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Phenomenon: Many U.S. medical schools have responded to the adoption of competency-based medical education (CBME) frameworks by renewing their final-year curricula and including internship preparatory courses. The purpose of this scoping review was to map the published literature regarding the final year to discern how medical schools have responded to this paradigm change. Approach: A structured 5-step approach was used to conduct this scoping review. Electronic searches of PubMed, ERIC, Scopus, MedEdPortal, and 8 medical education journals were conducted to identify relevant articles published from 2006 to 2016. Four authors screened articles for inclusion using standardized eligibility criteria; interrater agreement was discussed and calculated. Authors extracted data elements, and a consensus-based approach was used to categorize, sort, and structure information gathered. Findings: Among 6,485 articles retrieved, 817 articles were included in the study. From 2007–2011 to 2012–2016, articles addressing the final year of medical school increased 93%, whereas articles describing internship preparatory courses increased 218%. The majority of articles did not reference a CBME framework (572/817; 70%), the frequency of mentions increased 268% from 2007–2011 to 2012–2016. Nearly three fourths of preparatory course-related papers reference a CBME framework (37/50; 74%). Insights: Our findings may reflect a movement in U.S. medical schools toward using shared assessment metrics to support 4th-year medical students' preparation for their postgraduate medical education. Despite an increased reference to CBME, there is relatively little use of competency-based assessment frameworks to evaluate learning outcomes. This review also found a substantial increase in the frequency of articles referencing senior-year preparatory courses in U.S. medical schools. Articles tended to describe institution-specific research or experiences. Opportunities likely exist for multi-institutional and organizational collaboration in determining the structure of the final year of medical school. [ABSTRACT FROM AUTHOR]

In 2000, the American PT Association (APTA) published its Vision statement advocating for DA (DA) to PT. This narrative review of the literature aims to identify the current state of DA in the United States (US) and compare that status to the US Military. Initial PubMed search in the English language with keywords physical therapy (PT), physiotherapy, DA, self-referral, and primary contact from the year 2000 onwards with subsequent focused searches using keywords DA/self-referral/primary contact of physical therapists/physiotherapists on outcomes/autonomous practice/economic impact/patient satisfaction yielded 103 applicable studies on the topic. This paper excluded 40 international articles to focus on US military and civilian research. Current literature supports Physical Therapists (PTs) in an initial contact role based on patient safety, satisfaction, access to care, efficiency, healthcare utilization, and potential cost savings. Despite its success in the US Military, DA to PT in the US civilians remains limited and incomplete. PTs still await unrestricted DA and privileges associated with autonomous practice including the ability to order imaging and prescribe some medications. [ABSTRACT FROM AUTHOR]

Aim: Curriculum reform in medical schools continues to be an ever-present and challenging activity in medical education. This paper describes one school's experiences with specific curricular innovations that were developed or adapted and targeted to meet a clear set of curricular goals during the curriculum reform process. Those goals included: (a) promoting active learning and learner engagement; (b) establishing early professional identity; and (c) developing physician competencies in an integrated and contextual manner while allowing for individualized learning experiences for the millennial student. Methods: Six specific innovations championed by the school are described in detail. These included Themes in Medical Education, Translational Pillars, Stony Brook Teaching Families, Transition Courses, Educational Continuous Quality Improvement Processes, and our Career Advising Program. Development of the ideas and design of the innovations were done by faculty and student teams. Results: We discuss successes and ongoing challenges with these innovations which are currently in the fourth year of implementation. Conclusions: Our curriculum reform has emphasized the iterative process of curriculum building. Based on our experience, we discuss general and practical guidelines for curriculum innovation in its three phases: setting the stage, implementation, and monitoring for the achievement of intended goals. [ABSTRACT FROM AUTHOR]

This paper presents perspectives and controversies surrounding the use of milestones to assess competency in outcomes-based medical education. Global perspectives (Canada, Europe, and the United States) and developments supporting their rationales are discussed. In Canada, there is a significant movement away from conceptualizing competency based on time, and a move toward demonstration of specific competencies. The success of this movement may require complex (rather than reductionist) milestones that reflect students' progression through complexity and context and a method to narrate their journey. European countries (United Kingdom, France, and Germany) have stressed the complexity associated with time and milestones for medical students to truly achieve competence. To meet the changing demands of medicine, they view time as actually providing students with knowledge and exposure to achieve various milestones. In the United States, milestones are based on sampling throughout professional development to initiate lifelong learning. However, the use of milestones may not imply overall competence (reductionism). Milestones must be developed alongside outcomes-based curriculum with use of faculty and competency committees. The perspectives outlined in this paper underscore emerging challenges for implementing outcomes-based medical education and call for new conceptualizations of competence. [ABSTRACT FROM AUTHOR]

