Annotated bibliography - ACCELERATING CHANGE IN MEDICAL EDUCATION CONSORTIUM - 2nd edition - American Medical Association

 
Annotated bibliography - ACCELERATING CHANGE IN MEDICAL EDUCATION CONSORTIUM - 2nd edition - American Medical Association
2nd edition

Annotated
bibliography

ACCELERATING CHANGE IN MEDICAL EDUCATION CONSORTIUM
Annotated bibliography - ACCELERATING CHANGE IN MEDICAL EDUCATION CONSORTIUM - 2nd edition - American Medical Association
Creating a community of innovation
                      Annotated bibliography

This annotated bibliography is a compilation of scholarly work published by the schools of the
American Medical Association Accelerating Change in Medical Education Consortium related to
the innovations being implemented through consortium grants.

              Suggestions for additions, deletions, or edits should be emailed to:

                                 changemeded@ama-assn.org

  Links directly to the journal article or the National Library of Medicine listing are provided
        when available. Some journals are open access. Others require a subscription.

                                                                          Updated March 2, 2018
Annotated bibliography - ACCELERATING CHANGE IN MEDICAL EDUCATION CONSORTIUM - 2nd edition - American Medical Association
Ayala N, MacDonnell CP, Dumenco L,                   This article describes a study about medical
Dollase R, George P. A cross-sectional               students’ attitudes toward clinical
analysis of perceptions of                           informatics (CI) training and careers. A
interprofessional education in medical               web-based survey was distributed to the
students. Ann Behav Sci Med Educ.                    students at four allopathic medical schools.
2014;20:6-9.                                         The survey provided definitions and
                                                     examples of CI electives for medical
This article describes a longitudinal study          students, CI electives during residency, and
examining medical students’ attitudes                CI academic fellowships. The survey then
toward other health professions and                  asked students to rate their previous
interprofessional collaboration throughout           awareness and their potential interest in each
their four years of medical school training.         of these opportunities. Five hundred and
Medical students in this study participated in       fifty-seven medical students responded.
two required interprofessional education             Thirty percent of the student respondents
activities prior to graduation. One workshop         expressed at least some interest in a CI-
occurred early in their second year. The             related career, but they were no more aware
second occurred in the beginning of their            of training opportunities than their peers
third year. The study also included first year       who did not express such an interest. This
medical students as a control group since            article informs the work of medical
they had not yet participated in an                  educators interested in improving CI
interprofessional workshop. The Readiness            training by identifying a need for CI training
for Interprofessional Learning Scale                 and mentoring opportunities that may
(RIPLS) was used to measure students’                positively influence the size and skill set of
perceptions toward interprofessional                 the future CI workforce.
education. There was a statistically
significant difference on the total RIPLS            Baxley EG, Lawson L, Garrison HG, et
score between the Year 1 mean and the Year           al. The teachers of quality academy: A
4 mean. However, the difference                      learning community approach to
disappeared when the Year 2 mean was                 preparing faculty to teach health systems
compared with the Year 4 mean. This article          science. Acad Med. 2016;91:1655-1660.
informs efforts made by schools working to
better integrate interprofessional education         This article describes the Teachers of
                                                     Quality Academy (TQA) program
into their curricula by demonstrating that
both formal and informal opportunities               established by Brody School of Medicine at
                                                     East Carolina University in January 2014.
improve student attitudes toward
interprofessional collaboration.                     The program had a dual goal of preparing
                                                     faculty to lead frontline clinical
Banerjee R, George P, Priebe C, Alper E.             transformation while becoming proficient in
Medical student awareness of and interest            pedagogy and curriculum design necessary
in clinical informatics. J AM Med Inform             to prepare students for developing health
Assoc. 2015;22:e42-e47.                              systems science (HSS) competencies. The

