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To determine the quality of published rheumatology-focused continuing professional development (CPD) for primary care clinicians (PCCs) for improving the care of patients with rheumatic diseases.The authors conducted a systematic review of CPD focused on rheumatology topics for PCCs. A librarian systematically searched PubMed, Embase, Web of Science, ERIC, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sinico. Studies were limited to those conducted in North America after 1993. An extraction form that included the Medical Education Research Study Quality Instrument and the Kirkpatrick levels of learning outcomes was created through an iterative process and applied to the included articles.In total, 725 articles were retrieved, of which 9 were included. Results showed that CPD was directed more at noninflammatory arthritis than inflammatory arthritis. Autoimmune diseases were underrepresented; 4 studies discussed rheumatoid arthritis, and 1 study examined rheumatologic topics broadly. Newer research tended to include multimodal approaches that combined didactic and active learning strategies, showing an evolution toward more active learning. Although online learning is increasingly popular, interventions were predominantly face-to-face, with only a single example of e-learning. Studies were predominantly of moderate quality.Published studies of rheumatology-focused CPD are moving toward more interactive teaching modalities and are typically conducted in person, although virtual options for rheumatology-focused CPD should be explored to improve access to CPD. Autoimmune disease is an uncommon topic in CPD and represents an area for future expansion. Efficacy was difficult to assess given that most of the studies assessed for learner satisfaction, knowledge acquisition, or behavior change, whereas only 1 study focused on patient outcomes.

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

Purpose To conduct a bibliometric case study of the journal Perspectives on Medical Education (PME) to provide insights into the journal’s inner workings and to “take stock” of where PME is today, where it has been, and where it might go. Methods Data, including bibliographic metadata, reviewer and author details, and downloads, were collected for manuscripts submitted to and published in PME from the journal’s Editorial Manager and Web of Science. Gender of authors and reviewers was predicted using Genderize.io. To visualize and analyze collaboration patterns, citation relationships and term co-occurrence social network analyses (SNA) were conducted. VOSviewer was used to visualize the social network maps. Results Between 2012–2019 PME received, on average, 260 manuscripts annually (range = 73–402). Submissions were received from authors in 81 countries with the majority in the United States (US), United Kingdom, and the Netherlands. PME published 518 manuscripts with authors based in 31 countries, the majority being in the Netherlands, US, and Canada. PME articles were downloaded 717,613 times (mean per document: 1388). In total 1201 (55% women) unique peer reviewers were invited and 649 (57% women) completed reviews; 1227 (49% women) unique authors published in PME. SNA revealed that PME authors were quite collaborative, with most authoring articles with others and only a minority (n = 57) acting as single authors. Discussion This case study provides a glimpse into PME and offers evidence for PME’s next steps.

Introduction While authorship plays a powerful role in the academy, research indicates many authors engage in questionable practices like honorary authorship. This suggests that authorship may be a contested space where individuals must exercise agency-a dynamic and emergent process, embedded in context-to negotiate potentially conflicting norms among published criteria, disciplines and informal practices. This study explores how authors narrate their own and others' agency in making authorship decisions. Method We conducted a mixed-methods analysis of 24 first authors' accounts of authorship decisions on a recent multi-author paper. Authors included 14 females and 10 males in health professions education (HPE) from U.S. and Canadian institutions (10 assistant, 6 associate and 8 full professors). Analysis took place in three phases: (1) linguistic analysis of grammatical structures shown to be associated with agency (coding for main clause subjects and verb types); (2) narrative analysis to create a 'moral' and 'title' for each account; and (3) dialectic integration of (1) and (2). Results Descriptive statistics suggested that female participants used we subjects and material verbs (of doing) more than men and that full professors used relational verbs (of being and having) more than assistant and associate. Three broad types of agency were narrated: distributed (n = 15 participants), focusing on how resources and work were spread across team members; individual (n = 6), focusing on the first author's action; and collaborative (n = 3), focusing on group actions. These three types of agency contained four subtypes, e.g. supported, contested, task-based and negotiated. Discussion This study highlights the complex and emergent nature of agency narrated by authors when making authorship decisions. Published criteria offer us starting point-the stated rules of the authorship game; this paper offers us a next step-the enacted and narrated approach to the game.

IntroductionInterdisciplinary research has been deemed to be critical in solving society’s wicked problems, including those relevant to medical education. Medical education research has been assumed to be interdisciplinary. However, researchers have questioned this assumption. The present study, a conceptual replication, provides an analysis using a larger dataset and bibliometric methods to bring more clarity to our understanding on the nature of medical education interdisciplinarity or lack thereof.MethodThe authors retrieved the cited references of all published articles in 24 medical education journals between 2001-2020 from the Web of Science (WoS). We then identified the WoS classifications for the journals of each cited reference.ResultsThe 24 journals published 31,283 articles referencing 723,683 publications. We identified 493,973 (68.3%) of those cited references in 6,618 journals representing 242 categories, which represents 94% of all WoS categories. Close to half of all citations were categorized as “education, scientific disciplines” and “healthcare sciences and services”. Over the two decades studied, we observed consistent growth in the number of references in other categories, such as education, educational research, and nursing. Additionally, the variety of categories represented has also increased from 182 to 233 to include a diversity of topics such as business, management, and linguistics.DiscussionThis study corroborates prior work while also expanding it. Medical education research is built upon a limited range of fields referenced. Yet, the growth in categories over time and the ongoing increased diversity of included categories suggests interdisciplinarity that until now has yet to be recognized and represents a changing story.