Recent changes to clinical psychology training and supervision in Australia have been driven by a deliberate endeavour by regulatory authorities and professional bodies to align education and training with competency-based models of training, a development that is apparent internationally across health disciplines. A critical question is: how do reforms in Clinical Psychology training standards match international benchmarks for competency-based pedagogies? Objective: To outline key principles of competency-based pedagogies and to critically examine whether Australia's new standards and guidelines for accreditation of coursework, practicum requirements, and supervision are consistent with competency principles, and match similar guidelines proposed in the U.K. and the U.S.A. Method: Following a critical analysis of the extant literature, the authors highlight progress achieved, discuss major gaps and challenges, and examine the extent to which current accreditation changes constitute a reliable blueprint for the development of a competent psychology workforce for the country. Results and Conclusions: The current review indicates that in an overall sense, practitioner training in Australia is tracking well in comparison to international developments. Specifically, the decreased emphasis on the regulation of inputs (e.g., nature and type of coursework and practicum) is pedagogically sound and has the potential to promote training innovation and efficiencies. However, a revision of the current competency framework is required to underpin future progress. Also, the lack of reliable and valid competence instruments in combination with less than rigorous adherence to systematic, timely, and ecologically valid assessments constitute a major challenge and a serious threat to ensuring safe and competent psychology practice. What is already known about this topic: (1) Competency-based education and clinical training play important coordinated roles in ensuring the competence of clinical psychologists, consistent with the accreditation standards and registration requirements of the Psychology Board of Australia. (2) The Australian Psychology Accreditation Council (APAC, 2019) have recently published new accreditation standards for psychology programs that are based on competency principles. (3) The shift to the new paradigm is both exciting and challenging. It is exciting because it provides opportunities for innovation; it is challenging because it demands systemic change. What this topic adds: (1) The current paper compares and contrasts current standards and guidelines for accreditation in Australia with their counterparts in the U.K. and the U.S.A. (2) Although significant progress has been made in Australia, additional implementation efforts should be taken to establish a comprehensive and authoritative competency framework, incorporating empirically-supported means of assessment. Such a framework should be fit-for-purpose providing a grid that maps shared and unique aspects of competencies across registration levels and specialised endorsements. (3) The progressive relaxing of input criteria has the potential to seriously compromise the commitment to safe and competent psychological practice if training institutions do not adopt a re-designed system of ecologically valid assessments both during training and at the point of entry to the profession. (4) The need to ensure competence is maintained throughout a psychologist's career will remain a major challenge, given the ongoing and rapid advance of science. A commitment to the competency-based approach provides the necessary scaffolding for ongoing professional development. [ABSTRACT FROM AUTHOR]

Review date: Review period January 1992–December 2001. Final analysis July 2004–January 2005 . Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education . Objectives of review: Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it . Identify the strengths and limitations of the research effort to date, and identify objectives for future research . Search strategy: Ovid search of: BEI, ERIC, Medline, CINAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology . Criteria: Definitions: • Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional . • Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years . Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included . Exclusions : Not empirical; not early; post-basic; simulated rather than ‘authentic’ experience . Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation . Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention . Conclusions: Early experience helps medical students socialize to their chosen profession. It helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices . [ABSTRACT FROM AUTHOR]

The case of John versus Im (2002) stands for the proposition that clinical neuropsychologists are not qualified to diagnose traumatic brain injury. This ruling by the Supreme Court of Virginia prohibits neuropsychologists from testifying about these professional conclusions in the courtroom. However, in clinical practice neuropsychologists are often asked to disentangle the relative contribution of brain dysfunction and psychological factors to presenting symptomology. In the proposed submission, the authors provide an analysis of the neuropsychological testimony at issue in John versus Im using the admissibility standards for expert testimony that were established and refined by a trilogy of cases from the Supreme Court of the United States. The paper provides support for the notion that neuropsychological method has an established scientific base of knowledge, standards for clinical competence, and evidence of peer-reviewed acceptance by medical related disciplines. No other scientific discipline has employed a more rigorous methodology for assessing cognitive function and disentangling the relative contributions of brain dysfunction and psychological factors to presenting symptomology. By limiting the testimony of neuropsychologists as to cause of an individual's cognitive impairment, courts will exclude opinions based on scientific research and specialized knowledge that would assist in the trier of fact. [ABSTRACT FROM AUTHOR]

