licensing Examination (USMLE) sequence and the Accreditation Council for Graduate Medical Education (ACGME) milestones represent 2 major components along the continuum of assessment from undergraduate through graduate medical education. This study examines associations between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and ACGME emergency medicine (EM) milestone ratings.

Method: In February 2019, subject matter experts (SMEs) provided judgments of expected associations for each combination of Step examination and EM subcompetency.

The role of data science and machine learning in Health Professions Education: practical applications, theoretical contributions, and epistemic beliefs.

Data science is an inter-disciplinary field that uses computer-based algorithms and methods to gain insights from large and often complex datasets. Data science, which includes Artificial Intelligence techniques such as Machine Learning (ML), has been credited with the promise to transform Health Professions Education (HPE) by offering approaches to handle big (and often messy) data. To examine this promise, we conducted a critical review to explore: (1) published applications of data science and ML in HPE literature and (2) the potential role of data science and ML in shifting theoretical and epistemological perspectives in HPE research and practice.

Medical student experiences with accessing and entering patient information in electronic health records during the obstetrics-gynecology clerkship.

Background: Medical school graduates should be able to enter information from patient encounters and to write orders and prescriptions in the electronic health record. Studies have shown that, although students often can access electronic health records, some students may receive inadequate preparation for these skills. Greater understanding of student exposure to electronic health records during their obstetrics and gynecology clerkships can help to determine the extent to which students receive the educational experiences that may best prepare them for their future training and practice.

Electronic Health Record Use in Internal Medicine Clerkships and Sub-internships for Medical Students Graduating from 2012 to 2016.

Background: As electronic health records (EHRs) became broadly available in medical practice, effective use of EHRs by medical students emerged as an essential aspect of medical education. While new federal clinical documentation guidelines have the potential to encourage greater medical student EHR use and enhance student learning experiences with respect to EHRs, little is known nationally about how students have engaged with EHRs in the past.

Objective: This study examines medical student accounts of EHR use during their internal medicine (IM) clerkships and sub-internships during a 5-year time period prior to the new clinical documentation guidelines.

Medical Student Use of Electronic and Paper Health Records During Inpatient Clinical Clerkships: Results of a National Longitudinal Study.

Purpose: An important goal of medical education is to teach students to use an electronic health record (EHR) safely and effectively. The purpose of this study is to examine medical student accounts of EHR use during their core inpatient clinical clerkships using a national sample. Paper health records (PHRs) are similarly examined.

Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination.

Purpose: Physicians must pass the United States Medical Licensing Examination (USMLE) to obtain an unrestricted license to practice allopathic medicine in the United States. Little is known, however, about how well USMLE performance relates to physician behavior in practice, particularly conduct inconsistent with safe, effective patient care. The authors examined the extent to which USMLE scores relate to the odds of receiving a disciplinary action from a U.

Predicting Peer Nominations Among Medical Students: A Social Network Approach.

Purpose: Minimal attention has been paid to what factors may predict peer nomination or how peer nominations might exhibit a clustering effect. Focusing on the homophily principle that "birds of a feather flock together," and using a social network analysis approach, the authors investigated how certain student- and/or school-based factors might predict the likelihood of peer nomination, and the clusters, if any, that occur among those nominations.

Method: In 2013, the Jefferson Longitudinal Study of Medical Education included a special instrument to evaluate peer nominations.

Evaluating Validity Evidence for USMLE Step 2 Clinical Skills Data Gathering and Data Interpretation Scores: Does Performance Predict History-Taking and Physical Examination Ratings for First-Year Internal Medicine Residents?

Purpose: To add to the small body of validity research addressing whether scores from performance assessments of clinical skills are related to performance in supervised patient settings, the authors examined relationships between United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) data gathering and data interpretation scores and subsequent performance in history taking and physical examination in internal medicine residency training.

Method: The sample included 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and whose performance ratings from their first year of residency training were available. Hierarchical linear modeling techniques were used to examine the relationships among Step 2 CS data gathering and data interpretation scores and history-taking and physical examination ratings.

US Medical Student Performance on the NBME Subject Examination in Internal Medicine: Do Clerkship Sequence and Clerkship Length Matter?

Background: Prior to graduation, US medical students are required to complete clinical clerkship rotations, most commonly in the specialty areas of family medicine, internal medicine, obstetrics and gynecology (ob/gyn), pediatrics, psychiatry, and surgery. Within a school, the sequence in which students complete these clerkships varies. In addition, the length of these rotations varies, both within a school for different clerkships and between schools for the same clerkship.