Introduction Health professions educators risk misunderstandings where terms and concepts are not clearly defined, hampering the field’s progress. This risk is especially pronounced with ambiguity in describing roles. This study explores the variety of terms used by researchers and educators to describe “faculty”, with the aim to facilitate definitional clarity, and create a shared terminology and approach to describing this term. Methods The authors analyzed journal article abstracts to identify the specific words and phrases used to describe individuals or groups of people referred to as faculty. To identify abstracts, PubMed articles indexed with the Medical Subject Heading “faculty” published between 2007 and 2017 were retrieved. Authors iteratively extracted data and used content analysis to identify patterns and themes. Results A total of 5,436 citations were retrieved, of which 3,354 were deemed eligible. Based on a sample of 594 abstracts (17.7%), we found 279 unique terms. The most commonly used terms accounted for approximately one-third of the sample and included faculty or faculty member/s (n = 252; 26.4%); teacher/s (n = 59; 6.2%) and medical educator/s (n = 26; 2.7%) were also well represented. Content analysis highlighted that the different descriptors authors used referred to four role types: healthcare (e.g., doctor, physician), education (e.g., educator, teacher), academia (e.g., professor), and/or relationship to the learner (e.g., mentor). Discussion Faculty are described using a wide variety of terms, which can be linked to four role descriptions. The authors propose a template for researchers and educators who want to refer to faculty in their papers. This is important to advance the field and increase readers’ assessment of transferability. Supplementary Information The online version of this article (10.1007/s40037-021-00683-8) contains supplementary material, which is available to authorized users.

RATIONALE, AIMS AND OBJECTIVES: An important aspect of scholarly discussions about evidence-based practice (EBP) is how EBP is measured. Given the conceptual and empirical developments in the study of EBP over the last 3 decades, there is a need to better understand how to best measure EBP in educational and clinical contexts. The aim of this study was to identify and describe the main challenges, recommendations for practice, and areas of future research in the measurement of EBP across the health professions as reported by systematic reviews (SRs).We conducted a secondary analysis of qualitative data obtained in the context of a previously published umbrella review that aimed to compare SRs on EBP measures. Two reviewers independently extracted excerpts from the results and discussion/conclusion sections of the 10 included SRs that aligned with the three research aims. An iterative six-phase reflexive thematic analysis according to Braun and Clarke was conducted.Our thematic analysis produced five themes describing the main challenges associated with measuring EBP, four themes outlining main recommendations for practice, and four themes representing areas of future research. Challenges include limited psychometric testing and validity evidence for existing EBP measures; limitations with the self-report format; lack of construct clarity of EBP measures; inability to capture the complexity of the EBP process and outcomes; and the context-specific nature of EBP measures. Reported recommendations for practice include acknowledging the multidimensionality of EBP; adapting EBP measures to the context and re-examining the validity argument; and considering the feasibility and acceptability of measures. Areas of future research included the development of comprehensive, multidimensional EBP measures and the need for expert consensus on the operationalization of EBP.This study suggests that existing measures may be insufficient in capturing the multidimensional, contextual and dynamic nature of EBP. There is a need for a clear operationalization of EBP and an improved understanding and application of validity theory.

The voices of authors who publish medical education literature have a powerful impact on the field's discourses. Researchers have identified a lack of author diversity, which suggests potential epistemic injustice. This study investigates author characteristics to provide an evidence-based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing.The authors conducted a bibliometric analysis of all articles published in 24 medical education journals published between 2000 and 2020 to identify author characteristics, with an emphasis on author gender and geographic location and their intersection. Article metadata was downloaded from Web of Science. Genderize.io was used to predict author gender.The journals published 37 263 articles authored by 62 708 unique authors. Males were more prevalent across all authorship positions (n = 62 828; 55.7%) than females (n = 49 975; 44.3%). Authors listed affiliations in 146 countries of which 95 were classified as Global South. Few articles were written by multinational teams (n = 3765; 16.2%). Global South authors accounted for 12 007 (11.4%) author positions of which 3594 (3.8%) were female.This study provides an evidence-based starting point to discuss the imbalance of author voices in medical education, especially when considering the intersection of gender and geographical location, which further suggests epistemic injustice in medical education. If the field values a diversity of perspectives, there is considerable opportunity for improvement by engaging the community in discussions about what knowledge matters in medical education, the role of journals in promoting diversity, how to best use this baseline data and how to continue studying epistemic injustice in medical education.

Through 19 interviews with scientists, this study examines scientists’ use of media logic and their relationships with journalists using research as the focal point. The authors identified that the scientists shared a basic understanding of media logic classified in three patterns. Two patterns were previously identified by Olesk: 1) adaption (ability to explain research in a simple, engaging fashion but with a reactive approach to journalist interaction) and 2) adoption (proactively create and manage media interactions for strategic aims through a more active use of media logic). The other emerged as a new, third pattern, affiliation (enthusiastic contributors to journalists’ production practices and desire to engage in public outreach).