The United States (US) National Center for Interprofessional Practice and Education was funded at the University of Minnesota to serve as the National Coordinating Center for Interprofessional Education and Collaborative Practice (IPECP) in the US In 2012, the funders had specific expectations for operationalizing their vision that included scholarship, programs and leadership as an unbiased, neutral convener to align education with health system redesign. While US specific, the National Center benefited from and contributed to the international maturity of the field over the past decade. Through its various services and technology platforms, the National Center has a wide reach nationally and internationally. This perspective provides a unique view of the field in the US with observations and implications for the future. [ABSTRACT FROM AUTHOR]

Continued competency is poorly defined in emergency medical services (EMS), with no established method for verifying continued competency at a national level. The objective of this project was to refine understanding of continued competency for EMS clinicians in the U.S. and establish priorities for developing competency assessments. A panel of EMS managers, educators, medical directors, and experts in competency assessment, simulation, and certification used a modified Delphi technique to address two questions: "What is the content for continued competency in EMS that should be assessed or verified?" (content) and "How should continued competency of EMS clinicians be demonstrated?" (process). The Delphi process was conducted through electronic conferencing and survey software over a 6-month period. In round one, panelists responded to open-ended prompts and their contributions were analyzed and categorized into themes by independent reviewers. In round two, the panel rated theme importance using five-point Likert-type scales. In round three, the panel ranked their top 10 themes, and in round four, the panel selected the most important themes for each of the two questions through consensus-building discussions. Descriptive statistics and thematic analyses were performed with Excel and STATA 16. Fourteen invited experts participated in all Delphi activities. The panel contributed 70 content and 35 process items from the original prompts. Following thematic analysis, these contributions were reduced to 21 and 14 unique themes, respectively. The final top five prioritized themes for content important for continued competency included (1) airway, respiration, and ventilation, (2) patient assessment, (3) pharmacology, (4) pediatrics, and (5) management of time critical disease progressions. The final top five prioritized themes for the processes for continued competency assessment included (1) assessments of evidence-based practice, (2) performance-based assessments, (3) combined knowledge and skill assessments, (4) performance improvement over time, and (5) frequent, short knowledge assessments. This modified Delphi process identified priorities for content and assessment, laying the groundwork for EMS continued competency at a national level. These findings can be leveraged by national task forces to develop transparent and consistent guidelines for systems that verify continued competency related to certification, licensure, and local credentialing. [ABSTRACT FROM AUTHOR]

This research analyzes factors that patients consider when offered the option to have surgeries (knee-replacement or heart bypass) at one of three locations (local hospital, Center of Excellence hospital, or Medical Tourism) with financial incentives varying based on location/surgery. Quantitative and qualitative results, based on a national online survey of respondents over 45 years old, found a significant relationship between perceived risk and satisfaction based on location of the surgery. However, specific individual factors, such as personal responsibilities, concerns with travel, perception of healthcare quality, are found to impact patient location preference for surgery. [ABSTRACT FROM AUTHOR]