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Annotated bibliography - ACCELERATING CHANGE IN MEDICAL EDUCATION CONSORTIUM - 2nd edition - American Medical Association
TQA included the completion of the                   they discuss the advantages and disadvantages
Institute for Healthcare Improvement Open            of such an approach to curriculum
School Basic Certificate in Quality and              transformation. This article documents the
Safety; participation in six two-day learning        experience of one consortium school with
sessions on key HSS topics; completion of a          changing their curriculum and can inform the
quality improvement (QI) project; and                efforts at other medical schools making
participation in three online graduate               significant changes.
courses. Twenty-seven faculty members                Brown DR, Warren JB, Hyderi A, et al.
from four health science programs                    Finding a path to entrustment in
completed the program. All completed their           undergraduate medical education: A
QI projects. Nineteen (70%) have been                progress report from the AAMC Core
formally engaged in the design and delivery          Entrustable Professional Activities for
of the medical student curriculum in HSS.            Entering Residency Entrustment Concept
This article informs faculty development             Group. Acad Med. 2017;92:774-779.
programs in health professions education by
outlining a faculty development curriculum           This paper describes the progress of schools
for improving knowledge and skills in HSS            piloting the 13 core entrustable professional
as an educational initiative for faculty.            activities (EPA) for Entering Residency,
                                                     which were created to address gaps between
  NEW                                                medical school and residency, and better
Borkan JM, Paul G, Tunkel AR.                        prepare medical students to meet the
Curricular transformation: The case                  expectations of their residency program
against global change. Acad Med. Jan. 30,            directors. The core EPAs provide a
2018. [Epub ahead of print]                          framework for supervisors to be able to
                                                     utilize assessments and provide feedback to
In this commentary, the authors make the case        students about their ability to perform in
for medical schools to pursue more                   workplace settings. Ten medical schools are
circumscribed solutions to curricular redesign       piloting the implementation and evaluation
for undergraduate medical education rather           of the core EPAs to better understand how to
than whole system changes—at least as first          entrust students to perform specified
steps and perhaps as ultimate solutions. While       activities. Within the pilot, one work group
they focus primarily on the experience at the        focused on the concept of entrustment and
Warren Alpert Medical School (AMS) of
                                                     developed guiding principles for entrustment
Brown University, they believe the insights
                                                     based on discussions and a literature review.
gleaned from their experiences are
                                                     This group discussed the entrustment
generalizable to other innovations and other
                                                     process in the context of perceived trust of
medical schools. The authors describe the
                                                     the learner, a supervisor’s overall
implementation of the Primary Care –
Population Medicine track at AMS as a                workplace-based assessment of a learner,
working example of implementing                      and the summative decisions made for each
circumscribed rather than global change, and         core EPA. Entrustment was defined at the

                                                 2
point that students have the required                  their school’s policy for delaying
knowledge, skills, and attitudes, as well as at        graduation. Many schools do not include
the point of demonstrating elements of                 matching as a requirement for graduating.
trustworthiness which indicate student                 While delaying graduation may assist
entrustment of performing a core EPA                   students in improving clinical skills and
without supervision. In addition, the                  procuring stronger letters of
workgroup recommends guiding principles                recommendation, this may not be allowed at
for making summative decisions to make                 some institutions. Some schools do not
this process more transparent for students             allow this option once students have met
and faculty. This workgroup created a                  graduation requirements to avoid
developmental framework of                             jeopardizing a student’s ability to graduate if
trustworthiness, which is comprised of three           they are already in good standing, increased
distinct dimensions: discernment of                    indebtedness, and clinical site capacity.
limitations, truthfulness, and                         Second, it is unclear if adding more
conscientiousness. Various elements of this            information to the Dean’s Letter will
framework will be tested in the next phase             increase the likelihood that a student will
of the pilot including the validity of the scale       match in subsequent cycles. However, the
and various approaches used by each school.            authors recommend an addendum describing
Furthermore, the group will continue to                experiences not covered in the previous
evaluate and discuss facilitators and barriers         Dean’s Letter. Additional information about
to implementing the guiding principles                 experiences in advanced clinical rotations
within each school. The future work of this            may be an important factor for program
group in evaluating the entrustment process            directors seeking more clinical performance
and piloting different approaches to                   evaluations. If an unmatched student is
compiling evidence of trustworthiness will             unable to obtain a residency position during
help inform medical schools’ efforts in                the SOAP process, they generally have three
implementing a deliberate approach to                  options: seeking a position immediately
assessment that bridges the gap between                following the SOAP but before residency
medical school and residency.                          begins; obtaining a position the year
                                                       following residency due to a vacancy;
Bumsted T, Schneider BN, Deiorio NM.                   reapplying the next year, whether to the
Considerations for medical students and                same specialty or a different one. The
advisors after an unsuccessful match.                  authors also identified the 10 out of 33
Acad Med. 2017;92:918-922.                             factors program directors consider in
This perspective article discusses issues              applicants can be improved on after the
related to unmatched medical students, as              initial match process. Alternative avenues
well as options that they may consider with            for unmatched students to strengthen their
their advisors and medical schools through             application include paid employment,
this difficult experience. First, students and         volunteer work, or obtaining an additional
faculty need to familiarize themselves with            degree or certification, while others may