Ensuring that future physicians are competent to practice medicine is necessary for high quality patient care and safety. The shift toward competency-based education has placed renewed emphasis on ...

Women in the military have a high rate of unintended pregnancies, which is an issue both personally and with respect to the warfighting mission. One strategy to help servicewomen achieve family planning goals includes increasing education about and access to contraception. Research suggests that preference-sensitive decisions about contraceptives benefit from shared decision-making, and decision aids have been shown to facilitate this patient-centered approach. In this article, we describe the process by which we enhanced an existing evidence-based tool to meet the needs of military servicewomen and created Decide + Be Ready, a contraceptive decision-making mobile application. After extensive research into challenges faced by servicewomen with respect to contraceptive knowledge and access, we developed content for the decision aid and determined that a mobile app format would provide the privacy and convenience needed. Our team developed a prototype that, in collaboration with the Defense Health Agency Connected Health Branch, was tested with servicewomen and providers. User feedback shaped the final version, which can be accessed free from the App Store and Google Play. Early implementation has demonstrated patient and provider satisfaction. Obstacles to full implementation of Decide + Be Ready remain within the Military Health System. We lay out a roadmap for dissemination, implementation, and evaluation and explore the applications of the decision aid for health professions education in the realm of shared decision-making. Finally, we recommend consideration of decision aids for other health care decisions as a way to achieve patient-centered care, improve health outcomes, and potentially reduce costs.

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

INTRODUCTION: Remediation in medical education tends to focus on the struggling learner. However, understanding successful learners may provide valuable insights to problematic academic behavior. This study explored core study strategies reported by high-performing medical school students. METHOD: In the Fall of 2018 and 2019, high-performing first- and second-year medical students, defined as those who had performed over 90% on a national standardized assessment, were requested via e-mail to describe the study strategies that they believe contributed to their success. Student responses were analyzed using a template-driven approach, which drew upon common frameworks from cognitive learning theory. RESULTS: Thirty-seven high-performing students provided brief unstructured descriptions of their study strategies. Retrieval practice—the cognitive learning strategy of attempting to draw out information to active recall, typically through means of self-quizzing, practice questions, or flashcards—was the most commonly endorsed strategy, followed by spaced repetition. Use of outside commercial resources was commonly referenced, and approximately one-third endorsed a perception that some form of regularly practiced self-care contributed to their academic success. DISCUSSION: Retrieval practice, particularly combined with some form of spaced repetition, is often attributed as contributing to the success of high-performing learners. The use of commercial resources bears further exploration and consideration. Finally, the finding that self-care was identified as a contribution to academic performance goes beyond a focus on self-care solely for medical student well-being. This is an important distinction for both medical education and future research in this area.

Purpose This bibliometric analysis maps the landscape of knowledge syntheses in medical education. It provides scholars with a roadmap for understanding where the field has been and where it might go in the future, thereby informing research and educational practice. In particular, this analysis details the venues in which knowledge syntheses are published, the types of syntheses conducted, citation rates they produce, and altmetric attention they garner. Method In 2020, the authors conducted a bibliometric analysis of knowledge syntheses published in 14 core medical education journals from 1999 to 2019. To characterize the studies, metadata were extracted from PubMed, Web of Science, Altmetrics Explorer, and Unpaywall. Results The authors analyzed 963 knowledge syntheses representing 3.1% of the total articles published (n = 30,597). On average, 45.9 knowledge syntheses were published annually (SD = 35.85, median = 33), and there was an overall 2620% increase in the number of knowledge syntheses published from 1999 to 2019. The journals each published, on average, a total of 68.8 knowledge syntheses (SD = 67.2, median = 41) with Medical Education publishing the most (n = 189; 19%). Twenty-one types of knowledge synthesis were identified, the most prevalent being systematic reviews (n = 341; 35.4%) and scoping reviews (n = 88; 9.1%). Knowledge syntheses were cited an average of 53.80 times (SD = 107.12, median = 19) and received a mean Altmetric Attention Score of 14.12 (SD = 37.59, median = 6). Conclusions There has been considerable growth in knowledge syntheses in medical education over the past 20 years, contributing to medical education’s evidence base. Beyond this increase in volume, researchers have introduced methodological diversity in these publications, and the community has taken to social media to share knowledge syntheses. Implications for the field, including the impact of synthesis types and their relationship to knowledge translation, are discussed. Electronic supplementary material The online version of this article (10.1007/s40037-020-00626-9) contains supplementary material, which is available to authorized users.

Objectives Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. Method The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA‐ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. Results One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA‐ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. Conclusions Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised., Over the last 20 years, the number of #MedEd reviews has grown >2600% (4200% for scoping reviews). To explore this growth, Maggio et al. conducted a scoping review of 101 scoping reviews across 14 journals.

Introduction Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists’ careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown. Methods This study replicates Himmelstein’s work with a sample of 14 HPE journals published between 2008–2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded. Results Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72). Discussion This study presents publication metadata for journals that openly provide it—a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.