Learning is a complex phenomenon in which learners can vary in their learning orientation, learning approaches, and perception of the learning environment. Learners may be characterized as mastery oriented or performance oriented, and this learning orientation can influence their learning approaches, such as whether to seek feedback or ask for help. The learning environment includes institutional assessment policies and informal interactions that emphasize outcomes and differentiation among students. When learners perceive the learning environment as performance oriented, they feel competition from other learners and fear negative feedback. This complex interplay of learning orientation, its influence on feedback-seeking behavior, and the environmental influence and reinforcement of both can be captured through learner profiles. In this multi-institutional cross-sectional survey study of students from six U.S. medical schools, we investigated learner profiles that characterize how these domains manifest together across individual learners. We then determined how these profiles are associated with students' clerkship grades. Measures included the Patterns of Adaptive Learning for learning orientation, self-reports for learning approaches, and perceptions of the learning environment. We used latent profile analysis to cluster students who share common characteristics around orientation, behavior, and environment. The relationship between these profiles and the percentage of honors earned was examined using multiple regression analysis. We found four distinct learner profiles within 666 of 974 (68%) analyzable responses: (1) performance oriented with negative perceptions of environment, (2) mastery oriented with desirable learning approaches, (3) "average" group, and (4) mastery orientation only. Profile 1 (M = 39%) and Profile 4 (M = 38%) students received fewer clerkship honors compared with other profiles. Profile 2 students earned a significantly higher percentage of honors grades (M = 54%) compared with other students. Profile 3 students (average group) earned the second highest percentage of honors (M = 46%). Effect sizes comparing the percentage of honors varied from 0.32 to 0.65, indicating medium to large differences. The highest performers, as measured by clerkship honors grades, were mastery oriented, perceived a more positive learning environment, and were comfortable asking questions and seeking feedback for their learning. The lowest performing students were performance oriented and had negative perceptions of their learning environments. Contrary to previous findings, we found that the relationship between mastery orientation and learning approaches is not unidirectional but rather seems to be mediated by perceptions of the learning environment. [ABSTRACT FROM AUTHOR]

In this article author Rebecca A. Schwartz-Mette responds to a commentary on her article "Challenges in Addressing Graduate Student Impairment in Academic Professional Psychology Programs," that was written by Christopher Collins, Carol A. Falendar and Edward P. Shafranske. In her response Schwartz-Mette is critical of points which are raised in the commentary and offers insights into her own article.

Phenomenon: Point-of-care ultrasound is fast becoming standard clinical bedside practice for diverse specialties. Medical schools are responding by adding ultrasound education, though the majority use it to supplement the learning of basic sciences. Point-of-care ultrasound practice-based clinical skills education is rare. There also is a lack of standardization across curricula, leading to much variability in the ultrasound skills that medical students from different schools bring to residency. To best inform a point-of-care ultrasound curriculum for our Transition-to Residency program, we investigated literature on 1) how medical students are being prepared for use of point-of-care ultrasound in clinical practice, 2) what skills are being taught, 3) what point-of-care ultrasound skills residency programs expect from incoming residents. Approach: We reviewed literature to identify curricula in U.S. medical schools that teach the concepts, knowledge, and skills related to point-of-care ultrasound. We also mapped point-of-care ultrasound expectations set forth by the Entrustable Professional Activities for undergraduate medical education to the specialty-specific milestones identified by the Accreditation Council for Graduate Medical Education. Additionally, we reviewed specialty-specific professional organizations for position statements and guidelines describing the point-of-care ultrasound skills expected for practicing physicians in their respective specialties. The goal was to identify any needs and gaps in education regarding point-of-care ultrasound across the undergraduate to graduate medical education continuum to practice. Findings: We found seven published point-of-care ultrasound curricula for medical students. There was wide variability in these curricula regarding what point-of-care ultrasound content is being taught, as well as when and how this skill is taught. No Entrustable Professional Activity listed point-of-care ultrasound as a skill requirement for graduating medical students. For graduate medical education, there was wide variability across specialties in residency milestones related to point-of-care ultrasound; some (e.g., emergency medicine) listed extensive milestones while others (e.g., internal medicine) listed none. However, we found that many specialty-specific professional organizations do list detailed point-of-care ultrasound expectations for their practicing physicians. Insights: As point-of-care ultrasound is fast becoming common practice across many specialties, standardization of education and related competencies—similar to other clinical skills training—is necessary across medical schools. Mapping point-of-care ultrasound expectations to current teaching across the continuum from undergraduate to graduate medical education may allow schools to tailor point-of-care ultrasound training for Transition-to-Residency programs. We provide a sample pilot point-of-care ultrasound curriculum that we designed for our Transition-to-Residency course. [ABSTRACT FROM AUTHOR]

