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The article reviews several articles related to medicine including "Undergraduate Medical Education," in the "Journal of General Internal Medicine" in 2008, "Continuing Medical Education," in the journal "Annals of Internal Medicine" in 2007, and "Undergraduate Medical Education," in the "Journal of Urology" in 2008.

This journal watch is sponsored by the Alliance for Clinical Education (ACE). The purpose of this article is to summarize medical education manuscripts from specialty journals that are important and relevant to educators across specialties. Specialties included in our review were cardiology, gastroenterology, general internal medicine, pulmonology, nephrology, hematology and oncology, endocrinology, rheumatology, infectious disease, and neurology. We are grateful to Teaching and Learning in Medicine and ACE for giving us the opportunity to publish this review. The Clerkship Directors in Internal Medicine Research Committee conducted this review. Included are English articles published from September 2006 through September 2007. PubMed was searched for peer-reviewed research publications reporting primary data on medical education. Medical subject heading terms included combinations of medical education, medical student, residency training, practice, undergraduate medical education, graduate medical education, internship and residency, and continuing medical education. We also reviewed the bibliographies of all articles found though our PubMed search to identify additional articles that may not have been included in PubMed's search engine. Furthermore, we discussed identified articles with content experts in each specialty to ensure that appropriate journals and articles were included from each subspecialty. The journals that we selected for review are not often read by the typical medical educator. We included articles from general and subspecialty journals of internal medicine excluding the following, which have a focus on medical education or cross-specialties: Academic Medicine, Advances in Health Science Education, Medical Education, Medical Teacher, Teaching and Learning in Medicine, Journal of the American Medical Association, and New England Journal of Medicine. Specialties included in our review were cardiology, gastroenterology, general internal medicine, pulmonology, nephrology, hematology and oncology, endocrinology, rheumatology, infectious disease, and neurology. We also reviewed the bibliographies of all articles found though our PubMed search to identify additional articles. Furthermore, we discussed identified articles with content experts in each specialty to ensure that appropriate journals and articles were included from each subspecialty. Authors rated each article based on relevance, rigor, importance, and generalizibility of findings. We also sought to include articles from each phase in the continuum of medical education: undergraduate, graduate, and continuing medical education as well as qualitative and quantitative studies. Articles were ranked by each author. We then held conference calls and had e-mail discussions to establish consensus on the articles included in this review. The following is a summary of each selected article grouped by theme. [ABSTRACT FROM AUTHOR]

Background: The 4th-year internal medicine subinternship (subI), with its strong emphasis on experience-based learning and increased patient responsibilities, is an important component of undergraduate medical education. Discussions have begun amongst educational leaders on the importance of standardizing curriculum and evaluation tools utilized during the subinternship. Purpose: The objective of this survey was to describe the current state of educational practices regarding the subI curriculum, use of Clerkship Directors in Internal Medicine (CDIM) curricular guidelines, evaluation methodologies, and subintern call frequency and duty hours. Methods: The survey was a part of the CDIM annual survey sent to 109 institutional members in 2005. The subinternship survey included 17 questions that addressed the prevalence of formal curricula in the subinternship, use of CDIM curricular guidelines and resources, and the evaluation tools utilized for assessment of the subinternship. Two questions examined the call frequency and duty hours of the subinterns. Results: Eighty-eight members responded (81%). Of the respondents, 37% have a formal curriculum and 35% used CDIM curricular guidelines for the subinternship. More than half of the respondents agreed that the curricular guide helped organize their subI rotations (53%), and 48% agreed that it enhanced the quality of subI education. A global rating summative evaluation form (56%) was the most commonly used evaluation tool in the subinternship. Objective Structured Clinical Examinations1-3 (1%) and Mini-Clinical Evaluation Exercise (mini-CEX)4(2%) were much less utilized during the subinternship. The respondents expressed an interest in the development of a standardized exam (47%) and clinical assessment tools such as the mini-CEX (59%). The vast majority of IM subinterns participate in 3 to 9 calls per rotation and spend less than 80 hr in the hospital per week. Conclusions: A formal curriculum is offered in slightly more than one third of subIs. Clerkship directors expressed interest in developing standardized evaluation tools to assess subintern competencies. The majority of IM subinterns spend less than 80 hr in the hospital per week. Further studies are needed to assess barriers to incorporating a formal curriculum and develop standardized tools to assess subintern competencies. [ABSTRACT FROM AUTHOR]