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

The objective of the review was to estimate the quality of systematic reviews on evidence-based practice measures across health care professions and identify differences between systematic reviews regarding approaches used to assess the adequacy of evidence-based practice measures and recommended measures.Systematic reviews on the psychometric properties of evidence-based practice measures guide researchers, clinical managers, and educators in selecting an appropriate measure for use. The lack of psychometric standards specific to evidence-based practice measures, in addition to recent findings suggesting the low methodological quality of psychometric systematic reviews, calls into question the quality and methods of systematic reviews examining evidence-based practice measures.We included systematic reviews that identified measures that assessed evidence-based practice as a whole or of constituent parts (eg, knowledge, attitudes, skills, behaviors), and described the psychometric evidence for any health care professional group irrespective of assessment context (education or clinical practice).We searched five databases (MEDLINE, Embase, CINAHL, PsycINFO, and ERIC) on January 18, 2021. Two independent reviewers conducted screening, data extraction, and quality appraisal following the JBI approach. A narrative synthesis was performed.Ten systematic reviews, published between 2006 and 2020, were included and focused on the following groups: all health care professionals (n = 3), nurses (n = 2), occupational therapists (n = 2), physical therapists (n = 1), medical students (n = 1), and family medicine residents (n = 1). The overall quality of the systematic reviews was low: none of the reviews assessed the quality of primary studies or adhered to methodological guidelines, and only one registered a protocol. Reporting of psychometric evidence and measurement characteristics differed. While all the systematic reviews discussed internal consistency, feasibility was only addressed by three. Many approaches were used to assess the adequacy of measures, and five systematic reviews referenced tools. Criteria for the adequacy of individual properties and measures varied, but mainly followed standards for patient-reported outcome measures or the Standards of Educational and Psychological Testing. There were 204 unique measures identified across 10 reviews. One review explicitly recommended measures for occupational therapists, three reviews identified adequate measures for all health care professionals, and one review identified measures for medical students. The 27 measures deemed adequate by these five systematic reviews are described.Our results suggest a need to improve the overall methodological quality and reporting of systematic reviews on evidence-based practice measures to increase the trustworthiness of recommendations and allow comprehensive interpretation by end users. Risk of bias is common to all the included systematic reviews, as the quality of primary studies was not assessed. The diversity of tools and approaches used to evaluate the adequacy of evidence-based practice measures reflects tensions regarding the conceptualization of validity, suggesting a need to reflect on the most appropriate application of validity theory to evidence-based practice measures.PROSPERO CRD42020160874.

Purpose Recent calls to improve transparency in peer review have prompted examination of many aspects of the peer-review process. Peer-review systems often allow confidential comments to editors that could reduce transparency to authors, yet this option has escaped scrutiny. Our study explores 1) how reviewers use the confidential comments section and 2) alignment between comments to the editor and comments to authors with respect to content and tone. Methods Our dataset included 358 reviews of 168 manuscripts submitted between January 1, 2019 and August 24, 2020 to a health professions education journal with a single blind review process. We first identified reviews containing comments to the editor. Then, for the reviews with comments, we used procedures consistent with conventional and directed qualitative content analysis to develop a coding scheme and code comments for content, tone, and section of the manuscript. For reviews in which the reviewer recommended “reject,” we coded for alignment between reviewers’ comments to the editor and to authors. We report descriptive statistics. Results 49% of reviews contained comments to the editor (n = 176). Most of these comments summarized the reviewers’ impression of the article (85%), which included explicit reference to their recommended decision (44%) and suitability for the journal (10%). The majority of comments addressed argument quality (56%) or research design/methods/data (51%). The tone of comments tended to be critical (40%) or constructive (34%). For the 86 reviews recommending “reject,” the majority of comments to the editor contained content that also appeared in comments to the authors (80%); additional content tended to be irrelevant to the manuscript. Tone frequently aligned (91%). Conclusion Findings indicate variability in how reviewers use the confidential comments to editor section in online peer-review systems, though generally the way they use them suggests integrity and transparency to authors.

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Introduction Authors of knowledge syntheses make many subjective decisions during their review process. Those decisions, which are guided in part by author characteristics, can impact the conduct and conclusions of knowledge syntheses, which assimilate much of the evidence base in medical education. To better understand the evidence base, this study describes the characteristics of knowledge synthesis authors, focusing on gender, geography, and institution. Methods In 2020, the authors conducted meta-research to examine authors of 963 knowledge syntheses published between 1999 and 2019 in 14 core medical education journals. Results The authors identified 4,110 manuscript authors across all authorship positions. On average there were 4.3 authors per knowledge synthesis (SD = 2.51, Median = 4, Range = 1–22); 79 knowledge syntheses (8%) were single-author publications. Over time, the average number of authors per synthesis increased (M = 1.80 in 1999; M = 5.34 in 2019). Knowledge syntheses were authored by slightly more females (n = 2047; 50.5%) than males (n = 2005; 49.5%) across all author positions. Authors listed affiliations in 58 countries, and 58 knowledge syntheses (6%) included authors from low- or middle-income countries. Authors from the United States (n = 366; 38%), Canada (n = 233; 24%), and the United Kingdom (n = 180; 19%) published the most knowledge syntheses. Authors listed affiliation at 617 unique institutions, and first authors represented 362 unique institutions with greatest representation from University of Toronto (n = 55, 6%). Across all authorship positions, the large majority of knowledge syntheses (n = 753; 78%) included authors from institutions ranked in the top 200 globally. Conclusion Knowledge synthesis author teams have grown over the past 20 years, and while there is near gender parity across all author positions, authorship has been dominated by North American researchers located at highly ranked institutions. This suggests a potential overrepresentation of certain authors with particular characteristics, which may impact the conduct and conclusions of medical education knowledge syntheses.

