Med Ed Briefs

Addressing Segregated Care Using Clerkship Experiences

Citation:

Wilkinson R, Huxley-Reicher Z, Conner Fox GW, Feuerbach A, Tong M, Blum J, Pai A, Karani R, Muller D. Leveraging Clerkship Experiences to Address Segregated Care: A Survey-Based Approach to Student-Led Advocacy. Teach Learn Med 2022; DOI: 10.1080/10401334.2022.2088538.

What is this article about?

Segregated care, defined as segregating patients receiving Medicaid from patients with private insurance, leads to de facto segregation based on race and socioeconomic status.  Medical students at a New York academic health center recognized the inequitable treatment and sought to address it by collecting survey data from medical students. 

Why should you read the article?

The study was done at a large academic medical center in New York City with 3rd year medical students.  A survey instrument was designed to gauge the prevalence of segregated care, understand its impact on medical education, and identify opportunities for structural change. The survey included 16 questions; 8 were multiple choice and 8 open-ended questions. Analysis included descriptive statistics and thematic analysis. The survey was administered in March, 2019 to 140 students. Of the 65 respondents, 36 (56.3%) reported witnessing separation of patients by insurance status. Thirty-three (51.6%) reported witnessing differences in care based on insurance status. The frequency of these reports varied by rotation.

How can you use this article?

Thematic analysis resulted in four themes: disparate patient care (involved two subthemes of structural separation and differences in care), differences in educational opportunities, and negative emotional consequences.  Disparate patient care was noted in different physical locations (ie type of clinic) as well as preceptor behaviors. Educational opportunities were better with Medicaid patients because they were allowed to do complete work-ups on them, but those with insurance were given special treatment and were allowed to opt out of being seen by students. Recognition of these disparities resulted in students feeling hopeless and cynical about healthcare. 

The survey demonstrated widespread segregation of care that was having a negative impact on training experiences. Although the response rate was low, survey data was used to advocate for structural changes.

Published 2022-11-02

Review Author:  Gary L. Beck Dallaghan, PhD; Professor, Department of Medical Education, University of Texas at Tyler School of Medicine, Tyler TX. Member organization: Council on Medical Student Education in Pediatrics

—————————————————————————————————————————————-

Learning Conversations with Trainees

Citation:

Lisanne S. Welink, Esther de Groot, Marie-Louise E. Bartelink, Kaatje Van Roy, Roger A. M. J. Damoiseaux, and Peter Pype (2021) Learning Conversations with Trainees: An Undervalued but Useful EBM Learning Opportunity for Clinical Supervisors, Teaching and Learning in Medicine, 33:4, 382-389,  doi: 10.1080/10401334.2020.1854766.

What is this article about?

This article addresses the heart of evidence-based learning in the context of clinical practice. By exploring the unique relationship between clinician supervisors and trainees, this study defines the current goals and benefits of these learning conversations. Evidence-based practice encompasses three main components:  incorporation of “best evidence,” patient wishes, and clinician experience.  This framework was examined in the context of videotaped learning conversations between experienced clinician supervisors and their trainees. Predominant clinician supervisor perspectives on evidence-based learning in the workplace revealed a primary intent for unidirectional teaching to trainees with supervisor learning being a by-product rather than a primary goal. Future directions call for a more purposeful bidirectional model for evidence-based learning within the supervisor-trainee relationship.

Why should you read the article?

Evidence-based practice is the cornerstone of academic medicine and is constantly changing with new available evidence. Supervisors and trainees have unique skill sets that can amplify point-of-care learning and application to ongoing clinical practice. Intentional utilization of critically appraised evidence and clinical experience can guide more meaningful learning conversations in everyday clinical practice. As medicine continues to rapidly evolve, collaborative approaches to learning, teaching and application of evidence-based care are required.  Transitioning the typical unidirectional teaching and self-directed learning model to a more inclusive bidirectional model between supervisors and trainees may serve to validate trainees as evidence-based teachers capable of shaping clinical practice.

How can you use this article?

This article may be a useful tool for prompting conversations on how to best incorporate well-structured evidence-based medicine curricula in the clinical settings.  The enhancement of learning conversations through a bidirectional model may better inform evidence-based patient care by clinician supervisors and trainees alike in a fast-paced and ever-changing clinical practice.

Published 2022-05-06

Review Author:  Erin Saner, MD; Assistant Instructor, Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC. Member organization: Society of Teachers of Family Medicine

—————————————————————————————————————————————-

Clarifying Current Expectations OF and FOR Clerkship Directors

Citation:

Morgenstern BZ, Roman BJB, DeWaay D, Golden WC, Malloy E, Reddy RM, Rutter AE, Salas R, Soni M, Starr S, Sutton J, Wald DA, Pangaro LN. Expectations of and for Clerkship Directors 2.0: A Collaborative Statement from the Alliance for Clinical Education. Teach Learn Med. 2021 Aug-Sep;33(4):343-354. doi: 10.1080/10401334.2021.1929997.

What is this article about?

