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Introduction The coronavirus disease 2019 (COVID-19) pandemic affected almost every country around the world, and various forms of lockdown or quarantine measures were implemented. The lockdowns forced medical educators to step beyond traditional educational approaches and adopt distance education technologies to maintain continuity in the curriculum. This article presents selected strategies implemented by the Distance Learning Lab (DLL) at the Uniformed Services University of Health Sciences (USU), School of Medicine (SOM), in transitioning their instruction to an emergency distance education format during the COVID-19 pandemic. Materials and Methods When moving programs/courses to a distance education format, it is important to recognize that two primary stakeholders are involved in the process: faculty members and students. Therefore, to be successful in transitioning to distance education, strategies must address the needs of both groups and provide support and resources for both. The DLL used two lenses of adult learning and targeted needs assessment to design faculty and student support during the pandemic. The DLL adopted a learner-centered approach to education, focusing on meeting the faculty members and students where they are. This translated into three specific support strategies for faculty: (1) workshops, (2) individualized support, and (3) just-in-time self-paced support. For students, DLL faculty members conducted orientation sessions and provided just-in-time self-paced support. Results The DLL has conducted 440 consultations and 120 workshops for faculty members since March 2020, serving 626 faculty members (above 70% of SOM faculty members locally) at USU. In addition, the faculty support website has had 633 visitors and 3,455 pageviews. Feedback comments provided by faculty members have specifically highlighted the personalized approach and the active, participatory elements of the workshops and consultations. Evaluations of the student orientation sessions showed that they felt more confident in using the technologies after the orientation. The biggest increase in confidence levels was seen in the topic areas and technology tools unfamiliar to them. However, even for tools that students were familiar with before the orientation, there was an increase in confidence ratings. Conclusion Post-pandemic, the potential to use distance education remains. It is important to have support units that recognize and cater to the singular needs of medical faculty members and students as they continue to use distance technologies to facilitate student learning.

Introduction Competency-based education (CBE) programs usually evaluate student learning outcomes at a course level. However, a more comprehensive evaluation of student achievement of competencies requires evaluation at a programmatic level across all courses. There is currently insufficient literature on accomplishing this type of evaluation. In this article, we present an evaluation strategy adopted by the competency-based master’s degree program at the Center for Health Professions Education at the Uniformed Services University of Health Sciences to assess student achievement of competencies. We hypothesized that (1) learners would grow in the competencies through their time in the program and (2) learners would exhibit a behavioristic change as a result of their participation in the program. Materials and Methods The degree program at the Center for Health Professions Education conducts an annual student self-assessment of competencies using a competency survey. The competency survey data from graduated master’s students were collected, providing data from three time points: initial (pre-program survey), middle, and final (end-of-program survey). Open-ended responses from these three surveys were also analyzed. A general linear model for repeated measures was conducted. Significant effects were followed by post hoc tests across time. We also conducted post hoc analysis across domains to better understand the comparative levels of the domains at each time point. The responses to the open-ended prompt were thematically analyzed. Results Analysis of the quantitative data revealed that (1) learners reported significant growth across time, (2) learners had different perceptions of their competencies in each of the domains, and (3) not all domains experienced similar changes over time. Analysis of the free responses highlighted the impact of coursework on competency attainment and the behavioristic change in learners. Conclusions This study presents a strategic evaluation tool for course-based CBE programs that follow a traditional credit hour model. Programmatic evaluation of CBE programs should enable the inclusion of the learner’s voice and provide evaluation data that go beyond individual course evaluations.