Teaching medical students how to teach is a growing and essential focus of medical education, which has given rise to student teaching programs. Educating medical students on how to teach can improve their own learning and lay the foundation for a professional identity rooted in teaching. Still, medical student-as-teacher (MSAT) programs face numerous obstacles including time constraints, prioritizing curriculum, and determining effective evaluation techniques. The purpose of this scoping review is to map the current landscape of the literature on medical school initiatives designed to train students to teach to describe why medical student teaching programs are started; the benefits and barriers; who teaches them; what content is taught; and how content is delivered. With this new map, the authors aimed to facilitate the growth of new programs and provide a shared knowledge of practices derived from existing programs.The authors conducted a scoping review, guided by Arksey and O'Malley's framework, to map the literature of MSAT training programs. Six databases were searched using combinations of keywords and controlled vocabulary terms. Data were charted in duplicate using a collaboratively designed data charting tool. This review builds on the Marton et al. review and includes articles published from 2014 to 2020.Of the 1,644 manuscripts identified, the full-text of 57 were reviewed, and ultimately 27 were included. Articles included empirical research, synthetic reviews, opinion pieces, and a descriptive study. Analysis focused on modalities for teaching medical students how to teach; content to teach medical students about teaching; benefits and barriers to starting teaching programs; and the value of teaching programs for medical students.The rapid growth of MSAT programs suggests that this curricular offering is of great interest to the field. Literature shows an increase in evaluative efforts among programs, benefits for students beyond learning to teach, and evidence of effective engagement in medical students' designing and implementing programs.

BACKGROUND The field of medical education remains poorly delineated such that there is no broad consensus of articles or journals that comprise 'the field'. This lack of consensus indicates a missed opportunity for researchers to generate insights about the field that could facilitate conducting bibliometric studies and other research designs (e.g., systematic reviews) and also enable individuals to identify themselves as 'medical education researchers'. Other fields have utilised bibliometric field delineation, which is the assigning of articles or journals to a certain field in an effort to define that field. PROCESS In this Research Approach, three bibliometric field delineation approaches-information retrieval, core journals, and journal co-citation-are introduced. For each approach, the authors describe attempts to apply it in medical education and identify related strengths and weaknesses. Based on co-citation, the authors propose the Medical Education Journal List 24 (MEJ-24), as a starting point for delineating medical education and invite the community to collaborate on improving and potentially expanding this list. PEARLS As a research approach, field delineation is complicated, and there is no clear best way to delineate the field of medical education. However, recent advances in information science provide potentially fruitful approaches to deal with the field's complexity. When considering these approaches, researchers should consider collaborating with bibliometricians. Bibliometric approaches rely on available metadata for articles and journals, which necessitates that researchers examine the metadata prior to analysis to understand its strengths and weaknesses, and to assess how this might affect data interpretation. While using bibliometric approaches for field delineation is valuable, it is important to remember that these techniques are only as good as the research team's interpretation of the data, which suggests that an expanded approach is needed to better delineate medical education, an approach that includes active discussion within the medical education community.

PurposeThere is a growing desire for health professions educators to engage learners in more meaningful instruction. Many have tapped Wikipedia to offer an applied approach to engage learners, particularly as it relates to evidence-based medicine (EBM). However, little is known about the benefits and challenges of using Wikipedia as a pedagogical tool from the collective experience of educators who have sought to improve their instructional practice with it. This study aims to uncover and synthesize the perspectives of health professions education (HPE) instructors who have incorporated Wikipedia in their HPE courses.MethodsApplying a constructivist approach, the authors conducted semi-structured interviews with 17 participating HPE instructors who had substantively integrated Wikipedia into their curriculum. Participants were interviewed about their experiences of integrating Wikipedia editing into their courses. Thematic analysis was conducted on resulting transcripts.ResultsAuthors observed two broad themes among participants’ expressed benefits of teaching with Wikipedia: 1) provides a meaningful instructional alternative that also benefits society and develops learners’ information literacy and EBM skills, and 2) supports learners’ careers and professional identity formation. Identified challenges included: 1) high effort and time, 2) issues with sourcing references, and 3) challenging interactions with skeptics, editors, and students.DiscussionFindings build on known benefits, such as providing a real-world collaborative project that contextualizes students’ learning experiences. They also echo known challenges, such as the resource-intensive nature of teaching with Wikipedia. At the same time, findings extend the current literature by revealing a potential opportunity to approach crowd-sourced information tools, like Wikipedia, as a vehicle to engage and enculturate HPE students within a situated learning context. These findings present implications for HPE programs considering implementing Wikipedia and faculty development needed to help instructors harness crowd-sourced information tools’ pedagogical opportunities as well as anticipate their challenges.

