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Entrustable professional activities (EPAs) have seen widespread adoption in medical education and other health professions education. EPAs aim to provide a bridge between competency-based education and clinical practice by translating competencies into fundamental profession-specific tasks associated with clinical practice. Despite the extensive use of EPAs in health professions education, EPAs have yet to be introduced into chiropractic education. The purpose of this paper is to describe the development and introduction of EPAs as part of 2 community-based chiropractic student preceptorship education programs in the United States. EPAs were developed and introduced at 2 community-based chiropractic preceptorship sites in 5 distinct steps: (1) differentiating EPAs from competencies, learning objectives, and knowledge, skills, and attitudes; (2) identifying EPAs; (3) mapping EPAs to competencies and necessary experience, knowledge, and skills; (4) designing EPA assessment strategies; and (5) implementing the use of EPAs. A total of 13 individual EPAs were developed and mapped to Council on Chiropractic Education meta-competency outcomes and underlying experience, knowledge, and skills. Three assessment tools were created to evaluate student entrustability for EPAs and enhance student self-assessment. The EPAs and assessment tools were integrated into chiropractic student preceptorships at each site. This paper describes the development and introduction of EPAs at 2 community-based chiropractic preceptorship sites. Future research is needed to develop and standardize EPA use and assessment, and to evaluate outcomes associated with EPA use. [ABSTRACT FROM AUTHOR]

Background: Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counseling patients on anesthesia for this procedure. We designed an Option Grid™-style conversation aid, My Anesthesia Choice─Hip Fracture, to promote shared decision making in this interaction. This study will refine the aid and evaluate its implementation and effectiveness in clinical practice. Methods: The study will be conducted over 2 phases: qualitative interviews with relevant clinicians and patients to refine the aid, followed by a stepped wedge cluster randomized trial of the intervention at 6 settings in the US. Primary outcomes will include the percentage of eligible patients who receive the intervention (intervention reach) and the change in quality of patient/clinician communication (intervention effectiveness). Secondary outcomes addressing other RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) domains will also be collected. Outcomes will be compared between baseline data and an active implementation period and then compared between the active implementation period and a sustainment period. Implementation strategies are guided by three constructs from the Practical, Robust Implementation and Sustainability Model (PRISM): intervention, recipients, and implementation and sustainability infrastructure. Discussion: This is a novel, large-scale trial evaluating and implementing a shared decision-making conversation aid for anesthesia choices. Strong buy-in from site leads and expert advisors will support both the success of implementation and the future dissemination of results and the intervention. Results from this study will inform the broader implementation of this aid for patients with hip fractures and can lead to the development and implementation of similar conversation aids for other anesthesia choices. Trial registration: ClinicalTrials.gov, NCT06438640 [ABSTRACT FROM AUTHOR]

Background: An assessment program should be inclusive and ensure that the various components of medical knowledge, clinical skills, and professionalism are assessed. The level and the variation over time in the strength of the correlation between these components of assessment is still a matter of study. Based on the meaningful learning theory and the integrated learning theory, we hypothesize that these components increase their connections during the medical school course. Methods: This is a retrospective cohort study that analyzed data collected for a 10-year period in one medical school. We included students from the 3rd to 6th year of medical school from 2011 to 2021. Three assessment components were addressed: Knowledge, Clinical Skills, and Professionalism. For data analysis, Pearson correlation coefficients (R) and R2 were calculated to study the correlation between variables and a z-test on Fisher's r-to-z was used to determine the differences between correlation coefficients. Results: 949 medical students were included in the study. The correlation between Clinical Skills and Professionalism showed a medium to strong association (Pearson's R ranging from 0.485 to 0.734), while the correlation between Knowledge and Professionalism was weaker but exhibited a steady evolution with Pearson's R fluctuating between 0.075 and 0.218. The Knowledge and Clinical Skills correlation became statistically significant from 2013 onwards and peaking at Pearson's R of 0.440 for the cohort spanning 2016–2019. We also revealed a strengthening of correlations between Professionalism and Clinical Skills from the beginning to the end of clinical training, but not with the knowledge component. Conclusions: This analysis contributes to our understanding of the dynamics of correlations of different assessment components within an institution and provides a framework for how they interact and influence each other. Trial registration: This study was not a clinical trial, but a retrospective observational study, without health care interventions. Nevertheless, we provide herein the number of the study as submitted to the Ethics committee – CEICVS 146/2021. [ABSTRACT FROM AUTHOR]

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience. [ABSTRACT FROM AUTHOR]

The Seasonal Affective Disorder (SAD) is a disorder characterized by prolonged periods of depression and various physical and psychological symptoms experienced during specific seasons, typically winter. In this review aims to provide a comprehensive overview of SAD with a specific focus on psychophysiological aspects. Through the review from ancient times to the present, this paper explores the characteristics, causes, and underlying mechanisms of SAD. Particularly, it comprehensively reviews the research findings on the relationship between external factors such as light, sunlight, climate, and their association with SAD. Furthermore, the paper discusses the interplay between SAD and psychophysiological changes, along with the latest research trends in treatment and prevention strategies. By combining theoretical and practical perspectives on SAD, this article aims to provide a holistic understanding and offer suggestions for future research directions and clinical interventions. [ABSTRACT FROM AUTHOR]