Background Quality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM). Research on increasing diversity within the academic medicine student body or faculty notes the important role of leadership. Yet, there is a scarcity in research into diversity in leadership. Objective The purpose of this study is to go beyond aggregate numbers and answer the question: What is the level of parity representation, by gender and race, at department chair positions in academic IM departments? Design A cross-sectional analysis of race/ethnicity and gender in IM medical school departments from 2010 to 2020 was conducted using data from the American Association of Medical College’s (AAMC) Faculty Roster. The proportion of IM department chairs to IM faculty by race/ethnicity for each year (2010–2020) was used to calculate the Leadership Parity Index (LPI) in this study. LPI by gender and by gender and race/ethnicity were also calculated for each year. Results In aggregate numbers, Black or African American and Hispanic, Latino, or of Spanish Origin faculty remain under-represented in academic IM each making up, on average, approximately 4% of the total IM faculty. The LPI calculations revealed that faculty who identified as White were consistently over-represented as department chairs while Asian faculty were consistently under-represented in leadership and ranked lowest in leadership parity among the ethnic groups studied. The leadership parity index also showed that women faculty across all races were under-represented. Conclusion Women and Asian faculty encounter a ceiling effect that may be at play in IM departments. While significant progress still needs to be made in the representation of under-represented minorities, the findings of this study show that aggregate data does not provide a true picture of equity and parity in Internal Medicine faculties.

Introduction Military medicine is uniquely different from civilian medicine, and military physicians in the USA are primarily recruited through the Health Professions Scholarship Program (HPSP) and the Uniformed Services University of the Health Sciences (USUHS). Medical students at the USUHS receive more than 650 hours of military-specific curriculum and spend 21 days engaged in field exercises. HPSP students complete two 4-week officer training sessions during their 4 years of medical school. There is a clear discrepancy in preparation for military medicine between HPSP and USUHS students. The USUHS School of Medicine undertook an initiative to develop a fully online self-paced course on the fundamentals of military medicine topics to help HPSP students bridge the gap in their preparation. This article will describe how the online self-paced course was designed and present feedback from the pilot offering of this course. Materials and Methods As proof of concept of the effectiveness of an online self-paced course for teaching the fundamentals of military medicine to HPSP students, two chapters from the “Fundamentals of Military Medicine” published by the Borden Institute were transferred to an online format. Each chapter was offered as a module. In addition to the chapters, an introduction and closing module were added to the pilot course. The pilot course was offered over 6 weeks. Data for this study were obtained from module feedback surveys, pre- and post-course quizzes, participant focus groups, and course evaluation surveys. Pre- and post-test scores were analyzed to evaluate content knowledge. The open-ended survey questions on the feedback forms and focus group transcripts were collated and analyzed as textual data. Results Fifty-six volunteers enrolled in the study, and 42 completed the pre- and post-course quizzes. This participant pool included HPSP students (79%, n = 44) and military residents in civilian graduate medical education programs (21%, n = 12). The module feedback surveys showed that most participants spent 1 to 3 hours on each of the modules, which they rated as extremely or quite reasonable (Module 1: 64%, Module 2: 86%, Module 3: 83%). There was not much difference between the overall quality of the three modules. The participants found content on application to the military-specific context very valuable. Of the different course elements, video content was rated as the most effective. Participant feedback clearly highlighted that HPSP students want a course that informs them about the fundamentals of military medicine and demonstrates how the information would apply to their lives. Overall, the course was effective. HPSP students showed knowledge gains and self-reported satisfaction with the course’s objectives. They were able to locate information easily and understand the course expectations. Conclusions This pilot study has shown that there is a need for a course that provides the fundamentals of military medicine to HPSP students. A fully online self-paced course provides flexibility for the students and improves access.

Learners and leaders in medical education recognize the remarkable growth in clinically relevant information, persistent changes in the organization of health care, and the need to develop physicians able to adapt successfully to changes in their lives and practices. The success of those physicians and of those who facilitate their learning depends on a careful understanding of the psychological, social, and biological factors that influence physician development and lifelong learning. To improve research and policy, development and learning must be explored for finer understandings of physicians in relation to other beings and to the physical and social surroundings most conducive to better learning and outcomes.

Learners and leaders in medical education recognize the remarkable growth in clinically relevant information, persistent changes in the organization of health care, and the need to develop physicians able to adapt successfully to changes in their lives and practices. The success of those physicians and of those who facilitate their learning depends on a careful understanding of the psychological, social, and biological factors that influence physician development and lifelong learning. To improve research and policy, development and learning must be explored for finer understandings of physicians in relation to other beings and to the physical and social surroundings most conducive to better learning and outcomes.

