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health professions educators are increasingly called on to engage learners in more meaningful instruction. Many have used Wikipedia to offer an applied approach to engage learners, particularly learning related to evidence-based medicine (EBM). However, little is known about the benefits and challenges of using Wikipedia as a pedagogic tool from the collective experience of educators who have sought to improve their instructional practice with it. This study aims to synthesize the perspectives of health professions education (HPE) instructors on the incorporation of Wikipedia editing into their HPE courses.Applying a constructivist approach, the authors conducted semistructured interviews from July to December 2020, with 17 participating HPE instructors who had substantively integrated Wikipedia into their curriculum at 13 institutions. Participants were interviewed about their experiences of integrating Wikipedia editing into their courses. Thematic analysis was conducted on resulting transcripts.The authors observed 2 broad themes among participants' expressed benefits of teaching with Wikipedia. First, Wikipedia provides a meaningful instructional alternative that also helps society and develops learners' information literacy and EBM skills. Second, Wikipedia supports learners' careers and professional identity formation. Identified challenges included high effort and time, restrictive Wikipedia sourcing guidelines, and difficult interactions with stakeholders.Findings build on known benefits, such as providing a real-world collaborative project that contextualizes students' learning experiences. They also echo known challenges, such as the resource-intensive nature of teaching with Wikipedia. The findings of this study reveal the potential of Wikipedia to enculturate HPE students within a situated learning context. They also present implications for HPE programs that are considering implementing Wikipedia and faculty development needed to help instructors harness crowd-sourced information tools' pedagogic opportunities as well as anticipate their challenges.

Shared decision making, a collaborative approach between patient and provider that considers the patient's values and preferences in addition to the scientific evidence, is a complex clinical activity that has not realized its full potential. Gaps in education and training have been cited as barriers to shared decision making, and evidence is inconsistent on effective educational interventions. Because individual agents with their own social and behavioral contexts co-construct a shared decision, the educational approach may need to consider the role of patient agency and sociocultural influences. To address the inherent complexity in shared decision making, the authors identified cultural historical activity theory (CHAT) as a framework for analysis. Although certainly not the only relevant theory, CHAT offers an appropriate lens through which the multivoiced nature of shared decision making can be more clearly appreciated. In this article, the authors demonstrate the application of CHAT as a lens for researchers and educators to examine the complexity of shared decision making. The fictitious case presented in this article describes the use of CHAT with a patient who experiences 2 clinical encounters; during the second, shared decision making takes place. Elements of the case are threaded through the article, demonstrating a sample analysis of the interacting activity systems of the patient and physician and highlighting inherent tensions and contradictions. The authors propose CHAT as a tool for future research around the role of agency in shared decision making and other complex topics and as a framework for design of novel instructional strategies. Although not applicable to all topics and settings, CHAT has significant potential within health professions education.

Problem While ideal curricular structures for effective teaching of evidence-based medicine (EBM) have not been definitively determined, optimal strategies ensure that EBM teaching is interactive and clinically based, aligns with major trends in education and health care, and uses longitudinally integrated, whole-task activities. Approach The authors developed a longitudinal, semester-long project, embedded in a first-year medicine course, through which they taught EBM using Wikipedia as a platform. Students worked individually and in small groups to choose a medicine-related Wikipedia article, identify information gaps, search for high-quality resources, appraise the sources, and incorporate the new information into the article (i.e., by editing Wikipedia). Students also applied their new appraisal skills to critique a second article. The authors used an online tool to track and record student editing, and they obtained qualitative data on student perceptions of the project via survey. Duplicate marking of a sample of assignments was performed using the Valid Assessment of Learning in Undergraduate Education critical thinking rubric developed by Finley and Rhodes. Outcomes In fall 2017, 101 students made over 1,000 unique edits to 16 online Wikipedia articles, adding over 10,000 words. Through thematic analysis of qualitative data, the authors highlighted several aspects of the project that students appreciated, as well as barriers related to completing their projects. Correlation of the 17 consenting students' final assignments with the critical thinking rubric supports the assignment structure as a tool for assessing critical thinking. Next steps This authentic task adheres to the principles of high-quality EBM instruction and could be implemented by a variety of health care educational programs. Modifications to the delivery model are underway to address challenges identified.