Introduction The use of social media is rapidly changing how educational content is delivered and knowledge is translated for physicians and trainees. This scoping review aims to aggregate and report trends on how health professions educators harness the power of social media to engage physicians for the purposes of knowledge translation and education. Methods A scoping review was conducted by searching four databases (PubMed, Scopus, Embase, and ERIC) for publications emerging between 1990 to March 2018. Articles about social media usage for teaching physicians or their trainees for the purposes of knowledge translation or education were included. Relevant themes and trends were extracted and mapped for visualization and reporting, primarily using the Cook, Bordage, and Schmidt framework for types of educational studies (Description, Justification, and Clarification). Results There has been a steady increase in knowledge translation and education-related social media literature amongst physicians and their trainees since 1996. Prominent platforms include Twitter (n = 157), blogs (n = 104), Facebook (n = 103), and podcasts (n = 72). Dominant types of scholarship tended to be descriptive studies and innovation reports. Themes related to practice improvement, descriptions of the types of technology, and evidence-based practice were prominently featured. Conclusions Social media is ubiquitously used for knowledge translation and education targeting physicians and physician trainees. Some best practices have emerged despite the transient nature of various social media platforms. Researchers and educators may engage with physicians and their trainees using these platforms to increase uptake of new knowledge and affect change in the clinical environment. Electronic supplementary material The online version of this article (10.1007/s40037-019-00542-7) contains supplementary material, which is available to authorized users.

BackgroundThe field of medical education remains poorly delineated such that there is no broad consensus of the articles and journals that comprise “the field.” This lack of consensus has implications for conducting bibliometric studies and other research designs (e.g., systematic reviews); it also challenges the field to compare citation scores in the field and across others and for an individual to identify themselves as “a medical education researcher.” Other fields have utilized bibliometric field delineation, which is the assigning of articles or journals to a certain field in an effort to define that field.ProcessIn this Research Approach, three bibliometric field delineation approaches -- information retrieval, core journals, and journal co-citation -- are introduced. For each approach, the authors describe their attempt to apply it in the medical education context and identify related strengths and weaknesses. Based on co-citation, the authors propose the Medical Education Journal List 24 (MEJ-24), as a starting point for delineating medical education and invite the community to collaborate on improving and potentially expanding this list.PearlsAs a research approach, field delineation is complicated, and there is no clear best way to delineate the field of medical education. However, recent advances in information and computer science provide potentially more fruitful approaches to deal with the complexity of the field. When considering these emerging approaches, researchers should consider collaborating with bibliometricians.Bibliometric approaches rely on available metadata for articles and journals, which necessitates that researchers examine the metadata prior to analysis to understand its strengths and weaknesses, and to assess how this might affect their data interpretation. While using bibliometric approaches for field delineation is valuable, it is important to remember that these techniques are only as good as the research team’s interpretation of the data, which suggests that an expanded research approach is needed to better delineate medical education, an approach that includes active discussion within the medical education community.

Bibliometrics is the study of academic publishing that uses statistics to describe publishing trends and to highlight relationships between published works. Likened to epidemiology, researchers seek to answer questions about a field based on data about publications (e.g., authors, topics, funding) in the same way that an epidemiologist queries patient data to understand the health of a population. In this Eye Opener, the authors introduce bibliometrics and define its key terminology and concepts, including relational and evaluative bibliometrics. Readers are introduced to common bibliometric methods and their related strengths and weaknesses. The authors provide examples of bibliometrics applied in health professions education and propose potential future research directions. Health professions educators are consumers of bibliometric reports and can adopt its methodologies for future studies.

IntroductionWhile authorship plays a powerful role in the academy, research indicates many authors engage in questionable practices like honorary authorship. This suggests that authorship may be acontested spacewhere individuals must exerciseagency--a dynamic and emergent process, embedded in context--to negotiate potentially conflicting norms among published criteria, disciplines, and informal practices. This study explores how authors narrate their own and others’ agency in making authorship decisions.MethodWe conducted a mixed-methods analysis of 24 first authors’ accounts of authorship decisions on a recent multi-author paper. Authors included 14 females and 10 males in health professions education (HPE) from U.S. and Canadian institutions (10 assistant, 6 associate, and 8 full professors). Analysis took place in three phases: (1) linguistic analysis of grammatical structures shown to be associated with agency (coding for main clause subjects and verb types); (2) narrative analysis to create a “moral” and “title” for each account; and (3) integration of (1) and (2).ResultsParticipants narrated other authors most frequently as main clause subjects (n= 191), then themselves (I;n= 151), inanimate nouns (it, the paper;n= 146), and author team (we;n= 105). Three broad types of agency were narrated:distributed(n= 15 participants), focusing on how resources and work were spread across team members;individual(n= 6), focusing on the first author’s action; andcollaborative(n= 3), focusing on group actions. These three types of agency contained four sub-types, e.g., supported, contested, task-based, negotiated.DiscussionThis study highlights the complex and emergent nature of agency narrated by authors when making authorship decisions. Published criteria offer us starting point--thestated rulesof the authorship game; this paper offers us a next step--theenactedandnarrated approachto the game.