INTRODUCTION The authors explored the existence of explicit definitions, guiding competency frameworks, and learning theory to inform health professions education faculty development (FD) programs. The authors analyzed identified frameworks based on thematic focus, scope of targeted faculty, and design structure. METHODS A scoping review was used to identify health professions education literature between 2005 and 2020. Frameworks were characterized according to the scope of the faculty targeted and design structure, and then, domains were grouped into topical categories for analysis. RESULTS Twenty-three articles met the criteria for data extraction, of which only one (4.3%) described the explicit use of a learning theory and three (13%) included an explicit definition of FD. One (4.3%) used a recognized framework, whereas 12 (52.2%) developed a novel framework based on an existing outline. Ten (43.5%) described de novo framework development. Only three (13.0%) used entrustable professional activities or similar constructs. Five (21.7%) programs targeted multiple health professions, 11 (47.8%) targeted a single health profession, and seven (30.5%) targeted a specific specialty within a health profession. Only two frameworks included a developmental component. DISCUSSION Few authors describe an explicit definition, learning theory, or use a pre-established framework when framing their FD programs. The use of entrustable professional activities to structurally link competencies to work practices is also uncommon, as well as the use of developmental structures designed to support progressive FD over time.

Introduction Corneal laser refractive surgery (CRS) has emerged over the past three decades as a surgical method for correcting or improving vision. In the military, CRS helps warfighters achieve weapon grade vision, which offers a tactical advantage in the deployed environment. As refractive surgery has become more prevalent in both the military and civilian sector, more ophthalmologists need to learn about treatment options as well as management of complications in order to meet increasing patient demand. Currently, little is known about the most effective curriculum for teaching refractive surgery in training programs, and a standardized curriculum does not exist. Since unification of training programs is a Defense Health Agency priority, this study aimed to collect expert consensus on a standardized curriculum for CRS training in the military. Materials and Methods To achieve this goal, the Nominal Group Technique (NGT) was used wherein a panel of experts, currently practicing refractive surgeons involved in military refractive surgery training programs, arrived at consensus on a standardized CRS curriculum. The framework for developing this curriculum is based on Kern’s Six-Step Approach to Curriculum Development. The International Council of Ophthalmology refractive surgery curriculum, National Curriculum for Ophthalmology Residency Training, Accreditation Council for Graduate Medical Education competencies and surgical minimums, and American Academy of Ophthalmology Refractive Surgery Preferred Practice Guidelines were used as the starting materials from which panelists’ consensus was drawn. This consensus-building method allowed for equal representation of experts’ ideas and fostered collaboration to aid in the creation of a robust and standardized curriculum for refractive surgery training programs in the military. Results The panelist experts from this NGT were able to reach consensus on the components of a standardized military refractive surgery curriculum to include generalized and targeted needs assessment, goals and objectives, educational strategies, and curriculum implementation. Conclusion A standardized CRS curriculum is warranted in military training programs. This NGT achieved expert consensus on the goals, objectives, educational methods, and implementation strategies for a standardized CRS curriculum in military ophthalmology residency.

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.

Objectives Medicine is a practice characterized by ongoing learning, and unique qualities of the operational learning environment (LE) may affect learner needs. When physicians move between differing practice environments learners may encounter situations for which they are unprepared. Using a conceptual framework specific to the LE, we therefore asked the following research question: what is the difference in LE for Navy emergency medicine (EM) physicians who practice in U.S. hospitals but serve an operational environment, and how do these differences shape their learning needs? Methods We interviewed Navy EM physicians who recently deployed to explore their perceptions of the deployed LE, how it differed from the LE they practice in stateside, and the perceived effect this difference had on their learning needs. We used the constant comparative method to gather and analyze data until thematic saturation was achieved. Results We interviewed 12 physicians and identified six interconnected themes consistent with the LE framework in the literature: 1) patient care is central to the learning experience; 2) professional isolation versus connectedness; 3) a sense of meaningful practice engages the learner in the LE; 4) physicians as educators shape the LE; 5) team trust impacts the LE; and 6) the larger military organization impacts the LE. Conclusions Our themes span the conceptual framework put forth by previous work and did not find themes outside this framework. These interconnected themes describe the difference in LE between the stateside and deployed setting and impact the learning needs of Navy EM physicians. These results inform strategies to position the deployed medical unit for success.

