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Academic Medicine: Journal of the Association of American Medical Colleges

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https://www.readbyqxmd.com/read/28930765/encouraging-reflexivity-in-a-residency-leadership-development-program-expanding-outside-the-competency-approach
#1
Justin T Clapp, Emily K B Gordon, Dimitry J Baranov, Beulah Trey, Felice Y Tilin, Lee A Fleisher
PROBLEM: While leadership development is increasingly a goal of academic medicine, it is typically framed as competency acquisition, which can limit its focus to a circumscribed set of social behaviors. This orientation may also reinforce the cultural characteristics of academic medicine that can make effective leadership difficult, rather than training leaders capable of examining and changing this culture. Expanding leadership development so it promotes social reflexivity presents a way to bolster some of the weaknesses of the competency paradigm...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28930764/when-listening-is-better-than-reading-performance-gains-on-cardiac-auscultation-test-questions
#2
Kathleen Short, S Deniz Bucak, Francine Rosenthal, Mark R Raymond
PURPOSE: In 2007, the United States Medical Licensing Examination embedded multimedia simulations of heart sounds into multiple-choice questions. This study investigated changes in item difficulty as determined by examinee performance over time. The data reflect outcomes obtained following initial use of multimedia items from 2007 through 2012, after which an interface change occurred. METHOD: A total of 233,157 examinees responded to 1,306 cardiology test items over the six-year period; 138 items included multimedia simulations of heart sounds, while 1,168 text-based items without multimedia served as controls...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28930763/a-new-community-health-center-academic-medicine-partnership-for-medicaid-cost-control-powered-by-the-mega-teaching-health-center
#3
Richard E Rieselbach, Ted Epperly, Aaron Friedman, David Keahey, Eleanor McConnell, Karen Nichols, Greg Nycz, Jeanette Roberts, Kenneth Schmader, Peter Shin, Derri Shtasel
Community health centers (CHCs), a principal source of primary care for over 24 million patients, provide high-quality affordable care for medically underserved and lower-income populations in urban and rural communities. The authors propose that CHCs can assume an important role in the quest for health care reform by serving substantially more Medicaid patients. Major expansion of CHCs, powered by mega teaching health centers (THCs) in partnership with regional academic medical centers (AMCs) or teaching hospitals, could increase Medicaid beneficiaries' access to cost-effective care...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28930762/competency-based-medical-education-in-the-internal-medicine-clerkship-a-report-from-the-alliance-for-academic-internal-medicine-undergraduate-medical-education-task-force
#4
Sara B Fazio, Cynthia H Ledford, Paul B Aronowitz, Shobhina G Chheda, John H Choe, Stephanie A Call, Scott D Gitlin, Marty Muntz, L James Nixon, Anne G Pereira, John W Ragsdale, Emily A Stewart, Karen E Hauer
As medical educators continue to redefine learning and assessment across the continuum, implementation of competency-based medical education in the undergraduate setting has become a focus of many medical schools. While standards of competency have been defined for the graduating student, there is no uniform approach for defining competency expectations for students during their core clerkship year. The authors describe the process by which an Alliance for Academic Internal Medicine task force developed a paradigm for competency-based assessment of students during their inpatient internal medicine (IM) clerkship...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28930761/factors-associated-with-medical-school-graduates-intention-to-work-with-underserved-populations-policy-implications-for-advancing-workforce-diversity
#5
Andrea N Garcia, Tony Kuo, Lisa Arangua, Eliseo J Pérez-Stable
PURPOSE: Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). METHOD: Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28930760/medical-education-and-health-care-delivery-a-call-to-better-align-goals-and-purposes
#6
David P Sklar, Paul A Hemmer, Steven J Durning
The transformation of the U.S. health care system is under way, driven by the needs of an aging population, rising health care spending, and the availability of health information. However, the speed and effectiveness of the transformation of health care delivery will depend, in large part, upon engagement of the health professions community and changes in clinicians' practice behaviors. Current efforts to influence practice behaviors emphasize changes in the health payment system with incentives to move from fee-for-service to alternative payment models...