Previous literature has demonstrated a gap between what health care consumers say they want to know about their physicians and the publicly available information the health care industry provides. This systematic analysis of Yelp reviews from the 25 most populous U.S. metropolitan areas is predicated on the assumptions that patients who post online physician reviews include information they would find useful when choosing a physician, and that this information represents an ecologically valid sample for making inferences regarding patients' decision making process. Obstetrician gynecologists are twice as likely to be reviewed as other physicians, but this is, to our knowledge, the first study examining online reviews of obstetrician-gynecologists specifically. This study contributes to the literature on medical decision making, demonstrating that the physician choice decision is made using a heuristic tallying model, in which only two, nearly equally weighted parameters are meaningful: patient (which, within the reviews, incorporates physician interpersonal manner and physician knowledge and skills) and office management. Yelp reviews of obstetrician-gynecologists follow patterns previously established in scholarship: ratings are bimodal, and approximately two-thirds are positive. In the absence of objective, user-friendly physician-level information, patients will turn to review sites like Yelp when choosing physicians. Rather than resisting this trend, physicians and hospital systems would be better served by working with review sites, or creating their own, to emphasize aspects of the experience patients are qualified to evaluate: the physician's interpersonal manner and office management. [ABSTRACT FROM AUTHOR]

Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan. Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools. Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group). Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies ('communication skills', 'teamwork', 'professionalism', 'work-readiness', 'commitment to practise in rural communities', 'commitment to practise with underserved ethnic and cultural populations'), as well as 'overall performance' and 'overall clinical skills'. Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs. [ABSTRACT FROM AUTHOR]

The authors discuss a report that describe the transition of medical education towards adaptive learning and implementation of the adaptive curriculum in two U.S. medical schools. Topics mentioned include the benefits of frequent testing, application of a summative assessment format by the medical curriculum through progress testing, and introduction of integrated undergraduate syllabuses in line with General Medical Council guidance.

Purpose: Physician review portals are becoming increasingly popular among patients and often serve as a primary advisory tool during the search for a doctor. However, it has not been established whether these platforms favor leaders of the field; i.e., physicians with high academic rank. Here, we assessed online ratings of US ophthalmologists, selected for their outstanding scientific performance.Methods: This cross-sectional, Internet-based study was performed in September 2016. First, we selected US ophthalmologists who published at least one manuscript or conference abstract that reached at least 100 citations from 2006 to 2016. Second, academic impact of preselected physicians, measured by overall number of citations or Hirsch index, was correlated with their ratings on two physician review portals: healthgrades.com and zocdoc.com.Results: We selected 105 ophthalmologists who met established criteria. A total of 78 were rated on healthgrades.com, but only two were rated on zocdoc.com. The average rating on healthgrades.com was 4.2 +/-0.9, similar to the previously reported US mean for a physician (∼4). The rating did not correlate with the number of citations or with Hirsh index.Conclusions: Highly cited ophthalmologist are not rated proportionately to their scientific achievements. Their reviews are positive, but do not stand out in comparison to other physicians. Additionally, we found that this group of ophthalmologists might be significantly underrepresented on particular review websites. [ABSTRACT FROM AUTHOR]

Respite services are vital in supporting informal caregivers in need of a break from their caregiving duties. A respite training program aimed at developing respite provider competence and improving caregiver well-being was evaluated. Trainees experienced significant growth in their perceived respite knowledge and confidence to deliver respite from pretraining to posttraining. An objective core competency assessment confirmed posttraining knowledge in 10 core areas of respite. Family caregivers provided more favorable ratings on various measures of their well-being while receiving respite from a trained provider compared to before respite began and if respite were to end. Findings suggest that formal training prepares providers to deliver quality respite resulting in improved caregiver outcomes. [ABSTRACT FROM AUTHOR]

Over the last 40 years, several thousand Nigerian-trained doctors havemigrated to the U.S. to practice in what they regard as the state-of-theartof global biomedicine. Based on interviews with Nigerian physicians,this article shows how their professional mobility, and their transition tothe new professional environment of U.S. biomedicine, makes themaware of local differences in practicing medicine. Adapting to local waysof practicing in the U.S. creates a new sense of belonging andprofessional identity. Yet they also juxtapose highly technologised U.S.biomedicine with what they were trained to excel in within the medicalprofession in Nigeria – namely the ‘art of medicine' – that is, possessingprofound clinical skills to diagnose with few investigative technologies.By stressing their competence in the art of medicine, which they see aslacking among their U.S.-trained colleagues, they negotiate their positionin a global biomedical landscape and reconnect to a distinctly Nigerianway of practicing medicine. Their narratives thus shed light onperceptions of multiple biomedicines from the point of view ofphysicians moving from the global South to the global North, and howwithin a global biomedical landscape both ruptures and connectivitiesof competence are imagined. [ABSTRACT FROM AUTHOR]