This article from the Alliance for Clinical Education (ACE) updates a previous ACE statement from 2003, highlighting the importance of the clerkship director (CD) within the medical school and clinical department administration. The Clerkship Director role includes helping, supporting, grading and watching over medical students in their respective specialties. Clerkship Directors are “Jack of all Trades”; they need to maintain positive attitudes, demonstrate excellent temperament, and the ability to work through electronic platforms and computerized education. This article documents the clerkship director role, including qualifications, performance goals, and available resources and support.

Why should you read the article?

The Clerkship Director is the ultimate clinician-educator, responsible for the clinical curriculum, learner assessment, and innovative changes within clinical education. It is important for directors to recognize the resources available to aid in their roles, so they can successfully encourage development of the students. This article highlights new considerations for the clerkship director, including health systems science curriculum, technology innovations related to the SARS-CoV-2 pandemic, and diversity in the clinical learning environment. The Alliance for Clinical Education (ACE) looks to set a high standard for the clerkship director role and support the required investment in them.

How can you use this article?

Clerkship directors can use this article to negotiate and advocate for themselves, with the backing of the educational organizations across disciplines. This article outlines the Alliance for Clinical Education (ACE) recommendation of a 0.5 full time equivalent for the position. Clerkship directors should understand their job description, be provided with administrative support, and have opportunities for professional development.

Published 2022-04-08

Review Author:  Marilyn Kindig, DO; Assistant Professor and Clerkship Director, Wright State University, Boonshoft School of Medicine, Dayton, OH. Member organization: Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Student Perceptions Surrounding Elimination of Core Clerkship Grades

Citation:

Seligman L, Abdullahi A, Teherani A, Hauer KE. From grading to assessment for learning: a qualitative study of student perceptions surrounding elimination of core clerkship grades and enhanced formative feedback. Teaching and Learning in Medicine. 2021 May 27;33(3):314-25. DOI: 10.1080/10401334.2020.1847654.

What is this article about?

This is a qualitative study assessing the impact on students of the transition from honors-eligible grading to pass-fail grading during clerkships at UCSF. The research team included two medical students. Students who had only experienced pass-fail grading as well as students who had had clerkships under the honors-eligible grading plan were interviewed. Students reported high levels of engagement in their clerkships after the switch, describing high levels of motivation to learn and agency to learn. In general, students felt it was much easier to engage with material and to learn for the sake of learning, rather than to demonstrate “honors-worthy” attitudes. Students also reported higher levels of wellness, driven in part by the ability to make wellness-enhancing decisions (ie, going to the gym instead of studying for another hour). Wellbeing was also improved through reduced stress, increased authenticity, and improved school-life balance. Decreased levels of competitiveness and increased levels of collaboration were also described. Students did report concerns about the impact of the change on residency applications, but overall felt the move was a positive.

Why should you read the article?

Previous studies have suggested honors grading is inherently biased and disadvantages underrepresented students. Medical students also perceive honors grading to be unfair. Schools considering a transition away from honors grading to pass-fail grading may be concerned about the impact on students. This article describes positive student experiences with the transition to pass-fail clerkships.

How can you use this article?

If your course or institution is considering transitioning from honors-based grading on clerkships to pass-fail based grading on clerkships, this article supports the transition, finding that student agency, engagement, and wellness are all enhanced by pass-fail grading on clerkships.

Published 2022-03-02

Review Author:  Kate Rowland, MD, MS; Associate Professor and Vice Chair for Education, Rush University Chicago IL. Member organization: Society of Teachers of Family Medicine (STFM)

—————————————————————————————————————————————-

Contending with Our Racial Past in Medical Education: A Foucauldian Perspective

Citation:

Zaidi, Z., Partman, I. M., Whitehead, C. R., Kuper, A., & Wyatt, T. R. (2021). Contending with our racial past in medical education: a Foucauldian perspective. Teaching and learning in medicine, 33(4), 453-462. DOI: 10.1080/10401334.2021.1945929.

What is this article about?

In this invited article, the authors employ Foucauldian notions of power, knowledge, and normalization to lay bare the sometimes-hidden racist practices and processes that shape how medical students are prepared (or not prepared), admitted (or not admitted), included (or excluded), and trained in medical school and beyond. Medical education, the authors argue, as it wrestles with its own systemic racism, should more deeply examine its norms and modes of normalization (of acceptance, belonging, behavior, and professional identity formation). The deeply embedded hierarchy inherent in medicine is called out as a process that socializes student doctors into the “right kind of physician.” These hierarchy and socialization processes have served a purpose, they posit, one that has upheld the social contract medicine has with society, because they uphold expectations about the “right kind of physician.” They also, however, entrench racism in the medical education system and have stymied efforts to decrease racial inequity in training.

Why should you read the article?