                                                   3
decide to pursue a nonclinical career. Lastly,        This article informs medical schools
the authors offer guidelines to faculty               exploring implementation of scholarly
members on advising unmatched students.               concentrations to provide more learner-
This perspective assists medical schools in           focused opportunities.
creating deliberate strategies for advising
unmatched students, particularly at a time in         Cangiarella J, Fancher T, Jones B, et al.
                                                      Three-year MD programs: Perspectives
which medical schools are actively working
toward decreasing the shortage of primary             from the Consortium of Accelerated
                                                      Medical Pathway Programs (CAMPP).
care physicians.
                                                      Acad Med. 2017;92:483-490.
Burk-Rafel J, Mullan PB, Wagenschutz
                                                      This article describes the three-year medical
H, Pulst-Korenberg A, Skye E, Davis
MM. Scholarly concentration program                   degree programs of medical schools that are
                                                      members of the Consortium of Accelerated
development: A generalizable, data-
driven approach. Acad Med. 2016;91:S16-               Medical Pathway Programs (CAMPP),
                                                      which is supported by the Josiah Macy Jr.
S23.
                                                      Foundation. The goal of the consortium is to
This article describes an approach that               provide networking support and
medical schools can use to develop scholarly          collaboration opportunities for medical
concentration programs based on student               schools with existing accelerated programs,
preferences and existing expertise. First the         as well as provide information regarding
authors thematically analyzed the internet            scalable, replicable, and portable models for
content of scholarly concentration programs           medical schools considering implementing
at top research or primary care United States         an accelerated program. This article
medical schools. Next, the authors                    describes each program’s specialty focus,
conducted a survey to understand which                mission, financial support, and student
scholarly concentrations were of interest to          selection process among other relevant
students at their institution. Exploratory            descriptive information. In addition, the
factor analysis was used to examine the               authors address concerns with regard to
relationships between topics which were               students in accelerated programs learning
rated by students on the survey, and an               the same content as their peers in traditional
optimization algorithm was created to                 programs, as well as regulatory requirements
understand logistical approaches to                   and the implications of different options
increasing the number of students able to             regarding the residency match. Lastly, the
participate in their first or second choice of        authors describe lessons they have learned
concentration. The factor analysis indicated          through implementing an accelerated
eight pathway preferences that medical                program. The work of the CAMPP helps
schools could implement. The algorithm                medical schools understand how to improve
determined that offering six pathways would           the continuum from undergraduate medical
allow 95% of a 171 student first-year class           education to graduate medical education,
to participate in their first or second choice.       particularly as it relates to implementing