Background: International Medical Graduates (IMGs) are commonly understood to move from low to high resource countries with motivations including improved financial situations and cultures of emigration. A presumable exception to the above themes would be the Japanese IMG population. The aim of this study was to develop an understanding of the Japanese IMG experience. Methods: Using a grounded theory approach, we interviewed 19 Japanese IMGs working in the US and 16 Japanese IMGs working in Japan who had completed US clinical training. Questions addressed decision-making to pursue US clinical training, goals for the training, and career decision-making upon completing the training. Data collection and constant comparative analysis were conducted iteratively to identify emerging themes. Results: The emerging model of the Japanese IMG experience is focused around pivotal experiences that often include dissatisfaction with the quality of Japanese clinical training and personal exposures to US clinical education. Further decision-making in the pursuit of US residency is influenced by educator training quality, and clinical training and career opportunities. The desire to improve Japanese clinical training commonly influences career decision-making after US training. Conclusions: The Japanese IMG experience contrasts numerous perceptions of international physician migration and, in turn, enhances understanding of this paradigm. [ABSTRACT FROM AUTHOR]

Phenomenon: The integration of public health (PH) competency training into medical education, and further integration of PH and primary care, has been urged by the U.S. Institute of Medicine. However, PH competencies are numerous, and no consensus exists over which competencies are most important for adoption by current trainees. Our objective was to conduct a group concept mapping exercise with stakeholders identifying the most important and feasible PH skills to incorporate in medical and residency curricula.Approach: We utilized a group concept mapping technique via the Concept System Global Max (http://www.conceptsystems.com), where family medicine educators and PH professionals completed the phrase, “A key Public Health competency for physicians-in-training to learn is …” with 1–10 statements. The statement list was edited for duplication and other issues; stakeholders then sorted the statements and rated them for importance and feasibility of integration. Multidimensional scaling and cluster analysis were used to create a two-dimensional point map of domains of PH training, allowing visual comparison of groupings of related ideas and relative importance of these ideas.Findings: There were 116 nonduplicative statements (225 total) suggested by 120 participants. Three metacategories of competencies emerged: Clinic, Community & Culture, Health System Understanding, and Population Health Science & Data.Insights: We identified and organized a set of topics that serve as a foundation for the integration of family medicine and PH education. Incorporating these topics into medical education is viewed as important and feasible by family medicine educators and PH professions. [ABSTRACT FROM PUBLISHER]

The treatment of youthful offenders in correctional settings presents psychologists with a range of challenging ethical concerns. The inherent discord between psychologically based goals and correctional objectives yields a complicated ethical landscape for clinicians. These concerns can be partially addressed through the APA's revised Ethical Principles of Psychologists and Code of Conduct (2010) and field-specific practice guidelines but also require extensive further guidance to ensure competent and ethical practice. This article analyzes current information about youthful offenders, outlines disparities in stakeholder goals, provides an overview of ethical considerations of treating youthful offenders in correctional settings, and offers recommendations for education and practice. [ABSTRACT FROM AUTHOR]

This article asserts that macro practice is increasingly important in today’s rapidly changing and complex practice environment. It briefly explores the history of macro practice in U.S. social work, summarizes its major contributions to the profession and to U.S. society, and provides some suggestions for how social work programs can expand interest in macro practice among their students and increase the number of students who pursue macro-oriented careers. [ABSTRACT FROM PUBLISHER]

The importance of interprofessional education in health professions training is increasingly recognised through new accreditation guidelines. Clinician teachers from different professions may find themselves being asked to teach or supervise learners from multiple health professions, focusing on interprofessional dynamics, interprofessional communication, role understanding, and the values and ethics of collaboration. Clinician teachers often feel prepared to teach learners from their own profession but may feel ill prepared to teach learners from other professions. In this guide, we draw upon the collective experience from two countries: an institution from the United States with experience in guiding faculty to teach in a student-run interprofessional clinic and an institution from Canada that offers interprofessional experiences to students in community and hospital settings. This guide offers teaching advice to clinician educators in all health professions who plan to or already teach in an interprofessional clinical setting. We anticipate that clinician teachers can learn to fully engage learners from different professions, precept effectively, recognise common pitfalls, increase their confidence, reflect, and become role models to deliver effective teaching in interprofessional settings. [ABSTRACT FROM AUTHOR]