Background: Entrustable professional activities (EPAs) are observable process descriptions of clinical work units. EPAs support learners and tutors in assessment within healthcare settings. For use amongst our pharmacy students as well as pre-registration pharmacists we wanted to develop and validate an EPA for use in a clinical pharmacy setting at LMU University Hospital. Methods: The development of the clinical pharmacy EPA followed a set pathway. A rapid literature review informed the first draft, an interprofessional consensus group consisting of pharmacists, nurses, and medical doctors refined this draft. The refined version was then validated via online survey utilising clinical pharmacists from Germany. Results: We designed, refined and validated an EPA regarding medication reconciliation for assessment of pharmacy students and trainees within the pharmacy department at LMU University Hospital in Munich. Along with the EPA description an associated checklist to support the entrustment decision was created. For validation an online survey with 27 clinical pharmacists from all over Germany was conducted. Quality testing with the EQual rubric showed a good EPA quality. Conclusions: We developed the first clinical pharmacy EPA for use in a German context. Medication reconciliation is a suitable EPA candidate as it describes a clinical activity performed by pharmacists in many clinical settings. The newly developed and validated EPA 'Medication Reconciliation' will be used to assess pharmacy students and trainees. [ABSTRACT FROM AUTHOR]

Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear. Adding to the challenge is reduced time allocated to basic science in curricula and rapid expansion of relevant scientific fields. A return to science with greater depth after clinical clerkships has been suggested, although few schools have adopted such curricula and implementation can present challenges. The authors describe an innovation at Harvard Medical School, the Advanced Integrated Science Courses (AISCs), which are taken after core clerkships. Students are required to take 2 such courses, which are offered in a variety of topics. Rather than factual content, the learning objectives are a set of generalizable skills to enable students to critically evaluate emerging research and its relationship to medical practice. Making these generalizable skills the defining principle of the courses has several important advantages: it allows standardization of acquired skills to be combined with diverse course topics ranging from basic to translational and population sciences; students can choose courses and projects aligned with their interests, thereby enhancing engagement, curiosity, and career relevance; schools can tailor course offerings to the interests of local faculty; and the generalizable skills delineate a unique purpose of these courses within the overall medical school curriculum. For the 3 years AISCs have been offered, students rated the courses highly and reported learning the intended skill set effectively. The AISC concept addresses the challenge of preparing students for this era of rapidly expanding science and should be readily adaptable to other medical schools., (Copyright © 2022 by the Association of American Medical Colleges.)

Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care. [ABSTRACT FROM AUTHOR]

Background: Progress testing is an assessment method in which an examination reflecting competencies at graduation is regularly administered to students over multiple years, thereby facilitating self-directed learning. However, the significance of the objective structured clinical examination as a progress test in undergraduate education, needs to be determined. This study provides evidence of the role of the objective structured clinical examination for progress testing and optimal scoring methods for assessing students in different academic years. Methods: We conducted a sequential explanatory mixed-methods pilot study. Participants were assessed using the Item Rating Scale, the year-adjusted Global Rating Scale, and the Training Level Rating Scale. The characteristics of each scale were compared quantitatively. In addition, the influence of the objective structured clinical examination as a progress test on learning attitudes was examined. Qualitative data from a post-examination questionnaire were analyzed, using content analysis to explore influences on self-directed learning. Results: Sixth and fifth year clinical students (n = 235) took the objective structured clinical examination progress test. The total Item Rating Scales were recorded (%) as 59.03 ± 5.27 and 52.64 ± 5.08 (p < 0.01); Training Level Rating Scale was 3.94 ± 0.39 vs 3.22 ± 0.42 (p < 0.01); and the year-adjusted Global Rating Scale was 4.25 ± 0.44 vs 4.32 ± 0.52 (no significant difference), for the sixth and fifth year students, respectively. The correlations across stations and the reliability of each station were satisfactory. Four categories were identified in the qualitative analysis: "motivation to learn during the clinical clerkship was promoted," "dissatisfied with being asked about things they had not experienced," "confusion about being unable to use conventional test-taking strategies," and "insufficient understanding of competencies at graduation." The scores indicated significant differences in performance according to training year. Conclusions: This study provides evidence that the objective structured clinical examination can be used as a progress testing tool for undergraduate clinical clerkships. Further enhancement of training opportunities and dissemination of performance competency goals in clerkship curricula are required if we intend to promote self-directed learning through progress testing. [ABSTRACT FROM AUTHOR]

With the rise of competency-based medical education and workplace-based assessment (WBA) since the turn of the century, much has been written about methods of assessment. Direct observation and other sources of information have become standard in many clinical programs. Entrustable professional activities (EPAs) have also become a central focus of assessment in the clinical workplace. Paper and pencil (one of the earliest mobile technologies!) to document observations have become almost obsolete with the advent of digital technology. Typically, clinical supervisors are asked to document assessment ratings using forms on computers. However, accessing these forms can be cumbersome and is not easily integrated into existing clinical workflows. With a call for more frequent documentation, this practice is hardly sustainable, and mobile technology is quickly becoming indispensable. Documentation of learner performance at the point of care merges WBA with patient care and WBA increasingly uses smartphone applications for this purpose. This AMEE Guide was developed to support institutions and programs who wish to use mobile technology to implement EPA-based assessment and, more generally, any type of workplace-based assessment. It covers backgrounds of WBA, EPAs and entrustment decision-making, provides guidance for choosing or developing mobile technology, discusses challenges and describes best practices. [ABSTRACT FROM AUTHOR]

