Student professionalism in clerkships.

Intro: Professionalism can be challenging to assess during clerkships. Current literature focuses either on aspirational generalities or professionalism lapses. Most tools assessing professionalism employ Likert scales.

Maximizing Learning in the Operating Room: Residents' Perspectives.

Background: Few studies examine how residents can optimize their educational experience in the OR on their terms. This study aimed to examine residents' perceptions of how learners can maximize their education in the OR.

Method: Using constructivist grounded theory methodology, the authors conducted focus groups with general surgery residents, PGY1-5, followed by semi-structured interviews with attending surgeons from a single, academic medical center.

The educators' experience: Learning environments that support the master adaptive learner.

Background: The Master Adaptive Learner (MAL) theoretical framework describes an integrated approach to learning that combines features of educational theory on self-regulated learning and aspects of quality improvement. In order to develop MAL students, it is important to pay attention to the learning environment.

Purpose: To describe educators' perspectives about the needed to promote the development of master adaptive learners.

Defining the "Problem Resident" and the Implications of the Unfixable Problem: The Rationale for a "Front-door" Solution.

Introduction: Problem residents are common in graduate medical education, yet little is known about their characteristics, deficits, and the consequences for emergency medicine (EM) residencies. The American Board of Internal Medicine (ABIM) defines a problem resident as "a trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director [PD] or chief resident." Although this is a comprehensive definition, it lacks specificity.

Learning to balance efficiency and innovation for optimal adaptive expertise.

It is critical for health professionals to continue to learn and this must be supported by health professions education (HPE). Adaptive expert clinicians are not only expert in their work but have the additional capacity to learn and improve in their practices. The authors review a selective aspect of learning to become an adaptive expert: the capacity to optimally balance routine approaches that maximize efficiency with innovative ones where energy and resources are used to customize actions for novel or difficult situations.

Learning in the real place: medical students' learning and socialization in clerkships at one medical school.

Purpose: To understand medical students' learning experiences in clerkships: learning expectations (what they expect to learn), learning process (how they learn), and learning outcomes (what they learn).

Method: Using a longitudinal qualitative research design, the authors followed the experiences of 12 participants across their clerkship year (2011-2012) at the Southern Illinois University School of Medicine. Interview data from each participant were collected at three points (preclerkship, midclerkship, and postclerkship) and analyzed using a grounded theory approach.

Feedback matters: the impact of an intervention by the dean on unprofessional faculty at one medical school.

Purpose: Unprofessional behavior by faculty can result in poor patient care, poor role modeling, and mistreatment of trainees. To improve faculty or institutional behavior, unprofessional faculty must be given direct feedback. The authors sought to determine whether annually surveying medical students for their nominations of most and least professional faculty, coupled with direct feedback to unprofessional faculty from the dean, improved faculty's professional behavior.

Unprofessional behavior by specialty: a qualitative analysis of six years of student perceptions of medical school faculty.

Background: Unprofessional behavior has well documented negative effects both on the clinical care environment and on the learning environment. If unprofessional behavior varies by department or specialty, this has implications both for faculty development and for undergraduate and graduate level training.

Aims: We sought to learn which unprofessional behaviors were endemic in our school, and which were unique to particular departments.

The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.

Background: Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care.

Methods: Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication.

Future focus for professional development.

Professional development has evolved from individually focused sabbaticals and professional leaves to institutionally focused programs with an interest in developing faculty members' ability to teach in various environments as well as to succeed in the many endeavors they undertake. We address various issues related to professional development in the medical school arena. Professional development in medical school takes place in a context where faculty are stretched to engage in research and service not only for their own sake but also to financially support their institutions.

Biomedical knowledge, clinical cognition and diagnostic justification: a structural equation model.

Context: The process whereby medical students employ integrated analytic and non-analytic diagnostic strategies is not fully understood. Analysing academic performance data could provide a perspective complementary to that of laboratory experiments when investigating the nature of diagnostic strategy. This study examined the performance data of medical students in an integrated curriculum to determine the relative contributions of biomedical knowledge and clinical pattern recognition to diagnostic strategy.

The case of the entitled resident: a composite case study of a resident performance problem syndrome with interdisciplinary commentary.

Background: Residents with performance problems create substantial burden on programs and institutions. Understanding the nature and quality of performance problems can help in learning to address performance problems.

Aim: We sought to illuminate the effects of resident performance problems and the potential solutions for those problems from the perspectives of people with various roles in health care.

A surgical simulation curriculum for senior medical students based on TeamSTEPPS.

Objective: To investigate whether the existing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum can effectively teach senior medical students team skills. DESIGN Single-group preintervention and postintervention study.

Setting And Intervention: We integrated a TeamSTEPPS module into our existing resident readiness elective.

Pursuing professional accountability: an evidence-based approach to addressing residents with behavioral problems.

Objective: To develop an evidence-based approach to the identification, prevention, and management of surgical residents with behavioral problems.

Design: The American College of Surgeons and Southern Illinois University Department of Surgery hosted a 1-day think tank to develop strategies for early identification of problem residents and appropriate interventions. Participants read a selection of relevant literature before the meeting and reviewed case reports.

Academic and professional career outcomes of medical school graduates who failed USMLE Step 1 on the first attempt.

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed.

Using the hidden curriculum to teach professionalism during the surgery clerkship.

Background: It has been shown that medical student professionalism is influenced by the hidden curriculum, although the extent to which this occurs during the surgery clerkship is unknown. Furthermore, the processes within the hidden curriculum have been used to teach professionalism to medical students, but this strategy has not been used during the surgery clerkship. The purpose of this study was to review a 2-year experience with a surgery clerkship instructional session where the hidden curriculum was used to teach professionalism to medical students.

Capturing the teachable moment: a grounded theory study of verbal teaching interactions in the operating room.

Background: Teaching in the operating room is one of the major cornerstones of surgical education. As time available for intraoperative resident teaching diminishes, such teaching time becomes increasingly precious. We studied how surgeons communicate with residents during an operation, with the goal of enhancing intraoperative teaching opportunities.

Longitudinal research databases in medical education: facilitating the study of educational outcomes over time and across institutions.

Many education research questions cannot be answered using participants from one institution or short periods of follow-up. In response to societal demands for accountability and evidence of effectiveness, new models of research must be developed to study the outcomes of educational activities. Following the 2007 Millennium Conference on Medical Education Research, organizers assigned a task force to explore the use of longitudinal databases in education research.

Variables associated with full-time faculty appointment among contemporary U.S. Medical school graduates: implications for academic medicine workforce diversity.

Purpose: The authors sought to identify variables independently associated with full-time faculty appointment among recent medical graduates.

Method: With institutional review board approval, the authors developed a database of individualized records for six midwestern medical schools' 1997-2002 graduates. Using multivariate logistic regression, they identified variables independently associated with full-time faculty appointment from among demographic, medical-school-related, and career-intention variables.

The nature of general surgery resident performance problems.

Background: Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional behavior problems, and to describe and classify their nature.