September 14, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28906264/governance-of-academic-medical-centers-is-indeed-a-complex-and-unique-operation
#7
David S Guzick, Donald E Wilson
As academic medical centers (AMCs) have extended their operations into their communities, partnered with new organizations, and developed new modes of operation to achieve their missions, new governance approaches are required. Chari and colleagues, in this issue of Academic Medicine, describe the development and application of criteria to evaluate governance options for the University of California (UC), which has a number of public AMCs, almost all of which are components of individual UC universities. Although many of these criteria may also be applicable to smaller AMCs, a more individual approach to governance is required-that is, one must step back and first ask about the organization, structure, and goals of the entities to be governed...
September 12, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28906263/governing-academic-medical-center-systems-evaluating-and-choosing-among-alternative-governance-approaches
#8
Ramya Chari, Claire O'Hanlon, Peggy Chen, Kristin Leuschner, Christopher Nelson
The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission...
September 12, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28906262/characteristics-of-interim-deans-at-u-s-medical-schools-implications-for-institutions-and-individuals
#9
Sarah A Bunton, Pamela Sass, Rae Anne Sloane, R Kevin Grigsby
PURPOSE: To provide a baseline, descriptive understanding of individuals serving as interim deans at U.S. medical schools. Over the past quarter century, roughly 9% to 16% of all medical school deans were serving as interim leaders. This research reviews demographic characteristics, how long they served, and the impact of having served on one's likelihood of serving as a permanent dean. METHOD: The Association of American Medical Colleges' Council of Deans national database was the data source for this study...
September 12, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28877035/academic-medicine-and-medical-professionalism-a-legacy-and-a-portal-into-an-evolving-field-of-educational-scholarship
#10
Frederic W Hafferty
In this Invited Commentary, the author examines two curated Academic Medicine volumes showcasing foundational research and key writings on professionalism in medicine and medical education, collectively spanning from 1994 to 2016. The author reviews the beginnings of the medical professionalism movement and examines how the trends and themes reflected in the first volume-specifically the work to define, assess, and institutionalize professionalism-capture key elements in this movement. He then examines how the trends and themes in the second volume align with and build on those from the first, noting two themes that extend across a number of second volume articles: a unit-of-analysis issue and the challenge of context...
September 5, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28857791/the-high-value-care-rounding-tool-development-and-validity-evidence
#11
Corrie E McDaniel, Andrew A White, Miranda C Bradford, Carolyn D Sy, Tiffany Chen, Doug Brock, Jeffrey Foti, Jimmy B Beck
Little is known about current practices in high-value care (HVC) bedside teaching. A lack of instruments for measuring bedside HVC behaviors confounds efforts to assess the impact of curricular interventions. The authors aimed to define observable HVC concepts by developing an instrument to measure the content and frequency of HVC discussions.The authors developed the HVC Rounding Tool in four iterative phases, using Messick's validity framework. Phases 1 and 2 were designed to collect evidence of content validity, Phases 3 and 4 to collect evidence of response process and internal structure...
August 29, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28857790/critical-thoughts-about-the-core-entrustable-professional-activities-in-undergraduate-medical-education
#12
Edward Krupat
The Core Entrustable Professional Activities for Entering Residency (Core EPAs) have taken a strong hold on undergraduate medical education (UME). This Perspective questions their value added and considers the utility of the Core EPAs along two separate dimensions: (1) the ways they change the content and focus of the goals of UME; and (2) the extent to which entrustable professional activity (EPA)-based assessment conforms to basic principles of measurement theory as practiced in the social sciences. Concerning content and focus, the author asks whether the 13 Core EPAs frame UME too narrowly, putting competencies into the background and overlooking certain aspirational, but important and measurable, objectives of UME...
August 29, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28857789/competency-based-medical-education-and-the-ghost-of-kuhn-reflections-on-the-messy-and-meaningful-work-of-transformation
#13
Eric S Holmboe
The transition, if not transformation, to outcomes-based medical education likely represents a paradigm shift struggling to be realized. Paradigm shifts are messy and difficult but ultimately meaningful if done successfully. This struggle has engendered tension and disagreements, with many of these disagreements cast as either-or polarities. There is little disagreement, however, that the health care system is not effectively achieving the triple aim for all patients. Much of the tension and polarity revolve around how more effectively to prepare students and residents to work in and help change a complex health care system...