Medical educators have great interest in decreasing racial inequity in medicine. The authors acknowledge this interest, and the article gives a helpful frame to any medical educator interested in this work. A few of the efforts that have failed to reverse racial inequity are discussed, such as cultural competency and diversity programming, and some efforts that have been more effective are also named, like AAMC affirmative action policy. Still the authors return to a Foucauldian perspective: curricular and procedural changes go only so far. Racist power structures still exist, because we have not interrogated the deeper norms and modes of normalization that entrench racism in the system. The authors call for a radical dismantling. They describe potential strategies around curriculum change, advocacy, hiring, and hierarchy disruption.

How can you use this article?

The most valuable parts of this article come from its early background sections. In these earlier sections, the authors inspire us to recall what we learned in University about Foucault and help us see how a Foucauldian lens might refocus the ways we are looking at racism in medical education. We are given a new frame which might inspire greater innovation and justice-making. Especially at a time when assessment in medicine is changing (Step 1 and Step 2 CK), we might use the perspective put forth in this article to help us radically rethink the system of student acceptance, discrimination, and training.

Published 2022-02-04

Review Author:  Laurel B. Witt, MD, MPhil; Associate Professor and Director of Medical Student Education, Department of Family Medicine & Community Health—Kansas City, University of Kansas School of Medicine, Kansas City, KS. ACE Membership Organization: Society of Teachers of Family Medicine (STFM)

—————————————————————————————————————————————-

Should Medical Educators Help Learners Reframe Imposterism?

Citation:

Bruce Z. Morgenstern, Gary Beck Dallaghan (2021) Should Medical Educations Help Learners Reframe Imposterism? Teaching and Learning in Medicine, 334, 445-452, DOI: 10.1080/10401334.2020.1856112

What is this article about?

The authors in this article touch on the topic of the imposter phenomena, which has been shown time and time again to be nearly ubiquitous throughout the field of medicine.  While there may not be one definite description for the “syndrome”, most people recognize that it is a common feeling of inadequacy in high-achieving individuals. Imposter phenomena is often associated with mental health symptoms, lack of career progression, and burnout, as well as feelings like cynicism and exhaustion.  However, these authors suggest that imposterism may not be entirely malignant, since the traits that often predispose one to imposterism (ie. fear of failure, perfectionism) can at times be drivers in one’s success.  Morgenstern and Beck Dallaghan instead suggest that the behaviors, often thought to be caused by the feelings associated with being an “imposter”, should be the target of change.  We should perhaps address imposterism early in medical training and help those individuals develop the proper coping skills to prevent the negative behaviors while preserving the positive aspects that motivate one to strive for success.  Utilizing tools such as self-reflection could help physicians confront the feelings of elitism, overconfidence, and complacency, and instead focus on developing humility.  Emphasis on combating imposterism could have a particularly powerful impact if done early in training, at points of career transition, and in the development of faculty physicians.

Why should you read the article?

Imposterism is ubiquitous within the medical field across all stages of training. The personal traits and feelings associated with success in medicine can also be associated with negative behaviors seen in imposterism. Recognizing key features of imposterism may actually be a pillar to success and the associated negative sentiments and behaviors should be the focus of change.

How can you use this article?

This article presents a unique perspective of imposter syndrome and should drive conversation within the medical community on how to address the topic with students and professionals alike.  These methods could include self-reflective techniques, group sessions, or asynchronous learning and should be continually addressed throughout one’s career in medicine.

Published 2022-01-04

Review Author:  Dan Binder, MD, Assistant Instructor and Academic Fellow, Department of Family and Community Medicine. Wake Forest School of Medicine. Atrium Health-Wake Forest Baptist. Winston-Salem, NC. ACE Membership Organization: Society of Teachers of Family Medicine (STFM)

—————————————————————————————————————————————-

Assessment to Optimize Learning Strategies

Citation:

Wlodarczyk S, Muller-Juge V, Hauer KE, Tong MS, Ransohoff A, Boscardin C. Assessment to Optimize Learning Strategies: A Qualitative Study of Student and Faculty Perceptions. Teach Learn Med. 2021;33(3):245-257. doi:10.1080/10401334.2020.1852940

What is this article about?

This study explores how students and faculty adjusted their studying and teaching strategies to align with evidence-based learning strategies in response to a change in assessment format.

In 2016 a new assessment strategy utilized weekly formative quizzes to include open-ended and multiple-choice questions and summative open-ended examinations during the 18-month pre-clerkship phase. Interviews with students addressed their approach to studying and perceptions of the assessments. Interviews with faculty explored their approach to writing quizzes and rubrics, and how their teaching changed to meet the needs of the assessment strategy.

In a culture of “assessment for learning” students used evidence-based study strategies focusing on conceptual learning to prepare for the application of knowledge in clinical practice, and faculty promoted positive changes in teaching and in the quality of assessments. Specifically, with the formative weekly quiz and summative examination strategy, students prioritized conceptual understanding, and simulated clinical problem solving when they felt pushed to “think like a physician”. Both students and faculty engaged in continuous improvement of studying and teaching based on regular feedback from smaller and more regular assessments, as well as those that foster creating and justifying answers.

Why should you read the article?