Positive interpersonal relationships between college administration and faculty are necessary as they contribute to organizational climate measures, such as a sense of belonging and perceived organizational worth. Furthermore, such relationships may combat against faculty cynicism. Interpersonal experiences are particularly relevant in a post-coronavirus disease 2019 workplace in which interactions with colleagues are infrequent. Little is known about the effects of interpersonal experiences on part-time faculty specifically, as compared with full-time faculty. This study investigates teamwork experiences and interpersonal constraints as predictors of the attitudes and perceptions of full- and part-time faculty at a four-year public teaching college in the southwestern United States. After controlling for years working at the college, teamwork was a consistent predictor of higher sense of belonging, perceived organizational worth, and lower cynicism among full- and part-time faculty. Furthermore, the presence of negative coworker relationships was a significant predictor of lower sense of belonging and perceived organizational worth among full-time faculty. Inadequate help or lack of contact with co-workers was not a significant predictor of faculty attitudes and perceptions. The results of this study suggest the need for fostering teamwork and positive relationships among full- and part-time faculty in a meaningful and systemic manner within institutions of higher education. Additionally, this study provides support for institutionalizing a team-based approach to working among all faculty to foster perceived belonging and worth, while limiting cynicism. [ABSTRACT FROM AUTHOR]

Early career faculty face many challenges, including establishing a career direction, building skills, balancing work and personal life demands, finding mentors, and establishing collegial relationships within their departments. Early career funding has been shown to augment future success in academia; less is known about the impact of early career funding on the social, emotional, and professional identity aspects of work life. One theoretical perspective to examine this issue is self-determination theory, a broad psychological paradigm explaining motivation, well-being, and development. Self-determination theory is predicated on the idea that fulfillment of three basic needs leads to the achievement of integrated well-being. Optimizing autonomy (a sense of choice and control), competence (sense of mastery), and relatedness (a sense of belonging) accompanies greater motivation, productivity, and perceived success. The authors share how applying for and implementing an early career grant affected these three constructs. Early career funding manifested challenges and beneficial outcomes in relationship to each of the three psychological needs and led to important lessons that may be generally applicable to faculty across a wide range of disciplines. The authors offer broad principles as well as specific grant-related strategies for optimizing autonomy, competence, and relatedness while applying for and executing a grant. Practice points Self-determination theory may be used to understand the social, emotional, and professional development effects of career-altering projects such as attaining major grant funding. A medical educator can use the domains of self-determination theory – autonomy, competence, and relatedness – as levers to pull to enhance work well-being and realize potential. The pursuit of scholarly work in a personal field of interest can enhance autonomy. Optimal challenges are those that stretch the medical educator beyond their current stage of development and provide opportunities to develop and realize competence. The development and cultivation of a network of mentors, sponsors, and supportive colleagues can provide a strong sense of relatedness within the work. [ABSTRACT FROM AUTHOR]

Clinical supervisors are known to assess trainee performance idiosyncratically, causing concern about the validity of their ratings. The literature on this issue relies heavily on retrospective collection of decisions, resulting in the risk of inaccurate information regarding what actually drives raters' perceptions. Capturing in-the-moment information about supervisors' impressions could yield better insight into how to intervene. The purpose of this study, therefore, was to gather "real-time" judgments to explore what drives preceptors' judgments of student performance. We performed a prospective study in which physicians were asked to adjust a rating scale in real-time while watching two video-recordings of trainee clinical performances. Scores were captured in 1-s increments, examined for frequency, direction, and magnitude of adjustments, and compared to assessors' final entrustability judgment as measured by the modified Ottawa Clinic Assessment Tool. The standard deviation in raters' judgment was examined as a function of time to determine how long it takes impressions to begin to vary. 20 participants viewed 2 clinical vignettes. Considerable variability in ratings was observed with different behaviours triggering scale adjustments for different raters. That idiosyncrasy occurred very quickly, with the standard deviation in raters' judgments rapidly increasing within 30 s of case onset. Particular moments appeared to generally be influential, but their degree of influence still varied. Correlations between the final assessment and (a) score assigned upon first adjustment of the scale, (b) upon last adjustment, and (c) the mean score, were r = 0.13, 0.32, and 0.57 for one video and r = 0.30, 0.50, and 0.52 for the other, indicating the degree to which overall impressions reflected accumulation of raters' idiosyncratic moment-by-moment observations. Our results demonstrated that variability in raters' impressions begins very early in a case presentation and is associated with different behaviours having different influence on different raters. More generally, this study outlines a novel methodology that offers a new path for gaining insight into factors influencing assessor judgments. [ABSTRACT FROM AUTHOR]