August 29, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28834846/can-we-increase-the-value-and-decrease-the-cost-of-clinical-skills-assessment
#14
William P Burdick, John R Boulet, Kim Edward LeBlanc
Although the authors do not agree with medical students' bid to end the United States Medical Licensing Examination Step 2 Clinical Skills or Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation tests, they concur with Ecker and colleagues that conducting further research to support the validity argument, providing greater feedback on performance, and exploring options to reduce costs are important for addressing students' concerns. Evidence to support the validity of clinical skills exam scores and associated inferences already exists...
August 22, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28834845/primary-care-residents-in-teaching-health-centers-their-intentions-to-practice-in-underserved-settings-after-residency-training
#15
Zohray Talib, Mariellen Malloy Jewers, Julia H Strasser, David K Popiel, Debora Goetz Goldberg, Candice Chen, Hayden Kepley, Fitzhugh Mullan, Marsha Regenstein
PURPOSE: To describe the residents who chose to train in teaching health centers (THCs), which are community-based ambulatory patient care sites that sponsor primary care residencies, and their intentions to practice in underserved settings. METHOD: The authors surveyed all THC residents training in academic years 2013-2014, 2014-2015, and 2015-2016, comparing their demographic characteristics with data available for residents nationally, and examined THC residents' intentions to practice in underserved settings using logistic regression analysis...
August 22, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28834844/barriers-to-career-flexibility-in-academic-medicine-a-qualitative-analysis-of-reasons-for-the-underutilization-of-family-friendly-policies-and-implications-for-institutional-change-and-department-chair-leadership
#16
Kimberlee Shauman, Lydia P Howell, Debora A Paterniti, Laurel A Beckett, Amparo C Villablanca
PURPOSE: Academic medical and biomedical professionals need workplace flexibility to manage the demands of work and family roles and meet their commitments to both, but often fail to use the very programs and benefits that provide flexibility. This study investigated the reasons for faculty underutilization of work-life programs. METHOD: As part of a National Institutes of Health-funded study, in 2010 the authors investigated attitudes of clinical and/or research biomedical faculty at the University of California, Davis, toward work-life policies, and the rationale behind their individual decisions regarding use of flexibility policies...
August 22, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28834843/step-up-not-on-the-step-2-clinical-skills-exam-directors-of-clinical-skills-courses-docs-oppose-ending-step-2-cs
#17
David J Ecker, Felise B Milan, Todd Cassese, Jeanne M Farnan, Wendy S Madigosky, F Stanford Massie, Paul Mendez, Sharon Obadia, Robin K Ovitsh, Ronald Silvestri, Toshiko Uchida, Michelle Daniel
Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration...
August 22, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28834842/the-decanal-divide-women-in-decanal-roles-at-u-s-medical-schools
#18
Nina F Schor
PURPOSE: To test the hypotheses that women in medical school dean-level (decanal) positions occupy lower-rank and more image- and education-focused positions than men, and that state and woman-led schools have more women in decanal positions. METHOD: Data were collected on September 10-18, 2016, from Web sites of 136 allopathic, U.S. medical schools accredited by the Liaison Committee on Medical Education and represented on the roster of accredited MD programs in the United States with full accreditation as of June 22, 2016...
August 22, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28817433/class-wide-access-to-a-commercial-step-1-question-bank-during-preclinical-organ-based-modules-a-pilot-project
#19
James H Baños, Mark E Pepin, Nicholas Van Wagoner
PURPOSE: The authors examined the usefulness of a commercially available Step 1 question bank as a formative academic support tool throughout organ-based modules in an integrated preclinical medical curriculum. The authors also determined the extent to which correlation between question bank utilization and academic metrics varied with Medical College Admission Test (MCAT) scores. METHOD: In 2015, a cohort of 185 first-year medical students at University of Alabama School of Medicine were provided with 18-month full access to a commercially available Step 1 question bank of over 2,100 items throughout organ-based modules, although there were no requirements for use...
August 16, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28817432/the-problems-with-burnout-research
#20
Jodie Eckleberry-Hunt, Heather Kirkpatrick, Thomas Barbera
Burnout among physicians and physicians-in-training is well established as a potential threat to the health and well-being of health care providers and patients. However, there are myriad problems with current burnout research and its ongoing measurement that threaten the validity of the conclusions. For example, researchers have used differing ways of defining and measuring burnout. Those who have used the Maslach Burnout Inventory vary in recommended use of the instrument and cutoff scores. As a result, the authors suggest that the term "burnout" may be misused and recommend some reconsideration of the meaning of burnout...
August 16, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
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