IntroductionAcademia uses scholarly metrics, such as the h-index, to make hiring, promotion, and funding decisions. These high-stakes decisions require that those using scholarly metrics be able to recognize, interpret, critically assess and effectively and ethically use them. This study aimed to characterize educational videos about the h-index to understand available resources and provide recommendations for future educational initiatives.MethodsThe authors analyzed videos on the h-index posted to YouTube. Videos were identified by searching YouTube and were screened by two authors. To code the videos the authors created a coding sheet, which assessed content and presentation style with a focus on the videos’ educational quality based on Cognitive Load Theory. Two authors coded each video independently with discrepancies resolved by group consensus.ResultsThirty-one videos met inclusion criteria. Twenty-one videos (68%) were screencasts and seven used a “talking head” approach. Twenty-six videos defined the h-index (83%) and provided examples of how to calculate and find it. The importance of the h-index in high-stakes decisions was raised in 14 (45%) videos. Sixteen videos (52%) described caveats about using the h-index, with potential disadvantages to early researchers the most prevalent (n = 7; 23%). All videos incorporated various educational approaches with potential impact on viewer cognitive load. A minority of videos (n = 10; 32%) displayed professional production quality.DiscussionThe videos featured content with potential to enhance viewers’ metrics literacies such that many defined the h-index and described its calculation, providing viewers with skills to recognize and interpret the metric. However, less than half described the h-index as an author quality indicator, which has been contested, and caveats about h-index use were inconsistently presented, suggesting room for improvement. While most videos integrated practices to facilitate balancing viewers’ cognitive load, few (32%) were of professional production quality. Some videos missed opportunities to adopt particular practices that could benefit learning.

Introduction While early commenting on studies is seen as one of the advantages of preprints, the type of such comments, and the people who post them, have not been systematically explored. Materials and methods We analysed comments posted between 21 May 2015 and 9 September 2019 for 1983 bioRxiv preprints that received only one comment on the bioRxiv website. The comment types were classified by three coders independently, with all differences resolved by consensus. Results Our analysis showed that 69% of comments were posted by non-authors (N = 1366), and 31% by the preprints' authors themselves (N = 617). Twelve percent of non-author comments (N = 168) were full review reports traditionally found during journal review, while the rest most commonly contained praises (N = 577, 42%), suggestions (N = 399, 29%), or criticisms (N = 226, 17%). Authors' comments most commonly contained publication status updates (N = 354, 57%), additional study information (N = 158, 26%), or solicited feedback for the preprints (N = 65, 11%). Conclusions Our results indicate that comments posted for bioRxiv preprints may have potential benefits for both the public and the scholarly community. Further research is needed to measure the direct impact of these comments on comments made by journal peer reviewers, subsequent preprint versions or journal publications.

Purpose Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance defined as behavior change and/or patient outcomes? Method In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's levels 3 and/or 4. Result Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 27 (43%) incorporated eLearning interventions - either stand-alone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. Conclusions Across health professions CPD is an umbrella term incorporating formal and informal approaches in a multi-component approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.

While early commenting on studies is seen as one of the advantages of preprints, the nature of such comments, and the people who post them, have not been systematically explored. We analysed comments posted between 21 May 2015 and 9 September 2019 for 1,983 bioRxiv preprints that received only one comment. Sixty-nine percent of comments were posted by non-authors (n=1,366), and 31% by preprint authors (n=617). Twelve percent of non-author comments (n=168) were full review reports traditionally found during journal review, while the rest most commonly contained praises (n=577, 42%), suggestions (n=399, 29%), or criticisms (n=226, 17%). Authors’ comments most commonly contained publication status updates (n=354, 57%), additional study information (n=158, 26%), or solicited feedback for the preprints (n=65, 11%). Our study points to the value of preprint commenting, but further studies are needed to determine the role that comments play in shaping preprint versions and eventual journal publications.

The COVID-19 pandemic has caused major disruptions to the academic medicine community, including the cancellation of most medical and health professions conferences. In this Perspective, the authors examine both the short- and longer-term implications of these cancellations, including the effects on the professional development and advancement of junior faculty and learners. While the COVID-19 pandemic is new in 2020, impediments to conference attendance and participation are not. Cost, personal responsibilities at home, and clinical duties have always restricted attendance. The authors argue that the unprecedented hardships of this pandemic present a unique opportunity to reimagine how conferences can be conducted and to rethink what it means to be part of an academic community. While there are challenges with this digital transformation of academia, there are also undeniable opportunities: online abstracts and recorded presentations enable wider viewership, virtual sessions permit wider participation and greater interactivity, and the elimination of travel facilitates more diverse expert panel participation. The authors conclude with proposals for how conference organizers and participants can expand access by leveraging available distance learning technology and other virtual tools, both during the COVID-19 pandemic and beyond.