Researchers designed their assessment strategy to apply learning sciences principles including elaboration, interleaving, distributed learning and retrieval practice. This strategy encouraged students to shift away from passive study techniques, posing a potential tool to develop specific skills for future learning. Both groups identified factors that supported the use of these strategies, as well as challenges in their implementation.

How can you use this article?

This study supports that optimizing assessment formats facilitates desirable learning and teaching strategies. This study also outlines challenges in implementing an assessment strategy like this, and suggests options to transition resources away from less effective strategies.

Published 2021-12-02

Review Author:  Joanna Drowos DO, MPH, MBA, Associate Professor of Family Medicine, Associate Dean for Faculty Affairs. Department of Integrated Medical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL. Society of Teachers of Family Medicine

—————————————————————————————————————————————-

Linking Patient Care Ownership and Professional Identity Formation through Simulation

Citation:

Wyatt, T. R., Kleinheksel, A. J., & Tews, M. (2021). Linking Patient Care Ownership and Professional Identity Formation through Simulation. Teaching and learning in medicine, 33(2), 164–172. https://doi.org/10.1080/10401334.2020.1813583

What is this article about?

The central theme of this article is patient care ownership as a catalyst for third year medical students’ professional identity formation. This research study uses a constructivist approach in a simulation session (OSCE). Third year medical students are responsible for clinical decisions when they treat patients with asthma/respiratory distress, thereby triggering a sense of patient ownership. The OSCE was followed by a PEARLS de-briefing and focus groups to collect post simulation data. Results indicate three stages of student reflection and development when experiencing patient care ownership; 1. Disorientation 2. Roles and responsibilities are reconceptualized, which includes identifying gaps, a focus on specific skills, and a change in perspective 3. Professional goal reorientation to reprioritize and meet expectations. Professional identity formation is developed by the students’ insights of patient care ownership and their roles as future physicians.

Why should you read the article?

The authors address professional identity formation, a topic of interest to medical educators, using an OSCE as an educational intervention to develop skills relevant to this elusive topic. The article identifies three primary qualities of patient care ownership autonomy, responsibility, and decision making. Given the opportunity to experience these qualities the learners’ perception of themselves as physicians changed. For faculty, the study highlights the importance of reflecting on how we engage our learners in actual clinical settings that promote patient ownership and subsequently professional identity formation.

How can you use this article?

Specialty-specific specific OSCEs focused on patient ownership and professional identity skills can be developed and implemented for the clerkship. This presents opportunity to longitudinally impact our learners’ professional identity formation as future physicians early in their medical careers.

Published 2021-11-01

Review Author:  Teresa Lazar MD, MSEd, Assistant Professor & Co-director of the OB/GYN clerkship, Zucker School of Medicine Hofstra Northwell, Hempstead, NY. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Extending “Beyond Diversity”: Culturally Responsive Universal Design Principles for Medical Education 

Citation:

Erica Jaiyeola Odukoya, Tatiana Kelley, Barra Madden, Felicia Olawuni, Erica Maduakolam & Anna T. Cianciolo (2021) Extending “Beyond Diversity”: Culturally Responsive Universal Design Principles for Medical Education, Teaching and Learning in Medicine, 33:2, 109-115, DOI: 10.1080/10401334.2021.1890679

What is this article about?

The commentary by Odukoya et al is a follow up to a 2020 “Beyond Diversity” commentary by Maduakolam et al.  The first article introduces the idea of Culturally Responsive Universal Design for Learning (CRUDL) as an approach to foster ethnically and racially inclusive medical education, research, and clinical practice. In the current article, the authors take a deeper dive into how to bring this to fruition. The authors reference knowledge from prior articles on educational theory and the impact of trauma to propose methods to address three guiding principles: provide multiple means to access educational content, provide multiple means of engagement, and provide multiple means of action and expression. Principle 1 not only addresses using a variety of educational content delivery methods but also emphasizes the inclusion of experiences from diverse populations, such as through patient panels. The second CRUDL principle highlights facilitating the key skill of life-long learning. To better evaluate a diverse group of learners, the last principle focuses on expanding methods in which we assess achievement of learning objectives. 

Why should you read the article?

This thoughtful article is particularly unique in that it comes from the perspective of Black female medical students. The students have an important voice and present their ideas with support of evidence-based articles.   Logistically, LCME standards include a cultural competency component and so this is important for all schools who are, or are seeking to be, accredited. In addition, the past year has brought racial/ethnic inequalities and injustices to the forefront of national conversation, and it has been clear that there is much work to be done. While we often think of these inequities at the patient level, this article highlights the student/physician perspective as well.

How can you use this article?

The commentary provides a method to create a culturally responsive curriculum and utilizes research from other sources to help the reader implement the key principles presented. This is a great starting point for an educator hoping to improve upon their current curriculum.  Throughout the article, the authors also point out some opportunities to further expand knowledge. Those implementing the CRUDL principles could use research or quality improvement projects to evaluate the efficacy of their specific curriculum to share with medical educators.