Performance in physical examination on the USMLE Step 2 Clinical Skills examination.

Purpose: To provide descriptive information about history-taking (HX) and physical examination (PE) performance for U.S. medical students as documented by standardized patients (SPs) during the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination.

The relationship between communication scores from the USMLE Step 2 Clinical Skills examination and communication ratings for first-year internal medicine residents.

Purpose: This study extends available evidence about the relationship between scores on the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination and subsequent performance in residency. It focuses on the relationship between Step 2 CS communication and interpersonal skills scores and communication skills ratings that residency directors assign to residents in their first postgraduate year of internal medicine training. It represents the first large-scale evaluation of the extent to which Step 2 CS communication and interpersonal skills scores can be extrapolated to examinee performance in supervised practice.

Changes in anatomy instruction and USMLE performance: empirical evidence on the absence of a relationship.

Anatomy instruction has evolved over the past two decades as many medical schools have undergone various types of curricular reform. To provide empirical evidence about whether or not curricular changes impact the acquisition and retention of anatomy knowledge, this study investigated the effect of variation in gross anatomy course hours, curricular approach (stand-alone versus integrated), and laboratory experience (dissection versus dissection and prosection) on USMLE Steps 1 and 2 Clinical Knowledge (CK) scores. Gross anatomy course directors at 54 United States schools provided information about their gross anatomy courses via an online survey (response rate of 42%).

Gender differences in examinee performance on the Step 2 Clinical Skills data gathering (DG) and patient note (PN) components.

Multiple studies examining the relationship between physician gender and performance on examinations have found consistent significant gender differences, but relatively little information is available related to any gender effect on interviewing and written communication skills. The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) examination is a multi-station examination where examinees (physicians in training) interact with, and are rated by, standardized patients (SPs) portraying cases in an ambulatory setting. Data from a recent complete year (2009) were analyzed via a series of hierarchical linear models to examine the impact of examinee gender on performance on the data gathering (DG) and patient note (PN) components of this examination.

A multilevel analysis of examinee gender, standardized patient gender, and United States medical licensing examination step 2 clinical skills communication and interpersonal skills scores.

Background: Women typically demonstrate stronger communication skills on performance-based assessments using human raters in medical education settings. This study examines the effects of examinee and rater gender on communication and interpersonal skills (CIS) scores from the performance-based component of the United States Medical Licensing Examination, the Step 2 Clinical Skills (CS) examination.

Method: Data included demographic and performance information for examinees that took Step 2 CS for the first time in 2009.

Progress testing in clinical science education: results of a pilot project between the National Board of Medical Examiners and a US Medical School.

Background: Though progress tests have been used for several decades in various medical education settings, a few studies have offered analytic frameworks that could be used by practitioners to model growth of knowledge as a function of curricular and other variables of interest.

Aim: To explore the use of one form of progress testing in clinical education by modeling growth of knowledge in various disciplines as well as by assessing the impact of recent training (core rotation order) on performance using hierarchical linear modeling (HLM) and analysis of variance (ANOVA) frameworks.

Methods: This study included performances across four test administrations occurring between July 2006 and July 2007 for 130 students from a US medical school who graduated in 2008.

Assessing potentially dangerous medical actions with the computer-based case simulation portion of the USMLE step 3 examination.

Background: The 2000 Institute of Medicine report on patient safety brought renewed attention to the issue of preventable medical errors, and subsequently specialty boards and the National Board of Medical Examiners were encouraged to play a role in setting expectations around safety education. This paper examines potentially dangerous actions taken by examinees during the portion of the United States Medical Licensing Examination Step 3 that is particularly well suited to evaluating lapses in physician decision making, the Computer-based Case Simulation (CCS).

Method: Descriptive statistics and a general linear modeling approach were used to analyze dangerous actions ordered by 25,283 examinees that completed CCS for the first time between November 2006 and January 2008.

A multilevel analysis of examinee gender and USMLE step 1 performance.

Background: To examine the effects of (1) examinee gender on United States Medical Licensing Examination (USMLE) Step 1 performance, (2) examinee gender on the relationships between prematriculation measures and Step 1 performance, and (3) medical school characteristics on the relationships between examinee characteristics and Step 1 performance.

Method: A series of hierarchical linear models (examinees-nested-in-schools) was conducted predicting Step 1 scores. The sample included 66,412 examinees from 133 U.