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.

INTRODUCTION The purpose of this study was to examine Uniformed Services University (USU) women graduates in terms of percent of graduates', specialty choices and practice choices as compared to civilian women who graduate and practice medicine in the USA. This is a perspective that is currently not well understood. MATERIALS AND METHODS We conducted a retrospective cohort study of all USU women graduates (1980-2015) using the 2016 American Medical Association (AMA) Physician Masterfile that included data from the American Board of Medical Specialties (ABMS). To describe USU women graduates' current practice status we queried for: (1) medical school; (2) year of graduation; (3) practice state; (4) primary specialty board; and (5) major professional activity (office-based practice vs. full-time hospital staff). Data were analyzed using descriptive statistics. RESULTS Our findings indicate that the percentage of USU women graduates has increased over time and stands at 29% for the 2010-2015 cohort as compared to 48% for women graduating from all U.S. medical schools. USU women graduates have a slightly higher board certification rate (89%) than the national cohort (88%). USU women graduates also have a higher percentage in family medicine (19%) than the national cohort (14%). USU women graduates practice in 48 states and were equally split between full-time hospital staff and office-based practice which differs from the national cohort that has a much higher proportion in office-based practice (85%). CONCLUSIONS Women are making significant gains in enrollment at USU, obtaining board certification at similar, and in some cases, higher rates than their civilian peers, and practicing in diverse specialties. This study provides a descriptive picture of women's enrollment and practice characteristics from a military-based medical school. Future work could examine underlying factors that may influence their school choice, career experiences, and trajectories. Future research could also focus on women's experiences of mentoring and support to better understand these factors.

Resumen Introduccion La hipertension arterial (HTA) es un factor de riesgo cardiovascular modificable y su deteccion en edades tempranas podra permitir el diseno de estrategias para reducir el riesgo vascular en edades adultas. Objetivos Aportar valores de medida de presion arterial (PA) obtenidos con aparatos oscilometricos y fuera de la consulta medica. Material y metodos La PA fue medida con aparato oscilometrico validado, siguiendo el documento de consenso de la Sociedad Europea de Hipertension. Tambien se midieron la talla y el peso. Para relacionar los valores percentilados (90-95-99) de PA sistolica (PAS) y la PA diastolica PAD) con edad, sexo y talla se opto por utilizar la talla agrupada: T150 (≤150 cm), T160 (151-160 cm), T170 (161-170 cm) y T180 (≥171 cm). Resultados Se incluyeron 2.758 adolescentes de entre 12 y 17 anos. La PA aumenta con la edad, con diferencias de hasta 11 mmHg en chicos vs. 3 mmHg en chicas para PAS y de 3 vs. 1 mmHg para PAD. En PAS elevada, para los mas jovenes, la diferencia en funcion de la altura es de 15 mmHg en chicos vs. 8 mmHg en chicas, sin existir aumento significativo en los mas mayores en ningun genero. La PAD elevada varia en funcion de la talla: 10 mmHg en los chicos pequenos y 3 mmHg en los mayores, mientras que en las chicas la variacion es de 3 mmHg para todas las edades. Conclusiones Los valores de PAS/PAD en los adolescentes aumentan con la edad y, sobre todo, con la altura: las cifras llegan a ser muy similares en los mas altos, independientemente de la edad.

Continuing medical education (CME) as part of life-long learning in medicine should focus on patient outcomes and appropriate care by increasing knowledge, competence and/or performance of clinicians. In this article, we present the views of the different stakeholders on the future of CME, presented at the ISSECAM colloquium held in December 2018. Within the framework of the colloquium, a survey was done asking health care professionals about their learning practices. We present an integrated summary of the attendees’ views and survey results. Key elements for effective learning in CME and how they can be implemented have been identified. Increased interactivity and focus on real-life practice seem to have the highest likelihood to induce behavioural changes. In addition, online CME activities will steadily gain more weight in the learning curriculum of medical practitioners. CME providers should take these elements (interactivity, real-life practice, online) into consideration when designing their different activities.