CONTEXT: Trainees are exposed to medical errors throughout medical school and residency. Little is known about what facilitates and limits learning from these experiences. OBJ'ECT/VE: To identify major factors and areas of tension in trainees' learning from medical errors. DESIGN, SETTING, AND PARTICIPANTS: Structured telephone interviews with 59 trainees (medical students and residents) from 1 academic medical center. Five authors reviewed transcripts of audiotaped interviews using content analysis. RESULTS: Trainees were aware that medical errors occur from early in medical school. Many had an intense emotional response to the idea of committing errors in patient care. Students and residents noted variation and conflict in institutional recommendations and individual actions. Many expressed role confusion regarding whether and how to initiate discussion after errors occurred. Some noted the conflict between reporting errors to seniors who were responsible for their evaluation. Learners requested more open discussion of actual errors and faculty disclosure. No students or residents felt that they learned better from near misses than from actual errors, and many believed that they learned the most when harm was caused. CONCLUSIONS: Trainees are aware of medical errors, but remaining tensions may limit learning, institutions can immediately address variability in faculty response and local culture by disseminating clear, accessible algorithms to guide behavior when errors occur. Educators should develop longitudinal curricula that integrate actual cases and faculty disclosure. Future multi-institutional work should focus on identified themes such as teaching and learning in emotionally charged situations, learning from errors and near misses and balance between individual and systems responsibility. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To report how patient viewpoints on caring inform curriculum development for teaching sessions on delivering bad news, making the transition to palliative care, and communicating about a medical error. Methods: We conducted focus groups that used patients recruited from the surrounding community to view videotapes of physicians delivering bad news, talking with a patient about palliative care, and communicating about a medical error. We used focus group results, combined with evidence from the medical literature to inform curriculum content for workshops conducted with Internal Medicine and Family Medicine residents at the University of Massachusetts Medical School. Results: Patient perspectives on caring gathered through focus groups differed in significant ways from the existing medical literature on caring when providers are communicating in the challenging situations that were depicted. Our data pointed out that individual reactions were unique and sometimes contradictory in that one person saw behavior as caring that others thought was uncaring. Participants often used qualifiers in their comments like “appropriate” amounts of information, “measured” empathy, chooses words carefully to reflect the relative nature of caring. “Arranges to meet healthcare needs,” an issue that extends beyond the encounter, was seen as a new component of caring not previously described. Applying these concepts to curriculum required that we not only focus on the behavioral skills involved in these tasks, but also the processes of assessing patient''s informational and emotional needs, and then taking steps to meet them, while adjusting behavior in real time to meet patients needs for caring. Workshops delivered were highly evaluated by residents. Conclusion: Patient perspectives on caring when providers deliver bad news, discuss transitions to palliative care, and communicate about a medical error reinforce that patient expectations for caring are highly contextualized and physician behavior needs to be individualized. We taught residents not only behavioral skills, but also the process skills of anticipating patient reactions, recognizing patient clues, planning and choosing effective strategies on the fly, and assessing one''s own performance characteristic of communication expertise. Practice implications: Teaching caring attitudes with challenging communication tasks requires that learners appreciate and value not only caring behaviors but also learn the process by which they must adjust and titrate their actions to meet patient needs. [Copyright &y& Elsevier]

Abstract: Objective: Caring is closely associated with reduced malpractice litigation, adherence to treatment and even symptom relief. Caring also is included in pay for performance formulas as well as widely utilized for quality improvement purposes. Our objective in this prospective qualitative study was to define caring behaviors associated with three challenging encounters: discussing the transition from curative to palliative care, delivering bad news (cancer), and discussing a medical error (misplaced test result). The purpose was to lay the groundwork for the creation of a ‘patient-centered’ caring attitude checklist that could help the healthcare provider understand and ultimately enhance the patient''s experience of care. Methods: Groups of randomly selected lay people, henceforth referred to as patients: (1) engaged in ‘think aloud’ exercises to help create a 15-item caring behavior checklist; (2) used the checklist to rate videotapes of simulated challenging encounters conducted by twenty primary care physicians (total of 600 ratings sets); and (3) participated in 12 separate 1.5h focus groups discussing the caring (and non-caring) behaviors exhibited in videotapes of the highest and lowest rated encounters. Results: Thirteen behaviors emerged as focal for describing a doctor''s caring attitude but with disagreement as to whether specific examples of these behaviors were ‘caring’ or ‘uncaring.’ For example, although the concept of empathic inquiry was considered important by most patients, the physician question, “Is there someone you can call or talk with” (about a cancer diagnosis) was interpreted by one patient as ‘very caring’ while another was ‘impressed with how uncaring’ the statement appeared. Conclusion: At the conceptual level there is a set of behaviors that represent caring, however, the manifestation of these behaviors is ‘in the eye of the beholder.’ The most important element of caring may not be the set of behaviors but a set of underlying abilities that include taking the patient''s perspective and reflecting on the patient''s responses. Practice implications: Medical education must focus on the underlying abilities of caring. [Copyright &y& Elsevier]