Published 2021-10-01

Review Author:  Kristen Hood Watson MD, Assistant Dean for Resident Inclusion, Assistant Professor of Family Medicine, Medical University of South Carolina, Charleston, SC. ACE Member Organization:  Society of Teachers of Family Medicine

—————————————————————————————————————————————-

Learning through Teaching: Peer Teaching and Mentoring Experiences among Third-Year Medical Students

Citation:

Monica M. Yang, Blair P. Golden, Kenzie A. Cameron, Lauren Gard, Jennifer A. Bierman, Daniel B. Evans & Bruce L. Henschen. (2021). Learning through Teaching: Peer Teaching and Mentoring Experiences among Third-Year Medical Students. Teaching and Learning in Medicine. DOI: https://doi.org/10.1080/10401334.2021.1899930

What is this article about?

This article sought to understand medical students’ perceptions and experiences of peer teaching and mentoring in longitudinal, outpatient clinical settings through a study of two different primary outpatient primary care clerkships at Northwestern University Feinberg School of Medicine (FSM).

In 2015 and 2016, students were randomized to either the individual preceptorship (IP) clerkship, which followed a more traditional model of one-on-one preceptorship for the first two years of medical school and a four-week primary care block during third year, or the Education Centered Medical Home (ECMH) clerkship. The ECMH included students from all four years who worked together under a single preceptor throughout the duration of medical school, which created an environment conducive to peer teaching. A total of 33 students (14 IP and 19 ECMH students) participated in semi-structured interviews during their third year. Their responses were used for qualitative analysis to gain insight into their experiences peer teaching and serving as role models or mentors.

Why should you read the article?

This article reveals three interesting themes related to peer mentoring based on the student interviews: 1) “diversity of peer teaching and mentoring opportunities,” 2) “transitioning one’s role from learner to teacher,” and 3) “personal and professional development.” The article elaborates on the differences in experiences between the ECMH students and the IP students, including how ECHM cited the curriculum design as a key promoter of peer teaching and mentoring, expressed personal responsibility for the success of their mentees, and were more likely to describe increased confidence and independence with teaching.

How can you use this article?

Learning environments that promote peer mentoring in medical school are important for the professional and personal development of students into teachers. Curricula that incorporate peer mentoring may better prepare students for their future roles as resident and physician teachers as well as patient educators. A longitudinal setting that allows students at different knowledge levels to interact could be one way to provide consistent opportunities for peer mentoring experiences.

Published 2021-09-01

Review Author:  Neha S. Anand, MPH, fourth year medical student at Johns Hopkins University School of Medicine, Baltimore, MD. ACE Member Organization:  Council on Medical Student Education in Pediatrics

—————————————————————————————————————————————-

Moving toward Mastery: Changes in Student Perceptions of Clerkship Assessment with Pass/Fail Grading and Enhanced Feedback

Citation:

Justin L. Bullock, Lee Seligman, Cindy J. Lai, Patricia S. O’Sullivan & Karen E. Hauer (2021) Moving toward Mastery: Changes in Student Perceptions of Clerkship Assessment with Pass/Fail Grading and Enhanced Feedback. Teaching and Learning in Medicine, DOI:  https://doi.org/10.1080/10401334.2021.1922285

What is this article about?

Clerkship grading is an amorphous process, especially from a medical student’s perspective.  It becomes even more nebulous when a combination of clinical performance evaluations, subject exams and other assignments are somehow transformed into a tiered grade of Honors, High Pass, etc.  Because of concerns related to tiered grading contributing to performance approach-oriented learning, a pass/fail framework augmented by feedback with required workplace-based assessments was initiated at UCSF.  The purpose of this study was to examine if a pass/fail framework resulted in enhanced formative feedback and if student perceptions of fairness and accuracy of clerkship grades improved.

Why should you read the article?

This was a single-institution, before-after cross-sectional survey study.  Prior to the new grading framework, students’ perceptions of the tiered grading system were collected.  The cohort of students in the new grading framework were assessed upon completion of the clerkships. Analysis involved descriptive statistics and thematic analysis to analyze open-ended comments.

Student perception of fairness and accuracy of clerkship assessment improved with an effect size of .80.  Students also perceived grading to be fair and transparent in the new framework.  They also found that the learning environment was more mastery-oriented than in a tiered system.  Narrative comments corroborated findings, but also highlighted areas that could be improved with the workplace-based feedback process.

How can you use this article?

In a tiered-grading structure, students often spend more time trying to figure out how to get top grades.  This goal can drive some to avoid trying new skills that they may not look good doing.  This study demonstrated that a change to pass/fail on the clerkships resulted in students engaging more in learning.  Knowing that if they put in effort and are motivated to learn, they can receive a passing grade and focus on mastering material.

Published 2021-08-02

Review Author:  Gary L. Beck Dallaghan, Ph.D., Research Associate Professor of Pediatrics, Director of Educational Scholarship, UNC School of Medicine, Chapel Hill, NC. ACE Member Organization:  Council on Medical Student Education in Pediatrics

—————————————————————————————————————————————-

Language, Philosophy, and Medical Education

Citation:

John R. Skelton (2021) Language, Philosophy and Medical Education, Teaching and Learning in Medicine, 33:2, 210-216, DOI: 10.1080/10401334.2021.1877712.  https://doi.org/10.1080/10401334.2021.1877712

What is this article about?