There is increasing interest in how student engagement can be enhanced in medical schools: not just engagement with learning but with broader academic practices such as curriculum development, research, organisational leadership, and community involvement. To foster evidence-based practice, it is important to understand how institutions from diverse sociocultural contexts achieve excellence in student engagement. We analysed 11 successful applications for an international award in student engagement and interviewed nine key informants from five medical schools across four continents, characterising how and why student engagement was fostered at these institutions. Document analysis revealed considerable consensus on the core practices of student engagement, as well as innovative and creative practices often in response to local strengths and challenges. The interviews uncovered the importance of an authentic partnership culture between students and faculty which sustained mutually beneficial enhancements across multiple domains. Faculty promoted, welcomed, and acted on student inputs, and students reported greater willingness to participate if they could see the benefits. These combined to create self-perpetuating virtuous cycles of academic endeavour. Successful strategies included having participatory values actively reinforced by senior leadership, engagement activities that are driven by both students and staff, and focusing on strategies with reciprocal benefits for all stakeholders. [ABSTRACT FROM AUTHOR]

Competency‐based medical education (CBME) is an outcomes‐focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty‐specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence‐based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system. [ABSTRACT FROM AUTHOR]

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The Seasonal Affective Disorder (SAD) is a disorder characterized by prolonged periods of depression and various physical and psychological symptoms experienced during specific seasons, typically winter. In this review aims to provide a comprehensive overview of SAD with a specific focus on psychophysiological aspects. Through the review from ancient times to the present, this paper explores the characteristics, causes, and underlying mechanisms of SAD. Particularly, it comprehensively reviews the research findings on the relationship between external factors such as light, sunlight, climate, and their association with SAD. Furthermore, the paper discusses the interplay between SAD and psychophysiological changes, along with the latest research trends in treatment and prevention strategies. By combining theoretical and practical perspectives on SAD, this article aims to provide a holistic understanding and offer suggestions for future research directions and clinical interventions. [ABSTRACT FROM AUTHOR]

Purpose: The Medical Education Research Study Quality Instrument (MERSQI) has been used frequently to assess the methodological quality of medical education but not for dental education. The present study aimed to assess the methodological quality using MERSQI scores of articles published in the Journal of Dental Education (JDE) and the European Journal of Dental Education (EJDE)., Methods: A cross-sectional assessment of the quality of manuscripts published in 2012, 2017, and 2022 JDE and EJDE was conducted. MERSQI data, numbers of authors, first and corresponding author degrees, geographic origins, and funding information were also extracted for each included study. Descriptive and analytical statistics were conducted, and significance level was set at α < 0.05., Results: Four hundred ninety-five articles met the inclusion criteria. The most common study design was a single-group cross-sectional or single-group posttest and conducted in one institution for all studied years. In all journals and years, studies were assessed mainly by participants. The study outcome was mostly satisfaction, attitudes, perceptions, opinions, and general facts. The total mean MERSQI score for each journal and year varied. Year and geographic origin significantly affected the total MERSQI score. Papers originating from Asia had the highest score, followed by South America, Europe, North America, Oceania, and Africa., Conclusion: MERSQI score is applicable to the assessment of the methodological quality of dental educational research. The MERSQI score for most of the domains was similar for both journals. The MERSQI score was affected by publication years and geographic origins., (© 2024 American Dental Education Association.)

Location of trial sites can be a potential source of study bias. Considering that clinical trials have been mostly conducted in urban areas, the distribution of trial sites need to be evaluated. We analyzed clinical trial approval data using social network analysis to quantitatively assess the site-by-site connections. The approval list of clinical trials from the Ministry of Food and Drug Safety database between 2014 and 2021 was analyzed. The number of clinical trials per trial site was counted according to the approval year and study phase and evaluated for distribution using empirical cumulative distribution function plots. Trial sites and conducts of a clinical trial were mapped into nodes and edges in the social network analysis, and basic network parameters were obtained. The clinical trials were concentrated at several trial sites. Forty-nine to 60.6% of phase 1 and up to 30% of the other study phases of clinical trials were at the top 5 trial sites. The annual distribution of the number of clinical trials per site was comparable across the study period. Connections among the trial sites in the metropolitan area were prominent. Graph size and density were higher in phase 3 trials than in the other phases. We demonstrated that the conduct of clinical trials was concentrated in the Seoul Metropolitan Area in both number of trials and connections using social network analysis. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity (PA) plays an important role in achieving positive self-rated health (SRH) among cancer survivors. Wearable activity trackers (WATs) can be effective for self-monitoring and tracking PA. Studies have shown that survivors who use WATs are more likely to engage in more PA. However, few studies have examined the direct and indirect associations between WAT use, PA, and SRH mediated by constructs derived from self-determination theory, perceived health competence, and perceived social relatedness for health.Methods: Data on survivors were analyzed from National Cancer Institute's Health Information National Trend Survey (HINTS) Cycle 1-3 (n = 1,421). Path analysis was used to test the total, direct, and indirect associations.Results: Previous WAT use was directly associated with PA level (standardized beta (SB): 0.07, p = 0.005) and indirectly associated with SRH (SB: 0.04, p = 0.005), mediated by perceived health competence and PA. Perceived health competence was directly associated with SRH (SB: 0.51, p < .0001) and PA (SB: 0.20, p < .0001), and perceived social relatedness for health was not significantly associated with PA (SB: 0.005, p = 0.8) or SRH (SB: 0.02, p = 0.31).Conclusions: Overall, these results indicate that perceived health competence significantly mediated the associations between WAT use and SRH; however, WAT use was only directly associated with PA and was not mediated.Implications For Cancer Survivors: These findings support the notion that WATs may play a role in addressing SRH among cancer survivors through fostering perceived health competence by providing real-time feedback, goal setting, and opportunities for self-monitoring. [ABSTRACT FROM AUTHOR]