This chapter is an update and expansion of previous work and explores how professionals construct knowledge in the context of their practice by connecting concepts from their experiences and continuing professional education activities.

This chapter analyzes the development and changes within continuing professional education and the influence of four contested spaces on this field of adult education practice.

Background Physicians who become clinical educators need to transform their clinical knowledge to be effective teachers. The objective of this year-long qualitative study was to understand new physician preceptors’ development as clinical teachers. We explored preceptors’ and students’ insights with regard to meaningful teaching and learning interactions to provide evidence for the developmental journey. Methods Semi-structured interviews with the 9 new community hospital physicians and 37 medical students occurred at the beginning, weekly and at the end of the year. Weekly rounding observations were also completed. Interview recordings and observation notes were transcribed confidentially and analyzed using inductive thematic analysis. Results Irby’s forms of knowledge were selected as the underlying structure for presenting the results. For preceptors, the strongest areas were knowledge of medicine, patients and context. For students, knowledge of medicine was strongest. Knowledge of pedagogy and learners was an area of weakness for preceptors and more work is needed to continue their developmental growth. Conclusion This study provides evidence that new teacher-physicians experience learning processes similar to that of 3rd year students learning the clinical practice of medicine: it develops and deepens over time. New community physician preceptors require a robust, ongoing faculty development plan to enable more effective interactions for teaching and learning.

Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.

The National Collaborative for Improving the Clinical Learning Environment (NCICLE) is a growing group of over 40 organizations representing a variety of health professions. NCICLE is beginning a discussion of issues related to culture in health care, specifically how the current culture inhibits optimal outcomes, and the discordance between current early interprofessional education (IPE) curricula in health professions schools and traditional practice models in health care. In October 2017, the Accreditation Council for Graduate Medical Education and the Josiah Macy Jr. Foundation sponsored an NCICLE symposium on optimizing interprofessional clinical learning environments. In this Invited Commentary, the authors observe that interprofessional practice and education is a decades-long field that has presented a "Gordian knot" of intractable, complex problems to solve because medicine has often not been at the table for conversations about IPE. The NCICLE symposium represented an important opportunity for medicine to signal that finding new solutions for unraveling the interprofessional Gordian knot and creating optimal clinical learning environments requires meaningful participation from all health professions. Those solutions need to build on the long history of experience and research in IPE and collaborative practice. After the NCICLE symposium provided a promising beginning, the authors propose three essential issues and one key practical step forward to move the interprofessional agenda forward.

Introduction The education of health professionals and the assessment of their long-term goals are essential. Additionally, in the military health system (MHS), such programs also have the goals of improving readiness, providing high-quality care and meeting the needs and challenges of the MHS. The Uniformed Services University F. Edward Hebert School of Medicine (USUHS) has existed for over 40 years and the assessment of the longer term outcomes of its medical school graduates is an important endeavor. The purpose of this study is to describe the relationship of USUHS on the care in the MHS by reporting specialty choices, practice characteristics and locations of two consecutive cohorts of USUHS graduates and to compare these cohort findings with national data. Two cohorts were chosen as the first cohort has reached retirement and we sought to describe the impact of our graduates following their military service commitment. Materials and Methods We performed a retrospective analysis of our graduates (1980-2009) using data obtained from the American Medical Association Physician Masterfile in two 15-year cohorts. USU graduate data are described and compared with national allopathic medical school data in order to explore USUHS graduates' practice characteristics and how these contrast with national data. Results Family medicine was the most commonly identified primary care specialty across both USUHS cohorts. Other primary care specialties such as Internal Medicine and Pediatrics became more popular among USUHS graduates over time. There were a lower percentage of inactive USUHS graduates from the 1980-1994 cohorts than the U.S. national sample (3.23% vs. 3.98%). The proportion of USUHS graduates working in an office-based practice increased from 34.8% (1980-1994) to 43.6% (1995-2009) yet still was lower than U.S. national data (1980-1994: 73.5%; 1995-2009: 73.8%). The type of practice in which the majority of USUHS and national graduates were involved was direct patient care (over 70% of the population). Practice locations for medical school graduates included all 50 states. Furthermore, though several states such as Mississippi, Nevada, South Carolina, and Utah were among the top 20 practice locations among USUHS graduates, they did not appear among the top 20 practicing states for U.S. graduates. Conclusions USUHS can play a major role by training health care professionals needed to meet the large health care strategic goals of a transforming military health system. A high percentage of USUHS graduates had significant changes in practice characteristics over time, are staying in practice for longer time compared with U.S. graduates, and practice in all 50 states including those that are underserved.

