Redesigning the Clinical Learning Environment to Improve Interprofessional Care and Education: Multi-Method Program Evaluation of the iPACE Pilot Unit.

Background: In 2016, Maine Medical Center received an Accreditation Council for Graduate Medical Education Pursuing Excellence in Innovation grant to redesign the clinical learning environment to promote interprofessional care and education. The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and piloted on an adult inpatient medicine unit as an attempt achieve these aims.

Objective: We describe the iPACE model and associated outcomes.

The interplay between residency program culture and feedback culture: a cross-sectional study exploring perceptions of residents at three institutions.

Background: Giving and receiving feedback that changes performance is influenced significantly by the clinical learning environment. This environment is multi-dimensional but includes both organizational and feedback specific dimensions.

Objective: The objectives of this research were to investigate the relationship between residents' perceptions of residency program culture and feedback culture; and whether there were differences in resident perceptions of their programs' and feedback cultures based on their disciplines and institution.

Aligning Strategic Interests in an Academic Medical Center: A Framework for Evaluating GME Expansion Requests.

Background: In 2017, the Maine Medical Center Graduate Medical Education Committee received an unprecedented number of requests (n = 18) to start new graduate medical education (GME) programs or expand existing programs. There was no process by which multiple programs could be prioritized to compete for scarce GME resources.

Objective: We developed a framework to strategically assess and prioritize GME program expansion requests to yield the greatest benefits for patients, learners, and the institution as well as to meet regional and societal priorities.

The Art (and Artifice) of Seeking Feedback: Clerkship Students' Approaches to Asking for Feedback.

Purpose: As attention has shifted to learners as significant partners in feedback interactions, it is important to explore what feedback-seeking behaviors medical students use and how the faculty-student relationship affects feedback-seeking behaviors.

Method: This qualitative study was inspired by the organizational psychology literature. Third-year medical students were interviewed at Maine Medical Center in April-May 2017 after completing a traditional block rotation clerkship or a nine-month longitudinal integrated clerkship (LIC).

The Benefits of Honoring Patients as Teachers: A Qualitative Study.

Introduction: Medical training could not occur without the contributions of patients. Few programs are available that recognize patients for their essential role in medical education, and even fewer explore their impact. The Patients as Teachers (PaT) program was developed to provide an opportunity for medical students to formally honor patients for their contributions and to evaluate their effect on students' medical education.

The research contributions of predominantly North American Family Medicine educators to medical learner feedback: a descriptive analysis following a scoping review.

Background And Objectives: In 2016, we performed a scoping review as a means of mapping what is known in the literature about feedback to medical learners. In this descriptive analysis, we explore a subset of the results to assess the contributions of predominantly North American family medicine educators to the feedback literature.

Methods: Nineteen articles extracted from our original scoping review plus six articles identified from an additional search of the journal Family Medicine are described in-depth.

Trainees' Perceptions of Feedback: Validity Evidence for Two FEEDME (Feedback in Medical Education) Instruments.

Unlabelled: Construct: Medical educators consider feedback a core component of the educational process. Effective feedback allows learners to acquire new skills, knowledge, and attitudes. Learners' perceptions of feedback are an important aspect to assess with valid methods in order to improve the feedback skills of educators and the feedback culture.

The Feedback Tango: An Integrative Review and Analysis of the Content of the Teacher-Learner Feedback Exchange.

Purpose: To conduct an integrative review and analysis of the literature on the content of feedback to learners in medical education.

Method: Following completion of a scoping review in 2016, the authors analyzed a subset of articles published through 2015 describing the analysis of feedback exchange content in various contexts: audiotapes, clinical examination, feedback cards, multisource feedback, videotapes, and written feedback. Two reviewers extracted data from these articles and identified common themes.

Is feedback to medical learners associated with characteristics of improved patient care?

Purpose: To investigate the association of medical learner feedback with patient management and outcomes.

Methods: The authors investigated 27 articles that utilized patient data or chart reviews as a subset of a prior feedback scoping review. Data extraction was completed by two authors and all authors reviewed the descriptive data analysis.

Is It Time for Entrustable Professional Activities for Residency Program Directors?

Residency program directors (PDs) play an important role in establishing and leading high-quality graduate medical education programs. However, medical educators have failed to codify the position on a national level, and PDs are often not recognized for the significant role they play. The authors of this Commentary argue that the core entrustable professional activities (EPAs) framework may be a mechanism to further this work and define the roles and responsibilities of the PD position.