Background: Final-year undergraduate medical students often do not feel well prepared for their start of residency training. Self-assessment of competences is important so that medical trainees can take responsibility for their learning. In this study, we investigated how final-year medical students self-assessed their competences as they neared their transition to postgraduate training. The aim was to identify areas for improvement in undergraduate training. Methods: In the academic year 2019/2020, a national online survey was sent to final-year undergraduate medical students via their respective medical schools. The survey included ten facets of competence (FOC) most relevant for beginning residents. The participants were asked to self-assess their competence for each FOC on a 5-point Likert scale (1: strongly disagree to 5: strongly agree). We established an order of self-assessed FOC performance by means and calculated paired t-tests. Gender differences were assessed with independent t-tests. Results: A total of 1083 students from 35 medical schools completed the questionnaire. Mean age was 27.2 ± 3.1 years and 65.8% were female. Students rated their performance highest in the FOCs ‘Teamwork and collegiality’ and ‘Empathy and openness’ (97.1 and 95.0% ‘strongly agree’ or ‘agree’, respectively) and lowest in ‘Verbal communication with colleagues and supervisors’ and ‘Scientifically and empirically grounded method of working’ (22.8 and 40.2% ‘strongly disagree’, ‘disagree’, or ‘neither agree nor disagree’, respectively). Women rated their performance of ‘Teamwork and collegiality’, ‘Empathy and openness’, and ‘Knowing and maintaining own personal bounds and possibilities’ significantly higher than men did (Cohen’s d >.2), while men showed higher self-assessed performance in ‘Scientifically and empirically grounded method of working’ than women (Cohen’s d =.38). The FOCs ‘Responsibility’, ‘Knowing and maintaining own personal bounds and possibilities’, ‘Structure, work planning, and priorities’, ‘Coping with mistakes’, and ‘Scientifically and empirically grounded method of working’ revealed lower self-assessed performance than the order of FOC relevance established by physicians for beginning residents. Conclusions: The differences between the level of students’ self-assessed FOC performance and physicians’ ranking of FOC relevance revealed areas for improvement in undergraduate medical education related to health system sciences. Final-year students might benefit from additional or better training in management skills, professionalism, and evidence-based medicine. Surveys of self-assessed competences may be useful to monitor competence development during undergraduate training. [ABSTRACT FROM AUTHOR]

Despite the many clerkship models of medical education, all can be considered a form of experiential learning. Experiential learning is a complex pedagogical approach involving the development of cognitive skills in an environment with a unique culture with multiple stakeholders, which may impact learner motivation, confidence, and other noncognitive drivers of success. Students may delay the transition to the clerkship year for myriad reasons, and the intricate nature of experiential learning suggested this may impact student performance. This retrospective, observational study investigated the impact of clerkship postponement by measuring subsequent clerkship performance. Pre-clerkship and third-year clerkship performance were analyzed for three cohorts of students (classes of 2018, 2019, and 2020, N = 274) where students had the option to delay the start of their clerkship year. A mixed analysis of variance (ANOVA) and paired t-tests were conducted to compare academic performance over time among students who did and did not delay. Across three cohorts of students, 12% delayed the start of the clerkship year (N = 33). Regardless of prior academic performance, these students experienced a significant reduction in clerkship grades compared to their non-delaying peers. Delaying the start of the clerkship year may have negative durable effects on future academic performance. This information should be kept in mind for student advisement. [ABSTRACT FROM AUTHOR]

Dissection is a unique multisensory educational experience and is essential to learning the anatomical construction of the human and animal bodies. This study aims to introduce a specialized design for the assessment of dissection and to discuss the assessment's attributes. The design was a product of the "assessment drives learning" concept and was developed to motivate students to dissect. Students were awarded "dissection points" based on prior group dissection and identification of structures. Students' perception of the design was examined, and content analysis was performed. The assessment consisted of two parts: the first assigning each student group structures to "pin" on their previously dissected cadavers; the second was a group peer evaluation. The most critical factor for the assessment's success was careful selection of structures assigned to students to pin. The assessment was fit for the purpose, valid, reliable, and had a significant educational impact. Eighty‐three percent of students (n = 116) recommended maintaining the assessment design, as they felt it promoted a deep approach to learning as well as teamwork while reducing stress to a minimum. A strong correlation (Spearman's rho = 0.46, P < 0.0001) was present between the high rating of the design and the number of structures learned, as well as, high rating and lower stress level (Spearman's rho = 0.40, P < 0.0001). There was no apparent influence of grades on student perception of the effectiveness of the assessment. This specific design of evaluation could be used as part of anatomy education in veterinary and medical schools. [ABSTRACT FROM AUTHOR]