                                                  4
competency-based education programs                 Chen HC, McNamara M, Teherani A, ten
which may accelerate a student’s progress           Cate O, O’Sullivan P. Developing
toward graduation.                                  entrustable professional activities for
                                                    entry into clerkship. Acad Med.
Carney PA, Haedinger LA, Kahl LE,                   2016;91:247-255.
Deiorio NM, Bonura EM, Kraakevik JA.
The association between assigned                    This article describes a multistep process for
independent learning schedule and                   developing and appraising content validity
medical student performance on                      evidence for entrustable professional
examinations. Med Sci Educ. 2017;27:253-            activities (EPA) for clerkship entry. The
257.                                                process started with a study of student-run
                                                    clinics, the results of which were confirmed
This article explores the experiences of one        with preceptor interviews and student focus
medical school with a schedule structure that
                                                    groups. To ensure the relevance and
provides students with independent learning         adequacy of the EPA content domains
time throughout the week with weekly                derived from this process, they were mapped
examinations occurring on Friday.                   to existing competency frameworks to
Independent learning times are available on         establish credibility with stakeholders and
Monday afternoons, Tuesday mornings, and            provide a framework for observation and
Thursday afternoons. Students assigned to           assessment. Next, with the assistance of
Monday and Tuesday times were concerned             experts, the content of each EPA was
that they were at a disadvantage because            expanded on beyond its content domain to
they had less study time just prior to the          include a detailed delineation of the
examination. In response, the school                expected observable behaviors and the
conducted a study with one class of medical         context for those behaviors. These EPAs
students (second class to participate in the        were further refined three times with the
new curriculum and structure). There was no         help of local, national, and international
statistical difference in weekly test scores        medical educators through meetings and
based on when students were assigned to an
                                                    conferences. A final review was conducted
independent learning time. As medical               with an EPA expert and local stakeholders
schools begin to reform their curriculum and        to ensure adherence to EPA principles and
structure, it is important to develop an            the appropriateness and alignment of the
evidence base for new concerns that may
                                                    EPA content with curricular objectives. The
arise. This awareness will lead learners and        EPAs developed, as well as the multistep
researchers to explore other ways to improve        process utilized to develop them, informs
examination performance and will inform             both local and national efforts in developing
the work of other medical schools                   or improving competency frameworks for
implementing curricular reform.                     new content areas.

                                                5
Chertoff J, Wright A, Novak M, et al.                  NEW
Status of portfolios in undergraduate
                                                     Cirigliano MM, Guthrie C, Pusic MV, et
medical education in the LCME
accredited US medical school. Med Teach.             al. “Yes, and …” Exploring the future of
                                                     learning analytics in medical education.
2016;38:886-896.
                                                     Teach Learn Med. 2017;29(4):368-372.
This article describes the results of a survey
                                                     The article explores the future possibilities
to investigate the number of medical schools
accredited by the Liaison Committee on               of learning analytics in medical education,
                                                     including advancements in interaction
Medical Education utilizing portfolios, the
format of portfolios, information technology         metrics and the use of interactivity analysis
                                                     to deepen understanding of perceptual,
(IT) innovations, purpose of portfolios, and
their ability to engage faculty and students.        cognitive, and social learning and transfer
                                                     processes. Learning analytics is a
The majority of schools that responded and
identified themselves as portfolio-users,            multidisciplinary endeavor that uses data
                                                     collected from learner interactions with
utilized electronic longitudinal competency-
based portfolios with a minority utilizing           technology to uncover the relation between
                                                     learner activity online and subsequent
visual tracking of student progress over
time. Less than half of respondents reported         performance in order to reveal important
                                                     information about effective learning and
that portfolios were used for formative
and/or summative purposes. Respondents               study approaches. Analyses of this nature
also described faculty development as the            have the potential to improve theoretical
                                                     understanding of knowledge and skill
most important barrier to implementing
portfolios, which may lead to poor faculty           acquisition by elucidating the mechanisms
                                                     of action whereby learning occurs. The
engagement. Likewise, respondents
identified dedicated mentorship for the              sophistication of interaction metrics and
                                                     performance assessment measures is limited
students as the most important facilitator of
portfolio success. Another barrier to                only by the creativity (and budget) of those
                                                     who design and develop technology-
implementing portfolios is student resistance
due to limited experience and lack of                enhanced learning. Deriving deeper
                                                     understanding from learning analytics
engagement in reflective learning. Lastly, IT
and administrative support was identified as         requires equally sophisticated data collection
                                                     strategies that enable investigation of
a facilitator to implementing portfolios,
particularly with IT support that is                 context, validation of interaction metrics,
                                                     and evaluation of practical application. This
responsive to user input. This study informs
efforts made by medical education programs           article informs the consortium’s work on
                                                     improving assessment, particularly with
by identifying education technology needs
for medical schools, as well as by describing        regard to competency-based education and
                                                     technology enhanced learning in medical
factors that can facilitate and hinder IT
implementation within a specific locale.             education.