Since 1977, many systematic reviews have asked 2 fundamental questions: (1) Does CME improve physician performance and patient health outcomes? and (2) What are the mechanisms of action that lead to positive changes in these outcomes? The article's purpose is to synthesize the systematic review literature about CME effectiveness published since 2003.We identified 8 systematic reviews of CME effectiveness published since 2003 in which primary research studies in CME were reviewed and physicians' performance and/or patient health outcomes were included as outcome measures.Five systematic reviews addressed the question of "Is CME Effective?" using primary studies employing randomized controlled trials (RCTs) or experimental design methods and concluded: (1) CME does improve physician performance and patient health outcomes, and (2) CME has a more reliably positive impact on physician performance than on patient health outcomes. The 8 systematic reviews support previous research showing CME activities that are more interactive, use more methods, involve multiple exposures, are longer, and are focused on outcomes that are considered important by physicians lead to more positive outcomes.Future research on CME effectiveness must take account of the wider social, political, and organizational factors that play a role in physician performance and patient health outcomes. We now have 39 systematic reviews that present an evidence-based approach to designing CME that is more likely to improve physician performance and patient health outcomes. These insights from the scientific study of CME effectiveness should be incorporated in ongoing efforts to reform systems of CME and health care delivery.

INTRODUCTION The Uniformed Services University F. Edward Hebert School of Medicine just passed its 45th anniversary, opening in 1972. A goal of the medical school, like those nationally, is the production of high-quality physicians. The purpose of this study is to describe the practice characteristics of our USU graduates and to compare data with the national cohort of U.S. MD graduates. MATERIALS AND METHODS To accomplish this, we performed a retrospective analysis of U.S. graduates (1980-2009). We used the American Medical Association Physician Masterfile to describe our graduates' current practice profile and compare them with the national cohort. In order to ascertain if USU is meeting our goal to provide high-quality physicians, we also compare our findings with national allopathic school data to norm-reference our results. RESULTS Our findings indicate that USU graduates contribute to both primary care and specialty care and they practice in all 50 states. USU graduates continue to serve their nation after their obligation is complete, with 64% continuing to practice in federal hospitals and agencies. USU graduates also have a higher board certification rate (90%) than the national cohort (88%). CONCLUSION Following our 45th anniversary, we provide continuing evidence that USU is keeping its contract with society. We provide evidence that USU continues to meet its obligation to the nation's health care needs by producing high-quality physicians who serve the country in multiple ways after their military obligation is complete, thus extending the definition of staying power. Our study is not without limitations. First, we could not precisely define the cohort to exclude graduates who still had service obligations. Second, the AMA Physician Masterfile had some missing data fields, so nonresponse or misclassification bias is possible in our results. Study strengths include the long period of time and large number of graduates in each cohort.

High blood pressure (HBP) is a modifiable cardiovascular risk factor and its detection at early ages may allow strategies to be designed to reduce cardiovascular risk in adulthood.To provide blood pressure (BP) values in a sample of adolescents using an electronic oscillometric device.BP was measured according the European Society of Hypertension guidelines using an oscillometric device. Height and weight were also measured. Four height groups were used in order to associate the 90, 95, and 99 percentiles with systolic BP (pSBP) and diastolic BP percentiles (pDBP) for sex and age: H150 (≤ 150cm), H160(151-160cm), H170(161-170cm), and H180(≥171cm).Data from 2,758 students aged 12-17 years were included in the analysis. BP increases with age, with differences of up to 11mmHg in boys vs. 3mmHg in girls for SBP and 3mmHg vs. 1mmHg for DBP. In high SBP, for the younger adolescents, the difference related to height was 15mmHg in boys vs. 8mmHg in girls, with no significant increase in the older ones in either gender. The high BDP varied depending on the height, 10mmHg in younger boys and 3mmHg in older ones, while in girls the variation was 3mmHg for all ages.SBP/DBP in adolescents increases with age and also with height, giving similar figures in the taller ones, regardless of age.