In this manuscript, Dr. Skelton reflects upon the use of language in medical education and clinical encounters, from the perspective of an academic applied linguist. Dr. Skelton uses examples drawn from a variety of sources, ranging from observed clinical encounters from John Locke to Jean Luc Picard, to demonstrate the role of language interpersonal communication. In particular, he emphasizes the function of language as “doing things with words,” which is framing that originates with Speech Act Theory. He emphasizes four points relevant to clinical educators: the meaning of language varies according to context; the importance of having defined aims when speaking; the ability of language to illuminate, but not eliminate, ambiguity; and the relationship between language and power in the clinical setting.

Why should you read the article?

Dr. Skelton’s reflections on the task-focused use of language are particularly germane to anyone who has struggled to perfect the art of communicating effectively with patients, or has attempted to teach students and trainees to do so. His discussion of the disparity between “what we appear to mean on the surface, what we actually intend to mean, and what others take us to mean” is especially pertinent to medical education. He goes on to introduce the concept of communicative competence, and relate it to clinical practice, education, and professionalism.

How can you use this article?

This article touches on several philosophical and linguistic concepts which may be valuable to clinician educators involved in teaching communications skills, and concludes with some recommendations for educators. These include reflecting upon the power of language to effect change, encouraging the discussion of ideas, and embracing ambiguity and complexity in simulated scenarios.

Published 2021-07-01

Review Author:  Angela Shapshak, M.D., Associate Professor, Department of Neurology, University of Alabama School of Medicine, Birmingham, AL. ACE Member Organization: Consortium of Neurology Clerkship Directors

—————————————————————————————————————————————-

Medical Student Attitudes toward USMLE Step 1 and Health Systems Science – A Multi-Institutional Survey

Citation:  J. Bryan Carmody, Lauren M. Green, Patti G. Kiger, Jared D. Baxter, Todd Cassese, Tonya L. Fancher, Paul George, Erin J. Griffin, Yolanda C. Haywood, David Henderson, Nancy A. Hueppchen, David J. Karras, Andrea N. Leep Hunderfund, Janet E. Lindsley, Paul G. McGuire, Mimoza Meholli, Chad S. Miller, Seetha U. Monrad, Kari L. Nelson, Kristin A. Olson, Amit K. Pahwa, Stephanie R. Starr, Allan R. Tunkel, Richard N. Van Eck, Julie H. Youm, Deborah J. Ziring & Senthil K. Rajasekaran (2021) Medical Student Attitudes toward USMLE Step 1 and Health Systems Science – A Multi-Institutional Survey, Teaching and Learning in Medicine, 33:2, 139-153, DOI: 10.1080/10401334.2020.1825962.
https://doi.org/10.1080/10401334.2020.1825962

What is this article about?

Discussions surrounding the transition of the USMLE Step 1 to a pass or fail grading criteria while improving American healthcare are polarizing topics. This article explores medical students’ perceptions of the importance of the USMLE Step 1’s current numerical scoring system and the de-emphasis on lower yield topics such as Health Systems Sciences. The authors define Health System Sciences as “health systems improvement, population health, systems-thinking, and health policy.” It provides potential areas for improvement in healthcare education.

Why should you read the article?

Surveying a large sample of students at major academic centers across the US allows the authors to identify the motivations of medical students’ areas of emphasis of study. The article discusses the potential benefits on healthcare education with the transition to a USMLE Step 1 pass or fail system. It highlights the viable areas to restructure healthcare education and improve population health equity by implementing courses such as the Health Systems Sciences.

How can you use this article?

The article does not draw definitive evidence that restructuring healthcare education will improve population health; it does reflect on students’ motivational drives to emphasize specific topics over others. Traditionally, Health System Sciences and other related issues have been less of a focus for students because they are considered lower yield. The article provides a different perspective to support integrating these previous lower yield topics into the current curriculum.

Published 2021-06-04

Review Author:  Mila D. Shah-Bruce, M.D.; Assistant Professor and Director Ob/Gyn Clerkship; Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. ACE Member Organization: Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Applying the Theory of Gendered Organizations to the Lived Experience of Women with Established Careers in Academic Medicine 

Citation:  Dorene F. Balmer, Kelly A. Courts, Bridget Dougherty, Lucy Wolf Tuton, Stephanie Abbuhl & Laura E. Hirshfield (2020) Applying the Theory of Gendered Organizations to the Lived Experience of Women with Established Careers in Academic Medicine, Teaching and Learning in Medicine, 32:5, 466-475.   DOI: 10.1080/10401334.2020.1767106.
https://www.tandfonline.com/doi/full/10.1080/10401334.2020.1767106

What is this article about?