                                                 6
Clay AS, Chudgar SM, Turner KM, et al.              specific to the intensive care unit. A
How prepared are medical and nursing                majority of students who completed an
students to identify common hazards in              evaluation for the activity indicated that the
the intensive care unit? Ann Am Thorac              “Room of Horrors” should be used again
Soc. 2017;14:543-549.                               and provided examples for why they were
                                                    able to identify more hazards as an
This study explores how often nursing and           interprofessional team. This study informs
medical students identify patient safety            health professions education programs
issues in hospital settings, as well as the         implementing patient safety and
differences in individual and team                  interprofessional practice assessments. This
performance. Ninety-three fourth-year               simulation can be administered to students,
medical students and 51 accelerated                 faculty, and practitioners and can inform
Bachelor of Science in Nursing students             health systems of gaps in their patient safety
participated in the “Room of Horrors”               practices.
simulation as a mandatory component of
their coursework. These sessions occurred in        Clyne B, Rapoza B, George P. Leadership
a high-fidelity simulation room. Each               in undergraduate medical education:
student completed an individual simulation          Training future physician leaders. R I
and an interprofessional team simulation.           Med J. 2015;98:36-40.
These sessions occurred in a hospital setting
and included hazards specific to infection          This article describes the design and
control, hospital-acquired infections, skin         implementation of a leadership curriculum
                                                    at the Warren Alpert Medical School of
breakdown, and delirium. Assessment data
from the individual simulations informed a          Brown University (AMS) for students in the
                                                    primary care-population medicine program
patient safety discussion that occurred one
week later, which was followed by the team-         with the goal of engaging students with
                                                    leadership topics starting early in the
based simulation. A mixed-methods
approach was used to identify how often             preclinical stages of training. The
                                                    “Leadership in Health Care” (LHC) course
students identified patient safety issues and
to understand differences in individual and         was designed based on multiple needs
                                                    assessments, interviews with physician
team performance. Overall, hazard
identification was low, and there were              leaders, and consideration of a wide range of
                                                    leadership theories relevant to health care
interprofessional differences. While medical
students were more likely to identify               and appropriate to student curriculum. Each
                                                    LHC session focuses on one core topic using
indications for several therapies, nursing
students were more likely to identify               techniques that address the needs of adult
                                                    learners. They are designed to be goal-
improper use or incorrect functioning of
medical equipment. Although                         oriented, related to prior experiences,
                                                    practical, and interactive. Lastly, a critical
interprofessional teams of students
performed better than individuals, teams            component of the LHC course is the
                                                    leadership action project, which is a
missed many patient safety hazards that are

                                                7
longitudinal, experiential learning, team            need to develop both depth and diversity in
activity that allows students to apply lessons       local teaching expertise, and the community
learned in class to their leadership                 at large needs to develop a culture of
development. This article informs medical            sharing. Lastly, the authors call for increased
schools seeking to offer evidence-based              scholarly efforts directed to developing an
leadership experiences at their institutions.        evidence base of ET that ask questions
                                                     pertaining to the design and effective
Cook D, Triola M. Educational                        implementation of future courses, rather
technologies in health professions                   than comparisons of the past. This paper
education: Current state and future                  informs the broader health professions
directions. Josiah Macy Jr Foundation                education community on the necessary next
Conference on Enhancing Health                       steps for better implementing and
Professions Education through                        integrating ET within educational
Technology. 2015:71-111.                             experiences.
This paper, commissioned by the Josiah               Cunningham PRG, Baxley EG, Garrison
Macy Jr. Foundation, explores the various            HG. Transforming medical education is
technologies currently available for health          key to meeting North Carolina’s
professions education (HPE), the extent to           physician workforce needs. NCMJ.
which technologies have delivered on                 2016;77:115-120.
promised transformations, and how faculty
in HPE may maximize the value of                     This article discusses the role of Brody
educational technologies. Educational                School of Medicine’s model of preparing a
technologies (ET) are defined as materials           primary care physician workforce for
and devices created or adapted to solve              meeting North Carolina’s (NC) future
practical problems related to training,              physician workforce needs. Brody’s success
learner assessment, or education                     in meeting its mission of increasing the
administration. Specific educational                 supply of primary care physicians in NC can
technology trends in HPE are discussed.              be attributed to recruiting students only from
While computer-based technology can                  NC, conducting a holistic review of
facilitate the transmission of information           applicants, providing a primary care-focused
and the collection and analysis of data,             educational process, and maintaining low
technology itself will not transform how             tuition rates so specialty choice is not
students learn and educators must continue           significantly influenced by student debt. To
to focus on the fundamental principles of            address continuing issues of disparities
learning. In addition, due to the variation of       within NC, Brody is focusing on improving
institutional needs, it may be impossible to         the competency of its graduates in health
mandate any specific technological                   systems science and preparing its faculty to
infrastructure other than access to human            institute a curricular emphasis on health
expertise in developing and implementing             systems science. In addition, Brody is
needed solutions. As such, administrators            reemphasizing its original mission to