This is the sixth article in a series exploring interprofessional education during the COVID-19 pandemic. This article will focus on the considerations and adaptations made to assessing interprofessional education during this time. It will explore the alternative assessment strategies used by faculty, the modality of assessment and the tools used, student and faculty experiences and the challenges faced by both during the rapid pivot to remote learning and assessment. [ABSTRACT FROM AUTHOR]

Background: Given the widespread use of Multiple Mini Interviews (MMIs), their impact on the selection of candidates and the considerable resources invested in preparing and administering them, it is essential to ensure their quality. Given the variety of station formats used and the degree to which that factor resides in the control of training programmes that we know so little about, format's effect on MMI quality is a considerable oversight. This study assessed the effect of two popular station formats (interview vs. role‐play) on the psychometric properties of MMIs. Methods: We analysed candidate data from the first 8 years of the Integrated French MMIs (IF‐MMI) (2010–2017, n = 11 761 applicants), an MMI organised yearly by three francophone universities and administered at four testing sites located in two Canadian provinces. There were 84 role‐play and 96 interview stations administered, totalling 180 stations. Mixed design analyses of variance (ANOVAs) were used to test the effect of station format on candidates' scores and stations' discrimination. Cronbach's alpha coefficients for interview and role‐play stations were also compared. Predictive validity of both station formats was estimated with a mixed multiple linear regression model testing the relation between interview and role‐play scores with average clerkship performance for those who gained entry to medical school (n = 462). Results: Role‐play stations (M = 20.67, standard deviation [SD] = 3.38) had a slightly lower mean score than interview stations (M = 21.36, SD = 3.08), p < 0.01, Cohen's d = 0.2. The correlation between role‐play and interview stations scores was r = 0.5 (p < 0.01). Discrimination coefficients, Cronbach's alpha and predictive validity statistics did not vary by station format. Conclusion: Interview and role‐play stations have comparable psychometric properties, suggesting format to be interchangeable. Programmes should select station format based on match to the personal qualities for which they are trying to select. Renaud et al. found that interview and role‐play stations in Multiple Mini Interviews have comparable psychometric properties, suggesting station format to be interchangeable. [ABSTRACT FROM AUTHOR]

Objective: Entrustable Professional Activities (EPAs) are increasingly being used in competency-based medical education approaches. A general lack of time in clinical settings, however, prevents supervisors from providing their trainees with adequate feedback. With a willingness for more administrative tasks being low in both trainees and educators, the authors developed a radical user-friendly mobile application based on the EPA concept called "Surg-prEPAred". Design: Surg-prEPAred is designed to collect micro-assessment data for building competency profiles for surgical residents according to their curriculum. The goal of Surg-prEPAred is to facilitate the performance and documentation of workplace-based assessments. Through aggregated data the app generates a personalized competency profile for every trainee. During a pilot run of 4 months, followed by ongoing usage of the application with a total duration of 9 months (August 2019 to April 2020), 32 residents and 33 consultants made daily use of the application as a rating tool. Every rating included knowledge, skills and professional attitudes of the trainees. Before the initiation of the App and after the 9-month trial period trainees and supervisors where both sent questionnaires to evaluate the user friendliness and effectiveness of the App. Results: Five hundred ten App based assessments were generated. Out of 40 pre-defined EPAs, 36 were assessed. 15 trainees and 16 supervisors returned the questionnaires and stated the surg-prEPAred App as very valuable, effective and feasible to evaluate trainees in a clinical setting providing residents with an individual competence portfolio to receive precision medical education. Conclusions: The authors expectation is that the Surg-prEPAred App will contribute to an improvement of quality of medical education and thus to the quality of patient care and safety. In the future the goal is to have the App become an integral part of the official Swiss surgical curriculum accepted by the Swiss professional surgical society. [ABSTRACT FROM AUTHOR]

Purpose/objectives: Self‐assessment of clinical competence is an important tool for effective learning and training for some educational programs. The New York University (NYU) Langone Hospital's Advanced Education in General Dentistry (AEGD) Program has had its residents complete self‐assessment of clinical competency evaluations for many years. The evaluation is used to understand the residents' perception of their own clinical skill upon beginning the program and to determine the necessary resources to provide to the residents for them to meet program standards. The same evaluation is completed by the residents 6 months later to determine if they perceived advancement in their clinical performance while in the program. Dental education, along with other fields of education was disrupted by the coronavirus disease 2019 (COVID‐19) pandemic. The purpose of this study was to examine the impact of COVID‐19 on clinical competency self‐assessments among the NYU Langone AEGD residents before and during the pandemic. Methods: In this cross‐sectional study, data was collected from two AEGD cohorts representing 2019–2020 and 2020–2021 academic years; from July 2019 (n = 196) to January 2020 (n = 189) and July 2020 (n = 202) to January 2021 (n = 184). The self‐assessment evaluations were administered via an online residency management platform on the first days of July and January of the academic year. The survey consisted of 48 questions on "clinical skills and performance" as established by CODA standards for postdoctoral general dentistry programs. Results: Survey response rate was 100% for both cohorts. When comparing results, the findings indicate the COVID‐19 pandemic had interrupted clinical learning during dental school. However, training through the AEGD program led to improvements in perceived clinical competence by the residents in mid‐program evaluation. Conclusion: The self‐assessment evaluation can be used as a tool to enhance training as part of the AEGD program's performance improvement plan. [ABSTRACT FROM AUTHOR]