The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program. [ABSTRACT FROM AUTHOR]

Social work has historically recognized group work as a core practice methodology; however, group work’s prominence within the graduate curriculum has diminished over the years. This article reports the results of a national survey of accredited U.S. MSW programs’ curricular offerings in group work. The survey replicates and builds upon a 1994 Birnbaum and Auerbach study to identify changes and trends over this 20-year period. Overall, a further decline in group work curricular offerings was found. Strategies to renew and bolster commitment to group work education are offered. [ABSTRACT FROM PUBLISHER]

Background: Peers have been shown to be reliable raters in an objective structured clinical exam (OSCE). While the literature supports the use of senior level students in rating basic clinical skills, little is known about the reliability of peers of the same level of training in assessing complex clinical skills. Aim: To investigate the reliability of student peers of the same level of training in rating complex clinical skills in a geriatric OSCE. Methods: Peer ( n = 115) ratings were compared to faculty ratings using correlation and generalizability analysis. Paired Wilcoxon Signed-Rank test was used to establish peer learning benefits. Results: Reliability of the OSCE was moderately strong (G-coefficient = 0.70) with strong correlations between peer and faculty ratings for the overall OSCE ( r = 0.78, p = 0.001) and for each case ( r = 0.70-0.85, p = 0.001). Generalizability analysis indicated that raters contributed minimally to score variance. Peers reported gaining learning benefits from the rating process. Conclusion: Peer raters of the same level of training can provide accurate ratings of complex clinical tasks and can serve as an important resource in assessing student performance in an OSCE. The peer review process can also serve an important role in enhancing student learning. [ABSTRACT FROM AUTHOR]

Background: The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions.Purposes: The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students’ attitudes and beliefs toward subconscious bias and health disparities.Methods: A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed (“deniers”) or agreed (“accepters”) with the statement “Unconscious bias might affect some of my clinical decisions or behaviors.” Data analysis focused specifically on factors associated with this perspective.Results: The survey response rate was at least 69%. Of the responders, 22% were “deniers” and 77% were “accepters.” Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care.Conclusions: The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum. [ABSTRACT FROM PUBLISHER]

This study attempted to explore and clarify the ambiguity surrounding cultural concepts, broaden and deepen the current understanding of cultural competency, and operationalize its core components in multicultural education in the United States. The research findings presented in this study were organized into three overarching themes: Level I: knowledge development; Level II: integrative processes; and Level III: practice evaluation. The findings contributed to the formulation of levels in multicultural learning and to the specification of core cultural components in clinical practice. [ABSTRACT FROM PUBLISHER]

The article discusses devaluation of educational supervision in social work and provides an explanation of the development process experienced by the supervisee. The author believes that a lack of understanding of this process is what has led to a change in the traditional model of supervision to give rise to a system that addresses administrative issues directly. The article describes 5 stages in social work education, described by Reynolds, that help in understanding the treatment process.

The authors describe the prevalence, formation, maintenance, and evaluation of student aging interest groups. They conducted a cross-sectional electronic survey of the 46 academic medical centers funded by the Donald W. Reynolds Foundation. To evaluate their group of approximately 50 students, the authors conducted an electronic pretest and posttest of attitudes toward interdisciplinary education and knowledge about aging. Twenty-nine of 32 responding institutions funded by the Reynolds Foundation conducted a group; only medical students participated in one half of these groups. Panel presentations were the most prevalent group activity. Evaluation of their group revealed that an interprofessional service learning experience had the greatest impact on student perceptions of the educational preparation and competency of other disciplines. At posttest, medical students in their group had significantly less positive perceptions of actual cooperation between disciplines than did physical therapy or pharmacy students. Aging interest groups conducted by institutions funded by the Reynolds Foundation did not have a high level of interdisciplinary participation. Intermittent exposure to other disciplines during a small number of group activities may be insufficient to overcome “disciplinary split” and achieve interprofessional team orientation without changes in the structure of medical education. [ABSTRACT FROM PUBLISHER]