The authors use the Theory of Gendered Organizations as a framework for investigating gender bias in academic medicine.  Interview data from thirty women in mid-to advanced-level careers (associate or full professorship) were examined under the lens of interactions that were intentionally or unintentionally gendered.  Initial questioning did not include gender bias, specifically, though the issue was brought forth by the interviewees as they discussed authenticity in their careers, thus a specific line of questioning was added.  Their findings suggest that while overt measures have been taken to offset gender bias in formal processes within academic medicine, informal experiences include pervasive elements of bias that are deeply embedded in departmental culture.

Why should you read the article?

Gaps in gender inequity in academic medicine have been identified in attainment of leadership positions, academic advancement, and income. This article seeks to illustrate the difference between written policies and procedures supporting equity and women’s experiences in processes that lead to inequitable outcomes.  Many of the examples of experiences may unfortunately not be surprising; however, thinking about the enculturated process disparities, how deeply entrenched these attitudes may be in academic medicine, and how this perpetuates gender disparity is a powerful argument for systems change beyond simple policy rewriting.

The bright side of this study is the apparent dedication many of these physicians show in advocating for their junior female colleagues.  Inferentially, while advocacy alone may be of limited utility, the translational effect of essentially upstander behavior in gender advocacy may be a promising element of culture change.

How can you use this article?

Data are clear that gender disparity persists in salaries, academic promotion, and experiences.  The raw numbers may incite physicians to advocate for change, but this article digs a little deeper into the why’s.  Their qualitative findings highlight a need for more than just “lip service” policies and urge greater attention to culture and process.

Published 2021-05-06

Review Author:  Margaret Dow, M.D.; Director, Ob/Gyn Clerkship; Mayo Clinic Alix School of Medicine, Rochester, MN. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum 

Citation:  Mark R. Tonelli & Robyn Bluhm (2021) Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum, Teaching and Learning in Medicine, 33:1, 98-105, DOI: 10.1080/10401334.2020.1835666. https://www.tandfonline.com/doi/full/10.1080/10401334.2020.1835666

What is this article about?

Don’t shy away from the heady title!  The authors posit that epistemology, the philosophical branch dedicated to understanding knowledge itself, is an underemphasized element of medical education.  They argue that our recent emphasis on evidence-based medicine (EBM) has obscured the value and necessity of integrating clinical experience and underlying knowledge of pathophysiology in making sound clinical decisions.  They suggest that applying a metacognitive approach of applying EBM approaches to EBM itself may deepen learners’ understanding of the necessarily multifaceted nature of clinical medicine, as well as the potential pitfalls of using EBM as a sine qua non approach.  They conclude that teaching learners to think about how they are thinking improves their reasoning and contributes to sound decision-making.

Why should you read the article?

This article walks through defining epistemology, clarifying its value in medical education, and then breaking down a three-tiered approach to integrating its central tenets.  The authors encourage education on different types, levels, and hierarchies of evidence in the preclinical years, evolving to an understanding of how to assess evidence in undergraduate medical education, and culminating in an appreciation of integrating basic scientific knowledge, research findings, and clinical experience in graduate training and beyond.  In a refreshing turn, they emphasize the importance of considering lessons learned from the clinical realm as a valid and essential element of the art of medicine.

How can you use this article?

While the title might be frighteningly philosophical, the take home message is to encourage a much broader education on how to think about what we do and how to incorporate the value of basic sciences, research, and clinical experience into a more comprehensive approach.  They recommend utilizing case-based studies to explore these elements, and we as educators are positioned to benefit from this exercise as well.  Thinking about how we think may allow us to shape learners’ development even further by meting out what parts of our own approaches stem from underlying pathophysiology, from research, and from our experience.  The last of these can be difficult to identify clearly, and by doing so we model a broader, more integrated approach for the next generation to aspire to.

Published 2021-04-06

Review Author:  Margaret Dow, M.D.; Director, Ob/Gyn Clerkship; Mayo Clinic Alix School of Medicine, Rochester, MN. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change

Citation: James Dalton, Kimberley Ivory, Paul Macneill, Louise Nash, Jo River, Paul Dwyer, Claire Hooker, David Williams & Karen M. Scott (2020) Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change, Teaching and Learning in Medicine, 32:5, 531-540, DOI: 10.1080/10401334.2020.1768099 https://doi.org/10.1080/10401334.2020.1768099

What is this article about?

This article describes the use of Verbatim Theater (VT) to facilitate awareness and discussion of the hierarchy within the medical education and clinical environments, particularly related to mistreatment of learners and junior health professionals.  In VT, a script is created and performed using only the spoken words of informants for the purpose of attitudinal change.  In Australia, the Sydney Arts and Health Collective recruited and interviewed inter-professional healthcare students to create a play in the VT genre.  A month after performance of the play, open to the lay public, a subset of the audience comprising healthcare students and professionals reflected on training culture and potential for change.  Participants were able to recognize portrayals of their own experiences and propose antidotes to systemic issues, such as harassment and bullying.

Why should you read the article?