                                                 8
continue addressing the racial and ethnic             practice change, and strategically seeking
diversity of NC’s current health care                 feedback are the foundation of a MAL who
professionals by ensuring that as much as             functions effectively, balancing routine and
one-fifth of each medical school class is             adaptive expertise. In addition, the MAL
comprised of minority students (compared              model was informed by the Practice-Based
to a national mean of 6%). Moving forward,            Learning and Improvement competency
the ongoing decline in the number of                  domain of the Accreditation Council for
primary care physicians who choose to                 Graduate Medical Education and the
practice in NC needs to be addressed, and             American Board of Medical Specialties, as
NC must find ways to increase residency               well as the plan-do-study-act cycle used for
positions in the state and create more                continuous quality improvement. The major
opportunities for medical school graduates            components of the MAL process are
to do at least part of their residency training       planning, learning, assessing, and adjusting.
in rural areas of NC. Lastly, NC must create          The process for moving among these phases
policies, mechanisms, and incentives that             is meant to be iterative, based on existing
will help them meet the health care needs of          issues that are resolved and new questions
the future. This article validates the                that emerge. The MAL model and this
continued need for innovation in both                 article informs the health professions
undergraduate and graduate medical                    education community’s understanding of
education to address the needs of disparate           components related to student development,
populations in the United States.                     outcomes, and the impact of the learning
                                                      environment.
Cutrer WB, Miller B, Pusic MV, et al.
Fostering the development of master                   Daniel M, Fleming A, Grochowski CO, et
adaptive learners: A conceptual model to              al. Why not wait? Eight institutions share
guide skill acquisition in medical                    their experiences moving United States
education. Acad Med. 2017;92:70-75.                   Medical Licensing Examination Step 1
                                                      after core clinical clerkships. Acad Med.
This article introduces and discusses the
                                                      2017; 92:1515-1524.
conceptual model of a master adaptive
learner (MAL), which will provide future              This perspective article explores the
physicians with strategies for learning               experiences of eight medical schools that
within and adapting to a changing health              made curricular changes facilitating
care environment more effectively. The                students’ completion of the United States
concept of a MAL describes a metacognitive            Medical Licensing Examination (USMLE)
approach for learning based on self-                  Step 1 examination after they complete the
regulation that can foster the development            core clerkships. Currently, there is no
and use of adaptive expertise in practice.            consensus on this topic, and studies
Specific behaviors related to preparation for         examining basic science retention after
future learning, such as asking pertinent             completion of the USMLE Step 1 have some
questions, using resources that lead to               inconsistencies. Medical schools that have

                                                  9
made this change have done so with the                and individual differences in the context of
goals of improving retention of basic science         each school’s curriculum. This article fills a
content, integration of basic science content         gap in informing medical schools of the
within clinical settings, and student                 facilitators and barriers to making this
preparation for the USMLE Step 1 as the               change, as more educators are advocating
vignettes used within the examination have            for individualized experiences and
become longer, more complicated, and more             competency-based curricula.
clinically focused. The authors described
                                                      Deiorio NM, Carney PA, Kahl LE,
logistical details of moving the USMLE
Step 1, including issues related to timing and        Bonura EM, Juve AM. Coaching: A new
                                                      model for academic and career
relevant curricular features. Among these
eight schools, there was not one way of               achievement. Med Educ Online.
implementing this change, and some schools            2016;21:33480.
are flexible with the amount of time they             This article discusses the need for
allow for studying and completing the                 definitions and constructs for academic
examination. In addition, schools                     coaching in medical education, in order to
incorporated a variation of learning                  accurately assess the coaching relationship
platforms and activities to facilitate student        and processes. The purposes of the article
retention of basic science knowledge. All             are to (1) define the concept of coaching and
schools that have already made this change            create a conceptual framework applied to
and those that have USMLE Step 1 score                medical education and (2) identify and
data for students who completed the                   define constructs for measurement. As
examination before and after the core                 medical knowledge continues to expand,
clerkships reported some increase in                  physicians must become skilled in
aggregate scores, though these differences            identifying gaps in knowledge and skills and
may not be statistically significant and are          continually embark on cycles of self-
not generalizable. An unanticipated outcome           improvement. Coaching is emerging as a
experienced by schools that are flexible in           potential approach to facilitate this process,
when students can take the USMLE Step 1               and it represents a shift from traditional
reported that allowing students’                      advising and mentoring. With these
independence in choosing when they take               proposed definitions and constructs further
the examination caused students anxiety               research should be conducted to examine
with the lack of available data to inform             how to measure the coaching relationship
their decision. Additional empirical studies          and process and its effects on learning
need to be conducted to understand                    outcomes, lifelong self-directed learning,
examination score differences for students            and overall academic development at
who completed the examination before and              varying skill levels. This article informs the
after the core clerkships. Specific attention         work of health professions education
needs to be given to both low and high                programs seeking to implement or improve
performing students, as well as both class            coaching programs.