Journalists’ health and science reporting aid the public’s direct access to research through the inclusion of hyperlinks leading to original studies in peer-reviewed journals. While this effort supports the US-government mandate that research be made widely available, little is known about what research journalists share with the public. This cross-sectional exploratory study characterises US-government-funded research on cancer that appeared most frequently in news coverage and how that coverage varied by cancer type, disease incidence and mortality rates. The subject of analysis was 11436 research articles (published in 2016) on cancer funded by the US government and 642 news stories mentioning at least one of these articles. Based on Altmetric data, researchers identified articles via PubMed and characterised each based on the news media attention received online. Only 1.88% (n = 213) of research articles mentioning US government-funded cancer research included at least one mention in an online news publication. This is in contrast to previous research that found 16.8% (n = 1925) of articles received mention by online mass media publications. Of the 13 most common cancers in the US, 12 were the subject of at least one news mention; only urinary and bladder cancer received no mention. Traditional news sources included significantly more mentions of research on common cancers than digital native news sources. However, a general discrepancy exists between cancers prominent in news sources and those with the highest mortality rate. For instance, lung cancer accounted for the most deaths annually, while melanoma led to 56% less annual deaths; however, journalists cited research regarding these cancers nearly equally. Additionally, breast cancer received the greatest coverage per estimated annual death, while pancreatic cancer received the least coverage per death. Findings demonstrated a continued misalignment between prevalent cancers and cancers mentioned in online news media. Additionally, cancer control and prevention received less coverage from journalists than other cancer continuum stages, highlighting a continued underrepresentation of prevention-focused research. Results revealed a need for further scholarship regarding the role of journalists in research dissemination.

PurposeThis bibliometric analysis maps the landscape of knowledge syntheses in medical education. It provides scholars with a roadmap for understanding where the field has been and where it might go in the future. In particular, this analysis details the venues in which knowledge syntheses are published, the types of syntheses conducted, citation rates they produce, and altmetric attention they garner.MethodIn 2020, the authors conducted a bibliometric analysis of knowledge syntheses published in 14 core medical education journals from 1999 to 2019. To characterize the studies, metadata was extracted from Pubmed, Web of Science, Altmetrics Explorer, and Unpaywall.ResultsThe authors analyzed 963 knowledge syntheses representing 3.1% of total articles published (n=30,597). On average, 45.9 knowledge syntheses were published annually (SD=35.85, Median=33), and there was an overall 2,620% increase in the number of knowledge syntheses published from 1999 to 2019. The journals each published, on average, a total of 68.8 knowledge syntheses (SD=67.2, Median=41) with Medical Education publishing the most (n=189; 19%). Twenty-one knowledge synthesis types were identified; the most prevalent types were systematic reviews (n=341; 35.4%) and scoping reviews (n=88; 9.1%). Knowledge syntheses were cited an average of 53.80 times (SD=107.12, Median=19) and received a mean Altmetric Attention Score of 14.12 (SD=37.59, Median=6).ConclusionsThere has been considerable growth in knowledge syntheses in medical education over the past 20 years, contributing to medical education’s evidence base. Beyond this increase in volume, researchers have introduced methodological diversity in these publications, and the community has taken to social media to share knowledge syntheses. Implications for the field, including the impact of synthesis types and their relationship to knowledge translation, are discussed.

Introduction Wikipedia is an online encyclopedia read by millions seeking medical information. To provide health professions students with skills to critically assess, edit, and improve Wikipedia’s medical content, a skillset aligned with evidence-based medicine (EBM), Wikipedia courses have been integrated into health professions schools’ curriculum. This literature review and curricular inventory of Wikipedia educational initiatives provides an overview of current approaches and identifies directions for future initiatives and research. Methods Five databases were searched for articles describing educational interventions to train health professional students to edit Wikipedia. Course dashboards, maintained by Wiki Education (Wiki Edu), were searched for curricular materials. From these sources, key details were extracted and synthesized, including student and instructor type, course content, educational methods, and student outcomes. Results Six articles and 27 dashboards reported courses offered between 2015 and 2019. Courses were predominantly offered to medical and nursing students. Instructors delivered content via videos, live lectures, and online interactive modules. Course content included logistics of Wikipedia editing, EBM skills, and health literacy. All courses included assignments requiring students to edit Wikipedia independently or in groups. Limited details on assessment of student learning were available. Discussion A small but growing number of schools are training health professions education students to improve Wikipedia’s medical content. Course details are available on Wiki Edu dashboards and, to a lesser extent, in peer-reviewed publications. While more needs to be done in conducting and sharing assessment of student learning, integrating Wikipedia into health professions education has potential to facilitate learning of EBM and communication skills, improve Wikipedia’s online content, and engage students with an autonomous environment while learning. Future considerations should include a thorough assessment of student learning and practices, a final review of student edits to ensure they follow Wikipedia’s guidelines and are written in clear language, and improved sharing of teaching resources by instructors. Electronic supplementary material The online version of this article (10.1007/s40037-020-00620-1) contains supplementary material.

Articles on Wikipedia about health and medicine are maintained by WikiProject Medicine (WPM), and are widely used by health professionals, students and others. We have compared these articles, and reader engagement with them, to other articles on Wikipedia. We found that WPM articles are longer, possess a greater density of external links, and are visited more often than other articles on Wikipedia. Readers of WPM articles are more likely to hover over and view footnotes than other readers, but are less likely to visit the hyperlinked sources in these footnotes. Our findings suggest that WPM readers appear to use links to external sources to verify and authorize Wikipedia content, rather than to examine the sources themselves.

Background and Objectives: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. Methods: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs’ current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. Results: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. Conclusions: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.