This article brings together 3 timely topics of interest to medical educators:  1) addressing trainee mistreatment 2) using the arts and humanities 3) incorporating inter-professional education.  Over the past decade, identification of the longstanding problem of medical student mistreatment has garnered increased attention. Bullying and harassment of trainees is not unique to Australia, and crosses the boundaries of disciplines beyond medicine to nursing and other healthcare disciplines.  Simultaneously, the American Association of Medical Colleges initiatives encourage the integration of the arts in medical education and inter-professional education.  This article describes a specific example of the use of the arts to promote cultural change in healthcare training and the reflection and discussion it generated.

How can you use this article?

As the COVID pandemic shines a spotlight on disparities and systemic racism in society, healthcare and medical education, medical students are eager to participate and lead efforts in reform.  Consider this exemplar of a theatrical genre to create and implement educational experiences integrating the arts to promote attitudinal and social change in your own curriculum.

Published 2021-03-05

Review Author:  Mary Blazek, M.D.; Clinical Associate Professor and Director, Geriatric Psychiatry Clinic; University of Michigan Medical School, Ann Arbor, MI. ACE Member Organization:  Association of Directors of Medical Student Education in Psychiatry

—————————————————————————————————————————————-

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Citation: Michelle E. Kiger, Caylin Riley, Adrienne Stolfi, Stephanie Morrison, Ann Burke & Tai Lockspeiser. (2020). Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students, Teaching and Learning in Medicine, 32:4, 399-409, DOI: 10.1080/10401334.2020.1713790 https://www.tandfonline.com/doi/abs/10.1080/10401334.2020.1713790

What is this article about?

This article is studying the use of individualized learning plans (ILP) in pediatric clerkships at two different institutions to evaluate if sharing learner ILPs affects the feedback students receive from faculty and resident preceptors.  The authors’ hypothesis was that sharing the learners’ ILP with the preceptor would improve the quality of feedback, would enhance the specificity of the feedback related to the ILP and improve the feedback as perceived by the learner.

Why should you read the article?

This article discusses the feedback loop between faculty/resident preceptors and medical students using ILPs to help promote and strengthen that circular relationship.  As educators, we know that specific timely feedback enables medical students to make behavioral changes that improve their performance.  This article shows how ILPs have the potential to focus preceptor attention to a student’s specific learning goal and plan which could potentially allow students to progress their learning in those specific goals.

Additionally, this study shows that faculty and student engagement and buy in is important when incorporating ILPs into the curriculum. Students who had significant progress on their learning goals found the ILP exercise to be more useful.

How can you use this article?

The learning environment with long term relationships between students and preceptors are situations where ILPs can take advantage of the strong interpersonal relationship between student and teacher. Incorporating preceptors in the process of the student developing their ILP could also be beneficial in helping students form meaningful ILPs and help faculty focus feedback and learner progress.

Published 2021-02-05

Review Author:  Corinne A Bazella, M.D.; Associate Professor and Director, Ob/Gyn Clerkship; Case Western Reserve University School of Medicine, Cleveland, OH. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Unpacking Medical Students’ Mixed Engagement in Health Systems Science Education

Citation: Jed D. Gonzalo, Christopher Davis, Britta M. Thompson & Paul Haidet (2020) Unpacking Medical Students’ Mixed Engagement in Health Systems Science Education, Teaching and Learning in Medicine, 32:3, 250-258, DOI: 10.1080/10401334.2019.1704765  https://www.tandfonline.com/doi/full/10.1080/10401334.2019.1704765

What is this article about?

The authors evaluate, qualitatively, one institution’s learner evaluations of an integrated health systems science curriculum. This third pillar to medical education, in addition to the basic and clinical sciences, includes competencies devoted to interprofessional collaboration, population health, and high value care. Any significant change in medical education brings the challenge of faculty and learner buy-in, development of content experts and course leadership, and identification and retention of resources. Exploring learners’ perceptions helps identify challenges and solutions.

Why should you read the article?

This article highlights a central tension in medical education: are we preparing learners to become future physicians, or are we focusing on preparing learners for high-stakes factual examinations? The hidden curriculum creates pressure on the learner to see these non-tested topics as a waste of time. Learners may fail to see these health system sciences competencies as encompassing their professional identities as physicians, and more of a “somebody else’s” problem.

The other important takeaway here is the power of the data we routinely collect to evaluate our curricula. The importance of identifying and understanding the perceptions of the consumers of the curriculum, the learners, is vital to future modifications. This is not the tail wagging the dog; instead harnessing learners’ concerns may aid in highlighting why these competencies are important.

How can you use this article?

While not the main message of the article, the authors highlight the meaningful use of evaluation data in the continuous quality improvement of a curriculum. For an additional pillar of medical education to be successful, both faculty and learners need to buy in and accept it.  Specifically addressing learner perceptions can lead to increased acceptance and engagement in new curricula.

Published 2020-09-24

Review Author:  Scott Graziano, M.D., MS; Professor of Obstetrics & Gynecology and Assistant Dean for for Clinical Development and Third Year Curricular Director for Loyola University Chicago, Stritch School of Medicine, Chicago, IL.  ACE member organization:  Association of Professors of Gynecology and Obstetrics