As competency-based curricula get increasing attention in postgraduate medical education, Entrustable Professional Activities (EPAs) are gaining in popularity. The aim of this survey was to determine the use of EPAs in anesthesiology training programs across Europe and North America. A survey was developed and distributed to anesthesiology residency training program directors in Switzerland, Germany, Austria, Netherlands, USA and Canada. A convergent design mixed-methods approach was used to analyze both quantitative and qualitative data. The survey response rate was 38% (108 of 284). Seven percent of respondents used EPAs for making entrustment decisions. Fifty-three percent of institutions have not implemented any specific system to make such decisions. The majority of respondents agree that EPAs should become an integral part of the training of residents in anesthesiology as they are universal and easy to use. Although recommended by several national societies, EPAs are used in few anesthesiology training programs. Over half of responding programs have no specific system for making entrustment decisions. Although several countries are adopting or planning to adopt EPAs and national societies are recommending the use of EPAs as a framework in their competency-based programs, few are yet using these to make "competence" decisions. [ABSTRACT FROM AUTHOR]

Background: Teams caring for people living with cancer face many difficult clinical situations that are compounded by the pandemic and can have serious consequences on professional and personal life. This study aims to better understand how a multi-component intervention builds resilience in oncology teams. The intervention is based on a salutogenic approach, theories and empirical research on team resilience at work. This intervention research involves partnership between researchers and stakeholders in defining situations of adversity and solutions appropriate to context. Methods: The principles of realist evaluation are used to develop context-mechanism-outcome configurations of a multi-component intervention developed by researchers and field partners concerned with the resilience of oncology teams. The multiple case study involves oncology teams in natural contexts in four healthcare establishments in Québec (Canada). Qualitative and quantitative methods are employed. Qualitative data from individual interviews, group interviews and observation are analyzed using thematic content analysis. Quantitative data are collected through validated questionnaires measuring team resilience at work and its effect on teaming processes and cost-effectiveness. Integration of these data enables the elucidation of associations between intervention, context, mechanism and outcome. Discussion: The study will provide original data on contextual factors and mechanisms that promote team resilience in oncology settings. It suggests courses of action to better manage difficult situations that arise in a specialized care sector, minimize their negative effects and learn from them, during and after the waves of the pandemic. The mechanisms for problem resolution and arriving at realistic solutions to professional workforce and team effectiveness challenges can help improve practices in other settings. [ABSTRACT FROM AUTHOR]

Background: Medical schools have undergone a period of continual curricular change in recent years, particularly with regard to pre-clinical education. While these changes have many benefits for students, the impact on faculty is less clear. Methods: In this study, faculty motivation to teach in the pre-clinical medical curriculum was examined using self-determination theory (SDT) as a framework. Basic science and clinical faculty were surveyed on factors impacting their motivation to teach using validated scales of motivation as well as open-ended questions which were coded using self-determination theory (SDT) as a guiding framework. Results: Faculty reported that teaching activities often meet their basic psychological needs of competence, autonomy, and relatedness. Professors were more likely than associate professors to report that teaching met their need for autonomy. Faculty were more motivated by intrinsic as compared to external factors, although basic science faculty were more likely than clinical faculty to be motivated by external factors. Motivating and de-motivating factors fell into the themes Resources, Recognition and Rewards, Student Factors, Self-Efficacy, Curriculum, Contribution, and Enjoyment. The majority of factors tied to the faculty's need for relatedness. Based on these findings, a conceptual model for understanding medical school faculty motivation to teach was developed. Conclusions: Assessing faculty motivation to teach provided valuable insights into how faculty relate to their teaching roles and what factors influence them to continue in those roles. This information may be useful in guiding future faculty development and research efforts. [ABSTRACT FROM AUTHOR]

This study examines the way in which student characteristics and pre-admissions measures are statistically associated with the likelihood a student will require remediation for academic and professionalism offenses. We anchor our inquiry within Irby and Hamstra's (2016) conceptual framework of constructs of professionalism. Data from five graduating cohorts (2014–2018) from McMaster University (Hamilton, Canada) (N = 1,021) were retroactively collected and analyzed using traditional and multinominal logistic regression analyses. The relationship among student characteristics, pre-admissions variables, and referral for potential remediation both by occurrence (yes/no) as well as type (academic/professional/no referral) were examined separately. Findings indicate that gender (OR = 0.519, 95% CI 0.326–0.827, p < 0.01) and undergraduate grade point average (GPA) (OR = 0.245, 95% CI 0.070–0.855, p < 0.05) were significantly associated with instances of referral for potential professionalism and academic remediation, respectively. Women were less likely than men to require remediation for professionalism (OR = 0.332, 95% CI 0.174–0.602, p < 0.001). Undergraduate GPAs (OR = 0.826, 95% CI 0.021–0.539, p < 0.01) were significantly associated with remediation for academic reasons. Lower undergraduate GPAs were associated with a higher likelihood of remediation. These findings point to the admissions variables that are associated with instances that prompt referral for potential remediation. Where associations are not significant, we consider the application of different conceptualizations of professionalism across periods of admissions and training. We encourage those involved in applicant selection and student remediation to emphasize the importance of the interactions that occur between personal and contextual factors to influence learner behaviour and professional identity formation. [ABSTRACT FROM AUTHOR]