Feedback for Learners in Medical Education: What Is Known? A Scoping Review.

Purpose: To conduct a scoping review of the literature on feedback for learners in medical education.

Method: In 2015-2016, the authors searched the Ovid MEDLINE, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Web of Science, and Scopus databases and seven medical education journals (via OvidSP) for articles published January 1980-December 2015. Two reviewers screened articles for eligibility with inclusion criteria.

Organizing graduate medical education programs into communities of practice.

Background: A new organizational model of educational administrative support was instituted in the Department of Medical Education (DME) to better meet increasing national accreditation demands. Residency and fellowship programs were organized into four 'Communities of Practice' (CoOPs) based on discipline similarity, number of learners, and geographic location. Program coordinator reporting lines were shifted from individual departments to a centralized reporting structure within the DME.

Assessment of Medical Student and Resident/Fellow Knowledge, Comfort, and Training With Sexual History Taking in LGBTQ Patients.

Background And Objectives: Sexual health is an important aspect of overall health. Barriers to taking an adequate patient sexual history exist. Few studies have explored medical learners' comfort, knowledge, and training surrounding taking sexual histories with lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ) patients specifically.

Unfreezing the Flexnerian Model: introducing longitudinal integrated clerkships in rural communities.

Introduction: Physician shortages in rural areas remain severe but may be ameliorated by recent expansions in medical school class sizes. Expanding student exposure to rural medicine by increasing the amount of prolonged clinical experiences in rural areas may increase the likelihood of students pursuing a career in rural medicine. This research sought to investigate the perspective of rural physicians on the introduction of a rurally based nine-month Longitudinal Integrated Clerkship (LIC).

Physician shadowing by college students: what do patients think?

Background: The objective of this study is to determine patients' perceptions of physician shadowing by college students.

Methods: Thirty-two patients who agreed to have a college student shadow their physician participated in semi-structured interviews during July and August 2013 at two outpatient family medicine centers. Qualitative techniques were utilized to analyze the transcripts of the patient interviews and identify common themes.

Leadership development for program directors.

Background: Residency program directors have increasingly challenging roles, but they may not be receiving adequate leadership development.

Objective: To assess and facilitate program directors' leadership self-awareness and development at a workshop retreat.

Methods: At our annual program director retreat, program directors and associate program directors from a variety of specialties completed the Thomas-Kilmann Conflict Mode Instrument (TKI), which evaluates an individual's behavior in conflict situations, and the Hersey-Blanchard Situational Leadership (HBSL) model, which measures individuals' preferred leadership style in working with followers.

A systematic review of the use and effectiveness of the Objective Structured Teaching Encounter.

Background: The Objective Structured Teaching Encounter (OSTE) has been proposed as a means of promoting and assessing the teaching skills of medical faculty.

Aims: To describe the uses of the OSTE and the evidence supporting its effectiveness.

Method: MEDLINE (January 1966 through February 2010) was searched for English-language studies detailing the use of an OSTE for any educational purpose.

Using decentralized medical education to address the workforce needs of a rural state: a partnership between Maine Medical Center and Tufts University school of medicine.

Context: In February 2008, a new partnership between Maine Medical Center and Tufts University School of Medicine was formed to create a model medical school program.

Issue: Major forces for change included: the increasing physician workforce needs of Maine, the need to increase access for medical education for Maine students, the opportunity for educational innovation, the societal imperative to increase the number of primary care physicians, and the desire for clinical and research collaborations.

Lessons Learned: The authors describe the process for exploring this partnership, and establishing a separate track and campus for 36 students per year.

Recurrent takotsubo cardiomyopathy associated with pheochromocytoma.

Objective: To describe a case of recurrent takotsubo cardiomyopathy in a patient with pheochromocytoma.

Methods: We present a case report, including clinical and laboratory data. In addition, the current relevant literature pertaining to pheochromocytoma and takotsubo syndrome is reviewed and summarized.

Use of methotrexate to treat isolated Graves ophthalmopathy developing years after thyroidectomy and iodine 131 treatment of papillary thyroid cancer.

Objective: To describe a case of Graves ophthalmopathy developing years after subtotal thyroidectomy and radioactive iodine treatment of papillary thyroid cancer.

Methods: We present a case report including clinical and laboratory data. Current relevant literature is reviewed and summarized with regard to Graves ophthalmopathy.