This article was migrated. The article was marked as recommended. Patient safety is a preeminent healthcare concern in modern medicine. In the years since To Err is Human, researchers have found that the number of preventable deaths far exceeds 98,000; more accurately, 400,000 patients die each year from preventable healthcare errors. To combat the evolving patient safety crisis, a variety of organizations from Institute of Medicine to World Health Organization have called for the development of interprofessional healthcare teams. Interprofessional healthcare teams and teamwork have been a topic of discussion for over 40 years. And while some Interprofessional healthcare teams have been shown to be beneficial in some settings the success of these teams is not universal nor achieved in all healthcare settings. In short, research has found that interprofessional healthcare teams both improve and impede patient care. Building on this contradictions of interprofessional healthcare teams and teamwork, we present a model for the conceptualization of teamwork that could be readily applied to clinical experiences. This model is informed by the interprofessional healthcare team literature and relevant theories, and we believe will enable us to examine authentic interprofessional healthcare team interactions and identify moments when team interactions were breaking down, and reasons why those breakdowns were happening.

Our goal was to identify the clinical questions that health care professionals have at the point of care and explore whether these questions could be used to drive a needs assessment for continuing education programs.We gathered questions from 28 clinicians; 11 were directly observed for approximately 5 days per person, while others were given the option of submitting questions via e-mail, pocket card, or text message. They were asked to report all questions-everything from clear-cut questions to vague and fleeting uncertainties-and to evaluate their importance (low, moderate, or high priority). Questions were classified based on the Ely taxonomy of question type and by specialty domain.We collected 563 questions; most (n = 429) came from the direct observation participants. Most questions were high (n = 171) or moderate (n = 236) priority. Of 60 categories of question type, 65.8% of all questions (and 70% asked by primary care clinicians) fell into only 9 categories. The most common question types were "How should I treat finding/condition y given situation z?", "Is drug x indicated in situation y or for condition y?", and "What is the cause of symptom x?".More than two-thirds of physician questions fell into one of five competencies: cause of a clinical finding, test selection, prevention, treatment selection, and prognosis. By using these questions as a form of needs assessment, educators can develop programs that directly address the information needs and questions of learners in ways that are more likely to change performance and to ultimately benefit patients.

The authors in this chapter promote the democratic principle of participatory decision making by asking who benefits and who should benefit from adult education program planning.

Program planning activities are not culturally neutral but are replete with various cultural values and affected by them. This qualitative study was conducted in Korea and examines how cultural values influence educational planning in Korea. Specifically, the study was to examine how Confucian cultural values play out in educational planning in terms of negotiating power and interests. In-depth interviews were held in a variety of settings with 13 program planners. There were two primary categories of findings: (a) planners’ embedded Confucian values, such as group harmony, respect of hierarchy, propriety, face, bond of affection ( jeong), and distinctive gender roles, were reflected in the everyday actions of planners and (b) these Confucian values, especially those of age, gender, and group harmony, influenced the exercise of power and negotiation of power and interests.

(2009). Rooted in the Soil: The Social Experiences of Black Graduate Students at a Southern Research University. The Journal of Higher Education: Vol. 80, No. 2, pp. 178-203.

In this article, Juanita Johnson-Bailey, a Black female professor, and Ronald M. Cervero, a White male professor, examine and contrast their academic lives by exploring how race and gender have influenced their journeys and their experiences. Using journal excerpts, personal examples, and a comparative list of privileges, the authors present a picture of their different realities at a research university. The depiction of their collective forty years in academia reveals that White men and Black women are regarded and treated differently by colleagues and students. Manifestations of this disparate treatment are evident primarily in classroom and faculty interactions. An examination of the professors' relationships with people and with their institution illustrates that, overall, the Black woman is often relegated to a second-class existence characterized by hostility, isolation, and lack of respect, while the White man lives an ideal academic life as a respected scholar who disseminates knowledge, understands complexity, and embodies objectivity.