                                                 10
Deiorio N, Juvel AM. Developing an                     institutions can use when implementing and
academic coaching program.                             developing new coaching programs.
MedEdPublish. 2016.
                                                       Denny JC, Spickard A, Speltz PJ, Porier
This article presents recommendations for              R, Rosenstiel DE, Powers JS. Using
building a coaching program through review             natural language processing to provide
of the literature and the authors’ own                 personalized learning opportunities from
experiences. A clear definition of academic            trainee clinical notes. J Biomed Inform.
coaching as a developmental longitudinal               2015;56:292-299.
relationship distinct from advising,
mentoring, and teaching is the foundation on           This article describes a novel electronic
                                                       adviser system using natural language
which this concept should be introduced to
faculty and learners. In addition, faculty             processing (NLP) to identify two geriatric
                                                       medicine competencies from medical
with the right skills, not content expertise,
should be selected as academic coaches, as             student clinical notes in the electronic health
                                                       record (EHR). Clinical notes from third year
learners also need to be developed to be
coached. Likewise, coaches also need to be             medical students were processed using a
                                                       general-purpose NLP system to identify
prepared to help learners navigate their
academic experience. It is also helpful to             biomedical concepts and their section
                                                       context. The system analyzed these notes for
keep a regular schedule for both meetings
between the coach and learner, as well as for          relevance to the competencies and generated
faculty development to provide coaches with            custom email alerts to students with
                                                       embedded supplemental learning material
evidence-based resources and feedback on
their coaching. With regard to assessment              customized to their notes. In total, 393
                                                       emails were sent to 54 students (82%
data, electronic portfolios can be used to as a
tool to make assessment information readily            enrolled), including 270 for one competency
                                                       and 123 for the other. The system selected
available and transparent to coaches.
However, in this capacity it is not                    and emailed links to 260 unique documents
                                                       from the medical school curriculum in the
recommended that coaches also act as
assessors. Lastly, it is necessary to                  393 adviser emails sent to students, with
                                                       some documents being included by design.
acknowledge faculty members as coaches
and support them through creating an                   Students accessed educational links 34 times
                                                       from the 393 email alerts. Although the
environment in which they can learn from
each other, as well as other coaching                  system had a small effect in changing
                                                       behavior, the advantage of this assessment is
programs. One way to sustain a coaching
program’s growth is through a deliberate               that it is measuring real clinical change in
                                                       documentation. Given the low cost and
evaluation process that measures progress
on high-level outcomes. These                          burden of such a system, these education
                                                       advisers may be a useful adjunct to other
recommendations contextualize academic
coaching within health professions                     forms of instruction. This article provides an
                                                       example of how NLP has been used within
education, creating a framework that