Engaging in questionable research practices (QRPs) is a noted problem across many disciplines, including medical education. While QRPs are rarely discussed in the context of medical education, that does not mean that medical education researchers are immune. Therefore, the authors seek to raise medical educators' awareness of the responsible conduct of research (RCR) and call the community to action before QRPs negatively affect the field. The authors define QRPs and introduce examples that could easily happen in medical education research because of vulnerabilities particular to the field. The authors suggest that efforts in research, including medical education research, should focus on facilitating a change in the culture of research to foster RCR, and that these efforts should make explicit both the individual and system factors that ultimately influence researcher behavior. They propose a set of approaches within medical education training initiatives to foster such a culture: empowering research mentors as role models, open airing of research conduct dilemmas and infractions, protecting whistle blowers, establishing mechanisms for facilitating responsibly conducted research, and rewarding responsible researchers. The authors recommend that efforts at culture change be focused on the growing graduate programs, fellowships, and faculty academies in medical education to ensure that RCR training is an integral component for both students and faculty. They encourage medical education researchers to think creatively about solutions to the challenges they face and to act together as an international community to avoid wasting research efforts, damaging careers, and stunting medical education research through QRPs.

Manuscripts submitted to Academic Medicine (AM) undergo an internal editor review to determine whether they will be sent for external peer review. Increasingly, manuscripts are rejected at this early stage. This study seeks to inform scholars about common reasons for internal editor review rejections, increase transparency of the process, and provide suggestions for improving submissions.A mixed-methods approach was used to retrospectively analyze editors' free-text comments. Descriptive content analysis was performed of editors' comments for 369 manuscripts submitted between December 2014 and December 2015, and rejected prior to external peer review from AM. Comments were analyzed, categorized, and counted for explicit reasons for rejection.Nine categories of rejection reasons were identified: ineffective study question and/or design (338; 92%); suboptimal data collection process (180; 49%); weak discussion and/or conclusions (139; 37%); unimportant or irrelevant topic to the journal's mission (137; 37%); weak data analysis and/or presentation of results (120; 33%); text difficult to follow, to understand (89; 24%); inadequate or incomplete introduction (67; 18%); other publishing considerations (42; 11%); and issues with scientific conduct (20; 5%). Manuscripts had, on average, three or more reasons for rejection.Findings suggest that clear identification of a research question that is addressed by a well-designed study methodology on a topic aligned with the mission of the journal would address many of the problems that lead to rejection through the internal review process. The findings also align with research on external peer review.

Purpose Despite calls to improve nutrition education, training for medical students is inadequate. This systematic review provides an overview of published educational interventions for undergraduate-level health professionals and makes recommendations for improving nutrition training. Method The authors conducted a systematic review of articles (through July 16, 2015) and examined resources in MedEdPORTAL (through September 28, 2015) focused on materials published since January 2004 that describe nutrition educational interventions for undergraduate-level health professionals. The authors extracted data on pedagogical characteristics, content areas covered, study design, and study outcomes. Results Of 1,616 article citations, 32 met inclusion criteria. Most were designed at a single institution (n = 29) for medical students (n = 24). Of 51 MedEdPORTAL resources, 15 met inclusion criteria. Most were designed at a single institution (n = 12) for medical students (n = 15). Interventions spread across several countries, learner levels, and settings. Content areas covered included basic science nutrition, population health, counseling, and training framed by specific patient populations and organ systems. No clear trends were observed for intended learning outcomes, type of instructor, method of instruction, or duration. Conclusions The heterogeneity of interventions and the content areas covered highlight the lack of adopted curricular standards for teaching clinical nutrition. Recommendations that educators should consider include interprofessional education approaches, online learning, placing an emphasis on learners’ personal health behaviors, and standardized and real patient interactions. Educators should continue to publish curricular materials and prioritize the evaluation and sharing of resources.