Centring on the impact of power and politics embedded in the evaluation of training programmes, this study aimed to understand how organizational power relations affect the evaluation process for a training programme. A qualitative case study for the managerial leadership development programme of a Korean insurance company was designed. The HRD practitioners held control throughout the evaluation, and their dominant power was maintained and reproduced by other stakeholders' recognition of their expertise in training and development area. However, due to the structural relationship between the HRD unit and the corporate management, the HRD practitioners perceived themselves as marginalized. Unequal power relations were sustained in the evaluation mostly by stakeholders' self-regulation of their conduct in terms of norms, standards and expectations about their roles. This study found that despite the immense criticism of reaction measures, their continuing use in evaluation could be traced to their...

Changing employees' attitudes and beliefs is considered key to changing employee behavior. This article examines the impact on learners' management philosophies of their participation in a critical management studies (CMS) course. The study utilized a qualitative case study of CMS courses at two sites, one in the United Kingdom and one in the United States. Semi-structured interviews with eleven learners and class observations were the primary methods. The findings indicate that learners come into CMS classrooms with different philosophies, including critical orientations. CMS courses impact on the learners' management philosophy in multiple ways within the same course. The course simultaneously reinforces different, even opposing orientations at the same time. This study has important implications for training designed to influence the attitudes and beliefs of employees.

Discussions of learning in practice and in workplaces have been carried out within the various theories of learning. More recent discussions have unveiled the complexity inherent in learning in workplaces by acknowledging the presence of power relations in practice. However, the discussions fall short of an analysis on another more paramount power relation in practice – the relationship and effects of organizational ownership on learning in workplaces. Using the global phenomenon of concentrated media ownership, this paper presents a literature review to show that ownership is another higher form of power relation that shapes what and how professionals learn in practice.

The purpose of this study was to understand how White antiracist adult educators challenge racism. Seven participants from 5 different antiracist educational organizations were included. Data were collected over a 5-month period using interviews, documents, and participant observations and were analyzed using the constant comparative method. Results addressed the understandings of racism and White privilege that adult educators bring to their work and how these understandings guide them to challenge racism. A systemic understanding of racism, as well as an understanding of how their own White privilege affects them and People of Color, guided the adult educators’ work. Their analyses of racism influenced the participants to take particular and strategic actions to challenge racism. The study has implications for adult educators who recognize the entrenchment of racism in our society and who want to move their abstract understandings to the concrete level of daily interactions and take specific actions within their educational practices.

Strategies of response for HIV/AIDS education should account for structural relations of power, be culturally relevant to its audiences, and have the community as the focus of the intervention.

This article explores how planning the Botswana National Literacy Programme aided the state in maintaining its power and control over the past two decades. Using critical educational theory as the theoretical framework, it demonstrates how the planning of literacy education promotes conventional views of literacy and perpetuates state hegemony. It analyses how educational planners addressed competing choices of language, audience, and instructional design based on issues such as social status, gender, ethnic differences, and geographical location. The state views planning as a non-contested exercise representing different interests and common concerns. It has, however, met with some defiance from planners and facilitators who engaged in overt and quiet dissent from its hegemony. Consequently, the article explores ways to decentralise decision-making and devolve power to the district levels through using a participatory approach to involve all stakeholders in planning for the programme to respond t...

The purpose of this study was to understand how lesbians learn to negotiate the heterosexism of corporate America. The sample consisted of ten women at the management or executive level who were over the age of 30, identified as lesbians, had worked in their organization for at least two years, had at least two people who report directly to them and had budget responsibility. The primary data collection strategy was in-depth interviews and data were analyzed using the constant comparative method. Lesbians who have learned to negotiate the heterosexism of the corporate setting successfully have learned: a) to pre-screen individuals and groups for their receptivity toward the issue of lesbianism, b) to come out as individuals/lesbians in a strategic way, and c) to educate others about the unique issues that lesbians face in corporate settings. This learning occurred informally and incidentally through: a) dealing with human resources, b) participating in committees and groups, and c) participating in social...