In this paper we outline the key design principles of our clinical reasoning curriculum and share student evaluations of the DR course along with an audit [[7]] of the longitudinal clinical reasoning curriculum. The clinical reasoning curriculum features spaced sessions anchored by the diagnostic reasoning (DR) course at the end of an 18 month pre-clerkship curriculum. Curricular integration The reasoning curriculum features multiple opportunities for students to engage with clinical reasoning concepts from the beginning of medical school with increasing complexity (spiral learning) as students progress in their training [[33]]. Keywords: clinical reasoning; curriculum; diagnosis; diagnostic errors; undergraduate medical education (UME) EN clinical reasoning curriculum diagnosis diagnostic errors undergraduate medical education (UME) 265 273 9 05/12/22 20220501 NES 220501 Introduction The 2015 National Academy of Medicine report I Improving Diagnosis in Health Care i raised the profile of diagnostic error as a major quality and safety issue [[1]]. [Extracted from the article]

Quality improvement knowledge is a requirement of fellowship training. Our goal was to evaluate the efficacy of a 3-year quality improvement and patient safety (QI/PS) curriculum that gives fellows both didactic knowledge and first-hand experience with improvement science, and meets Clinical Learning Environment Review (CLER) requirements. Knowledge assessment is obtained through pre- and post-surveys. A secondary measure of success is academic products resulting from fellows' QI/PS work, and future participation in QI/PS efforts. Since 2019, 51 pre-tests and 36 post-tests were completed, showing improvement across all competencies. Fellows have produced one published manuscript, two poster presentations, and two oral presentations describing their improvement work. Additionally, mentoring faculty members have gone on to lead other QI work throughout the division. This longitudinal QI/PS curriculum provides both knowledge and experience in QI/PS work. It also creates opportunities for academic publications and presentations, builds faculty expertise, and most importantly, works to improve multiple aspects of patient care. This curriculum can serve as a model for other cardiology fellowships working to meet CLER requirements., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The transfer of classic concepts of competency-based medical education into clinical practice has been proven to be difficult in the past, being described as partially fragmented, misleading and inadequate. At the beginning of training, novice doctors commonly feel overwhelmed, overloaded and exposed to extreme time pressure. The discrepancy between expected and actual clinical competence of doctors at the start of their speciality training jeopardizes patient safety. The framework of Entrustable Professional Activities (EPAs) is a promising instrument to effectively integrate competency-based training into clinical practice and may help to close this gap and consequently to improve patient safety. Methods: For anaesthesiology, we developed 5 EPAs for final-year medical students. The EPAs comprised the following seven categories: 1. Title, 2. Specifications, 3. Limitations, 4. Competency domains, 5. Knowledge, abilities and skills, professional attitudes, 6. Assessment and 7. Entrustment. Based on a modified, online-based Delphi study, we further developed and refined these EPAs. Education experts were recruited from the alumni network of the Master of Medical Education (MME) degree course from the University of Heidelberg, Germany. Results: 28 data sets were evaluated in three Delphi rounds. 82% of study participants had previous experience with EPAs. Qualitative and quantitative data formed the basis during the iterative process and resulted in complete descriptions of 5 EPAs for final-year medical students in anaesthesiology. Conclusions: Our study including the associated description of 5 EPAs represent a further step and starting point for EPA-based curricula in medical training in Germany linking undergraduate training, to residency training and continuous medical education. [ABSTRACT FROM AUTHOR]

Background: Imperial College London launched a new, spiral undergraduate medical curriculum in September 2019. Clinical & Scientific Integrative cases (CSI) is an innovative, flagship module, which uses pioneering methodology to provide early-years learning that [1] is patient-centred, [2] integrates clinical and scientific curriculum content, [3] develops advanced team-work skills and [4] provides engaging, student-driven learning. These aims are designed to produce medical graduates equipped to excel in a modern healthcare environment. Methods: CSI has adopted a novel educational approach which utilises contemporary digital resources to deliver a collaborative case-based learning (CBL) component, paired with a team-based learning (TBL) component that incorporates both learning and programmatic assessment. This paper serves to explore how first-year students experienced CSI in relation to its key aims, drawing upon quantitative and qualitative data from feedback surveys from CSI's inaugural year. It provides a description and analysis of the module's design, delivery, successes and challenges. Results: Our findings indicate that CSI has been extremely well-received and that the majority of students agree that it met its aims. Survey outputs indicate success in integrating multiple elements of the curriculum, developing an early holistic approach towards patients, expediting the development of important team-working skills, and delivering authentic and challenging clinical problems, which our students found highly relevant. Challenges have included supporting students to adapt to a student-driven, deep learning approach. Conclusions: First-year students appear to have adopted a patient-centred outlook, the ability to integrate knowledge from across the curriculum, an appreciation for other team members and the self-efficacy to collaboratively tackle challenging, authentic clinical problems. Ultimately, CSI's innovative design is attractive and pertinent to the needs of modern medical students and ultimately, future doctors. [ABSTRACT FROM AUTHOR]