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There are no program evaluation approaches designed for a crisis, such as the COVID-19 pandemic. It is critical to evaluate the educational impact of COVID-19 to keep administrators informed and guide decision-making. The authors used systems thinking to design an evaluation model. The evaluation results suggest complex interactions between individuals and course level changes due to COVID-19. Specifically, year 1–2 students found more education metrics lacking relative to year 3–4 students, faculty, and course directors. There was no consensus for the value of similar instructional/assessment adaptations. The evaluation model can be adapted by other medical schools to fit systems-based needs.

Concern about medical student attendance has been rising over the last decade. Thinking a required attendance policy would fix things, we instituted such a mandate in 2010 only to find that although students were present at lecture and other learning sessions they were disengaged. In addition, we experienced growing distrust between faculty and students and tensions between the Student Affairs and Curriculum offices. After five years, we dismantled the policy in favor of encouraged attendance. We discuss both positive and negative surprising consequences that followed this new approach to attendance which has reshaped our vision for the medical school learning experience. It has been transformative and has afforded us the opportunity to redefine our results in accord with the culture in which we aspire to live and work.

Promoting optimal health outcomes for diverse patients and populations requires the acknowledgement and strengthening of interdependent relationships between health professions education programs, health systems, and the communities they serve. Educational programs must recognize their role as integral components of a larger system. Educators must strive to break down silos and synergize efforts to foster a health care workforce positioned for collaborative, equitable, community-oriented practice. Sharing interprofessional and interinstitutional strategies can foster wide propagation of educational innovation while accommodating local contexts. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium leveraged interdependence to accomplish transformative innovations catalyzed by systems thinking and a community of innovation.

This Conversation Starters article presents a selected research abstract from the 2016 Association of American Medical Colleges Western Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the needs assessment study. These thoughts explore how the general theoretical mechanisms of transition may be integrated with cognitive load theory in order to design interventions and environments that foster transition.

Problem Effectively solving problems as a team under stressful conditions is central to medical practice; however, because summative examinations in medical education must test individual competence, they are typically solitary assessments. Approach Using two-stage examinations, in which students first answer questions individually (Stage 1) and then discuss them in teams prior to resubmitting their answers (Stage 2), is one method for rectifying this discordance. On the basis of principles of social constructivism, the authors hypothesized that two-stage examinations would lead to better retention of, specifically, items answered incorrectly at Stage 1. In fall 2014, they divided 104 first-year medical students into two groups of 52 students. Groups alternated each week between taking one- and two-stage examinations such that each student completed 6 one-stage and 6 two-stage examinations. The authors reassessed 61 concepts on a final examination and, using the Wilcoxon signed ranked tests, compared performance for all concepts and for just those students initially missed, between Stages 1 and 2. Outcomes Final examination performance on all previously assessed concepts was not significantly different between the one-and two-stage conditions (P = .77); however, performance on only concepts that students initially answered incorrectly on a prior examination improved by 12% for the two-stage condition relative to the one-stage condition (P = .02, r = 0.17). Next Steps Team assessment may be most useful for assessing concepts students find difficult, as opposed to all content. More research is needed to determine whether these results apply to all medical school topics and student cohorts.

The Holmes Scholars Network is a national mentoring program for graduate students from racial and cultural groups currently underrepresented in the education professoriate who are preparing to become college or university faculty in teacher education. Begun in Fall 1991, the Network was conceived by the Holmes Group, now the Holmes Partnership, as a vehicle to diversify the ranks of those who conduct teacher preparation programs in institutions of higher education across the country. A coalition for school renewal and the reform of teacher education, the Holmes Partnership currently consists of 78 local partnerships-colleges or schools of education in universities around the United States and their collaborating professional development schools (PDSs)-and seven national professional organizations, or national partners.1 In addition, a na

Many variations of the transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction have been attempted since the procedure was first described. One common modification involves the use of both rectus muscles, which may accommodate a bilateral reconstruction or provide a more reliable blood supply to a unilateral reconstruction. Objective studies measuring various aspects of physical strength after bilateral rectus harvest and subjective reports of various physical symptoms have challenged the morbidity of a double-rectus harvest. Whether this represents increased morbidity in practical terms is best clarified by asking the patients. To answer this question, 124 TRAM flap reconstruction patients (62 unipedicled patients and 62 bipedicled patients) completed a survey containing questions regarding postoperative physical activities and abilities, outcome with regard to specific physical symptoms, and satisfaction with the procedure. The overwhelming majority of patients reported no untoward effect postoperatively regarding the following: workday performance (or=90 percent), workday performance involving physical labor (or=78 percent), physical recreation (or=77 percent), abdominal appearance (or=77 percent), standing posture (or=95 percent), and back pain (or=81 percent). When comparing unipedicled and bipedicled TRAM patient groups, there was no statistically significant difference between the two groups for any of these criteria. However, a subjective decrease in abdominal muscle strength was reported by 42 percent of unipedicled and 64 percent of bipedicled TRAM flap patients, and decreased abdominal muscle strength was the most frequently cited reason for dissatisfaction. Interestingly, this decreased strength did not affect the daily activities of the majority of patients, who were happy with the procedure (96 percent) and would recommend it to others (96 percent).

1. Enhance the importance and improve understanding of the quality control function in the trial. 2. Investigate the process of quality control and ensure that local clinics had a process for monitoring all procedures and data on which the results of the trial are based. 3. Observe all technical procedures to ensure standardization and stress the importance of technical data quality. 4. Identify quality control problems. 5. Assist local quality control officers (QCOs) and suggest ways to help solve problems. 6. Increase communication between QCOs and the QCC. 7. Provide quality control orientation for the staff. 8. Document the quality control process.

Analyses of frail elderly populations and their service needs are increasingly important in shaping future policies for long term care (LTC) financing and service delivery. Because assessment information on elderly LTC clients generates essential data bases on programs and the population, it is important that the data be reliable. This article describes a method for obtaining reliable assessment data in multisite programs involving many clinical assessors. Regular reliability checks showed marked improvement over time and generally high levels of interrater reliability.

Evaluation of long-term care programs has suffered from a lack of comparable, reliable data, both within and across programs. This article discusses a methodology for development of clinical/research assessment tools, training of assessment interviewers, and ongoing checking of interrater reliability, applied to a multisite national health and long-term care demonstration. Audio tapes of case managers' clinical assessment interviews are extensively used. Reliability results are fed back into an ongoing training program. First year results are reported, showing steady improvement across all sites in reliability of data from a complex assessment instrument. The program has potential for wide application and improvement of data bases that are important for future development of public policy in long-term care.

Pulmonary function testing was used in MRFIT to monitor the presence of airways disease and to assess changes in pulmonary function over time. The pulmonary function indices that were measured were FEV1, FVC, and MMEF, (FEF25-75). Quality control of technician training, equipment maintenance, data collection, and data measurement were essential to ensure that results, over time and from various clinics, could be compared. Based on the MRFIT experience, it is strongly recommended that centralized training in testing techniques and spirometer maintenance take place before a clinical trial begins, and periodically throughout a trial. Such training, combined with quality control follow-up, should prevent the loss of data due to inadequate spirometer maintenance and invalid testing procedures.