The Black Adoption Research and Placement Center is a nonprofit organization delivering culturally specific adoption and foster care services. The organization developed as a response to concerns in the African-American community about the high numbers of African-American children entering and not exiting the public foster care system. The organization has undergone significant transformations over its 25-year history in relation to social, political, and economic changes that have altered the ways that the agency finances and delivers services. The history of Black Adoption Research and Placement Center presents an organization that has weathered many challenges because of its strong leadership, its committed governing body, its external relationships, and its internal operations. [ABSTRACT FROM AUTHOR]

Background: Recent efforts to identify the essential skills and competencies required for medical practice have resulted in an expansion of the educational outcomes for which medical schools are accountable. Teachers in the preclinical years, formerly focused on the transmission of biomedical principles and factual information, are now charged with presenting discipline-specific concepts with an emphasis on clinical relevance while advancing active learning, critical thinking, communication skills, and other professional competencies. Problem-based learning has been widely introduced to support these educational goals but other, less resource-intensive, discussion methodologies have not been extensively explored. Aim: To examine the feasibility of case-method teaching (CMT) during the preclinical curricula to integrate basic science concepts in the management of clinical problems. Methods: CMT sessions were conducted with students during the first- and second-year of hybrid curricula at two US medical schools. Results: First- and second-year medical classes of 40-95 students prepared for and actively engaged in single session case discussions and were able to productively apply basic science principles in clinical problem-solving. Conclusion: CMT represents a feasible and resource-conservative pedagogical format to promote critical thinking and to integrate basic science principles during the preclinical curriculum. [ABSTRACT FROM AUTHOR]

Licensure testing programs in the United States (e.g., nursing) face an increasing challenge of measuring the competency of internationally trained candidates, both in relation to their clinical competence and their English language competence. To assist with the latter, professional licensing bodies often adopt well-established and widely available international English language proficiency measures. In this context, the National Council of State Boards of Nursing (NCSBN) sought to develop a nursing-specific passing standard on the International English Language Testing System that U.S. jurisdictions could consider in their licensure decisions for internationally trained candidates. Findings from a standard setting exercise were considered by NCSBN's Examination Committee in conjunction with other relevant information to produce a legally defensible passing standard on the test. This article reports in detail on the standard setting exercise conducted as part of this policy-making process; it describes the techniques adopted, the procedures followed, and the outcomes obtained. The study is contextualized within the current literature on standard setting. The latter part of the article describes the nature of the policy-making process to which the study contributed and discusses some of the implications of including a language literacy test as part of a licensure testing program. [ABSTRACT FROM AUTHOR]

Background: Research on the validity of using the Medical College Admissions Test (MCAT) and undergraduate grade point average (GPA) for selection to medical school has produced conflicting interpretations. There is debate regarding the degree to which coefficients diminish over the course of educational and professional outcomes and disagreement over whether these two measures can predict clinical performance. Purpose: To summarize and interpret the validity literature using validity generalization techniques that account for measurement error. Methods: Validity generalization techniques were used to summarize MCAT and undergraduate GPA validity research. A meta-analysis was performed to evaluate validity coefficients for two outcome domains across educational and professional attainment levels. Results: The ability to predict academic performance decreases slightly for written tests. For clinical performance assessments, existing research does not allow an assessment of change across training levels. However, relevant studies suggest that MCAT and undergraduate GPA have a positive predictive relationship with clinical skills. Conclusion: A validity generalization perspective of the literature supports the use of MCAT and undergraduate GPA for selection to medical school. [ABSTRACT FROM AUTHOR]

Background: The use of standardized patients has been an accepted instructional methodology in medical education for many years. A logical evolution of this methodology is the creation of a standardized patient family. Description: This article describes one such standardized family, the Jones family, and how the family is used to teach interpersonal skills, interviewing, communication, counseling, and history-taking skills to medical students. Evaluation: After several years of using the Jones family, we have found that more comprehensive scripts need to be developed, that recruitment and retention of standardized patients for a yearlong program does not seem to be a problem, and that the value added by a standardized family greatly enhances the educational experience for students. A standardized family seems a logical educational vehicle for teaching continuity of care, confidentiality, contextual placement of medical information within family dynamics, cultural beliefs, community orientation, and generalism. Conclusion: A standardized family is a viable instructional methodology that deserves greater use in medical education. [ABSTRACT FROM AUTHOR]

Examines the health competencies of health care systems in the U.S. Hegemony of the citizen role on the client and consumer roles in individual and collective health care decisions; Definition of the health competency; Identification of contexts in health competencies.