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Purpose: To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools., Method: The study was conducted by the Massachusetts Medical Schools' Collaborative, a working group committed to ensuring all medical students in Massachusetts receive foundational training in serious illness communication (SIC) and palliative care. Eight focus groups (2 per participating medical school) were conducted during January-May 2021 and included a total of 50 students from Boston University Chobanian & Avedisian School of Medicine, Harvard Medical School, Tufts University School of Medicine, and the UMass Chan Medical School. Data collected from focus groups were discussed and coded. Themes were identified using the immersion/crystallization qualitative data analysis approach., Results: Six key themes emerged. Students viewed SIC as essential to high-quality medical practice regardless of specialty, and believed training in SIC skills and palliative care should be required in medical school curricula. Students preferred to learn and practice these skills using frameworks, particularly in real-world situations. Students recognized the expertise of palliative care specialists and described them as a scarce, often misunderstood resource in health care. Students reported it was mostly "luck" if they were included in family meetings and observed good role models. Finally, students desired practice in debriefing after difficult and emotional situations., Conclusions: This study confirms long-standing themes on students' experiences with SIC and palliative care topics, including feeling inadequately prepared to care for seriously ill patients as future physicians. Our study collected students' perspectives as actionable data to develop recommendations for curricular change. Collaborative faculty also created recommendations based on the focus group data for immediate and ongoing SIC and palliative care curricular change in Massachusetts, which can apply to medical schools nationwide., (Copyright © 2024 the Association of American Medical Colleges.)

The COVID-19 pandemic has presented unprecedented challenges and opportunities for medical schools in the United States. In this Invited Commentary, the authors describe a unique collaboration between the University of Massachusetts Medical School (UMMS), the only public medical school in the state; the University of Massachusetts Memorial Medical Center (UMMMC); and the Commonwealth of Massachusetts. Through this partnership, UMMS was able to graduate fourth-year medical students 2 months early and deploy them to UMMMC to care for patients and alleviate workforce shortages during the COVID-19 surge, which peaked in Massachusetts in April 2020. The authors describe how they determined if students had fulfilled graduation requirements to graduate early, what commencement and the accompanying awards ceremony looked like this year as virtual events, the special emergency 90-day limited license these new graduates were given to practice at UMMMC during this time, and the impact these new physicians had in the hospital allowing residents and attendings to be redeployed to care for COVID-19 patients.

Critical thinking is essential to a health professional's competence to assess, diagnose, and care for patients. Defined as the ability to apply higher-order cognitive skills (conceptualization, analysis, evaluation) and the disposition to be deliberate about thinking (being open-minded or intellectually honest) that lead to action that is logical and appropriate, critical thinking represents a "meta-competency" that transcends other knowledge, skills, abilities, and behaviors required in health care professions. Despite its importance, the developmental stages of critical thinking have not been delineated for nurses and physicians. As part of a task force of educators who considered different developmental stage theories, the authors have iteratively refined and proposed milestones in critical thinking. The attributes associated with unreflective, beginning, practicing, advanced, accomplished, and challenged critical thinkers are conceived as independent of an individual's level of training. Depending on circumstances and environmental factors, even the most experienced clinician may demonstrate attributes associated with a challenged thinker. The authors use the illustrative case of a patient with abdominal pain to demonstrate how critical thinking may manifest in learners at different stages of development, analyzing how the learner at each stage applies information obtained in the patient interaction to arrive at a differential diagnosis and plan for evaluation. The authors share important considerations and provide this work as a foundation for the development of effective approaches to teaching and promoting critical thinking and to establishing expectations for learners in this essential meta-competency.

Purpose: Growing data support interprofessional teams as an important part of medical education. This study describes attitudes, barriers, and practices regarding interprofessional education (IPE) in internal medicine (IM) clerkships in the United States and Canada., Method: In 2009, a section on IPE was included on the Clerkship Directors in Internal Medicine annual survey. This section contained 23 multiple-choice questions exploring both core and subinternship experiences. Data were analyzed using descriptive statistics and Rasch analysis., Results: Sixty-nine of 107 institutional members responded to the survey (64% response rate). Approximately 68% of responding clerkship directors believed that IPE is important to the practice of IM. However, only 57% believed that it should become a part of the undergraduate clinical curriculum. The three most significant barriers to IPE in the IM clerkship were scheduling alignment, time in the existing curriculum, and resources in time and money. Although more than half of respondents felt IPE should be included in the clinical curriculum, 81% indicated that there was no formal curriculum on IPE in their core IM clerkship, and 84% indicated that there was no formal curriculum during IM subinternship rotations at their institution., Conclusions: There is limited penetration of IPE into one of the foundational clinical training episodes for medical students in Liaison Committee for Medical Education-accredited schools. This may be related to misperceptions of the relative value of these experiences and limitations of curricular time. Learning in and from successful models of interprofessional teams in clinical practice may help overcome these barriers.

Purpose: To describe current patient safety curricula at U.S. and Canadian medical schools and identify factors associated with adoption of these programs., Method: A survey was mailed to institutional members of the Clerkship Directors in Internal Medicine at U.S. and Canadian academic medical schools in 2006. Respondents self-reported implementation of patient safety curricula and associated methods of instruction at the institution level., Results: The survey had a 76% response rate (83/110). Only 25% of institutional members reported that their schools had explicit patient safety curricula. All respondents that reported having curricula use lectures and small-group instruction, and these were more likely to occur in preclinical settings. Topics and methods of instruction included reporting adverse incidents and analysis of medical errors; improvement of physician order writing to prevent medication errors; core measures; national patient safety goals; and standardization of medical care through the use of clinical guidelines and order set templates. Although only 25% of respondents reported having explicit curricula, 72% agreed that patient safety instruction should occur during medical school., Conclusions: Despite calls from regulatory, medical, and educational organizations to increase patient safety training of medical students, internal medicine clerkship directors report that few schools in the United States and Canada have implemented specific patient safety curricula. Most existing patient safety curricula use lecture and small-group discussion as preferred methods of instruction.

Background: Preceptors must respond to trainees' medical errors, but little is known about what factors influence their responses., Method: A total of 115 primary care preceptors from 16 medical schools responded to two medical error vignettes involving a trainee. Nine trainee-related factors were randomly varied. Preceptors indicated whether they would discuss what led to the error, provide reassurance, share responsibility, express disappointment, and adjust their written evaluation of the trainee., Results: Almost all preceptors would discuss what led to the error; relatively few would express disappointment. The trainee's prior history of errors, knowledge level relative to peers, receptivity to feedback, training level, emotional reaction, offering to apologize, and offering an excuse were predictive of preceptors' responses; gender and time-in-office were not., Conclusion: This study identified seven trainee-related factors as predictive of preceptors' responses to medical errors. More research is needed to identify other influential factors, and to improve teaching from medical errors.