Supplemental Digital Content is available in the text., Problem Most medical students use Wikipedia as an information source, yet medical schools do not train students to improve Wikipedia or use it critically. Approach Between November 2013 and November 2015, the authors offered fourth-year medical students a credit-bearing course to edit Wikipedia. The course was designed, delivered, and evaluated by faculty, medical librarians, and personnel from WikiProject Medicine, Wikipedia Education Foundation, and Translators Without Borders. The authors assessed the effect of the students’ edits on Wikipedia’s content, the effect of the course on student participants, and readership of students’ chosen articles. Outcomes Forty-three enrolled students made 1,528 edits (average 36/student), contributing 493,994 content bytes (average 11,488/student). They added higher-quality and removed lower-quality sources for a net addition of 274 references (average 6/student). As of July 2016, none of the contributions of the first 28 students (2013, 2014) have been reversed or vandalized. Students discovered a tension between comprehensiveness and readability/translatability, yet readability of most articles increased. Students felt they improved their articles, enjoyed giving back “specifically to Wikipedia,” and broadened their sense of physician responsibilities in the socially networked information era. During only the “active editing months,” Wikipedia traffic statistics indicate that the 43 articles were collectively viewed 1,116,065 times. Subsequent to students’ efforts, these articles have been viewed nearly 22 million times. Next Steps If other schools replicate and improve on this initiative, future multi-institution studies could more accurately measure the effect of medical students on Wikipedia, and vice versa.

Evidence-based medicine (EBM) is a fixture in many medical school curricula. Yet, little is known about the challenges medical students face in learning EBM or the educational approaches that medical schools use to overcome these challenges.A qualitative multi-institutional case study was conducted between December 2013 and July 2014. On the basis of the Association of American Medical Colleges 2012 Medical School Graduation Questionnaire data, the authors selected 22 U.S. and Canadian Liaison Committee on Medical Education-accredited medical schools with graduates reporting confidence in their EBM skills. Participants were interviewed and asked to submit EBM curricular materials. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach.Thirty-one EBM instructors (17 clinicians, 11 librarians, 2 educationalists, and 1 epidemiologist) were interviewed from 17 medical schools (13 in the United States, 4 in Canada). Four common EBM learning challenges were identified: suboptimal role models, students' lack of willingness to admit uncertainty, a lack of clinical context, and students' difficulty mastering EBM skills. Five educational approaches to these challenges that were common across the participating institutions were identified: integrating EBM with other courses and content, incorporating clinical content into EBM training, EBM faculty development, EBM whole-task exercises, and longitudinal integration of EBM.The identification of these four learner-centered EBM challenges expands on the literature on challenges in teaching and practicing EBM, and the identification of these five educational approaches provides medical educators with potential strategies to inform the design of EBM curricula.

Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

Medical education literature has been found to lack key components of scientific reporting, including adequate descriptions of literature searches, thus preventing medical educators from replicating and building on previous scholarship. The purpose of this study was to examine the reproducibility of search strategies as reported in medical education literature reviews.The authors searched for and identified literature reviews published in 2009 in Academic Medicine, Teaching and Learning in Medicine, and Medical Education. They searched for citations whose titles included the words "meta-analysis," "systematic literature review," "systematic review," or "literature review," or whose publication type MEDLINE listed as "meta-analysis" or "review." The authors created a checklist to identify key characteristics of literature searches and of literature search reporting within the full text of the reviews. The authors deemed searches reproducible only if the review reported both a search date and Boolean operators.Of the 34 reviews meeting the inclusion criteria, 19 (56%) explicitly described a literature search and mentioned MEDLINE; however, only 14 (41%) also mentioned searches of nonmedical databases. Eighteen reviews (53%) listed search terms, but only 6 (18%) listed Medical Subject Headings, and only 2 (6%) mentioned Boolean operators. Fifteen (44%) noted the use of limits. None of the reviews included reproducible searches.According to this analysis, literature search strategies in medical education reviews are highly variable and generally not reproducible. The authors provide recommendations to facilitate future high-quality, transparent, and reproducible literature searches.