                                                  11
an EHR-based intervention to provide                   rigor, reliability, validity, and security. The
students feedback outside of the potentially           authors recommend reducing the costs for
time-pressured clinical environment. As                students, exploring alternatives, increasing
some schools are considering new                       the value and transparency of the current
information that can be integrated into EHRs           examinations, recognizing and enhancing
for teaching and practice, this article                the strengths of the current examinations,
provides an example of how competencies                and engaging in a national dialogue about
may be evaluated using NLP in EHR-based                the issue. This article explores one aspect of
interventions.                                         assessment that can have an impact on
                                                       medical education transformation.
  NEW
                                                       Elks ML, Herbert-Carter J, Smith M,
Ecker DJ, Milan FB, Cassese T, et al.                  Klement B, Knight BB, Anachebe NF.
Step up—not on—the Step 2 Clinical
                                                       Shifting the curve: Fostering academic
Skills Exam: Directors of Clinical Skills              Success in a diverse student body. Acad
Courses (DOCS) oppose ending Step 2                    Med. 2018; 93: 66-70.
CS. Acad Med. 2017 Aug 22. [Epub ahead
of print]                                              This article describes a process that resulted
                                                       in a high level of academic success for a
This article explores the student-initiated            diverse student body at the Morehouse
movement to end the United States Medical              School of Medicine (MSM), a historically
Licensing Examination Step 2 Clinical                  black medical school. On average, about
Skills and the Comprehensive Osteopathic               75% of matriculating students are African-
Medical Licensing Examination Level 2-                 American and 5% are from other
Performance Evaluation and makes                       underrepresented groups in medicine. Their
recommendations to improve their                       entering grade point averages (GPA) and
usefulness to students, medical schools, and           Medical College Admission Test (MCAT)
key stakeholders. The authors, elected                 scores are similar to those reported
representatives of the Directors of Clinical           nationally by race/ethnicity, but their United
Skills Courses, an organization comprising             States Licensing Examination (USMLE)
clinical skills educators in the United States         Step 1 scores are higher than expected based
and beyond, believe abolishing the national            on their MCAT. To understand which
clinical skills examinations would have a              factors contribute to their success on the
major negative impact on the clinical skills           USMLE Step 1 the authors first compared
training of medical students, and that                 their students’ MCAT scores to the national
forfeiting a national clinical skills                  average for each cohort. Next, the authors
competency standard has the potential to               determined scores from the students’ first
diminish the quality of care provided to               attempt at the USMLE Step 1 and calculated
patients. The proposed transfer of                     correlation coefficients comparing the
responsibility for clinical skills examinations        MCAT scores to the USMLE Step 1 scores
to medical schools also raises significant             for each class. Next, they used a formula
concerns about local assessment quality,
                                                  12
from the literature to predict students’               individual learner level; a longitudinal
USMLE Step 1 scores based on their GPA                 capture of data from a single institution from
and MCAT scores, and their students’ scores            multiple sources, times, and cohorts; parallel
were 22.6 points higher than the calculations          capture of data across different institutions
predicted. Lastly, they collected data from            at a single time point; combining
course evaluations, an annual questionnaire,           longitudinal and cross-sectional data; and
and interviews and focus groups with faculty           combining data from educational and
members and students to understand which               clinical information repositories. Likewise,
factors influenced these outcomes. Based on            educational analytics are used to look for
their qualitative analysis, the authors believe        patterns in educational practice or
this success can be attributed to the milieu           performance, although it is unclear how big
and mentoring at the school, structure and             data should be used to guide both learners
content of the curriculum, and monitoring.             and institutions in making decisions.
At MSM, faculty and peer supports are                  Additionally, it is important to remember
offered through longitudinal learning                  that big data is open to bias and
communities that begin in the students’ first          misinterpretation no less than traditional
year of medical school. In addition, MSM               methods of research, evaluation, or
has several mechanisms in place to provide             assessment. This article informs the health
feedback to students and continuous quality            professions educators’ efforts in developing
improvement for faculty. Several mixed                 large data sets to measure the impact of
methods studies are underway to more                   innovations over time. As the researchers
closely examine the factors identified. This           and evaluators build datasets, it is important
report, and future studies, will help other            to be cognizant of the purpose, methods, and
educational programs facilitate                        challenges articulated in this article.
environments that lead to successful
                                                       Ehrenfeld JM, Spickard WA, Cutrer WB.
outcomes for a diverse student body.
                                                       Medical student contributions in the
Ellaway RH, Pusic MV, Galbraith RM,                    workplace: Can we put a value on
Cameron T. Developing the role of big                  priceless? J Med Syst. 2016:40;128
data and analytics in health professional
                                                       This article discusses the need for a series of
education. Med Teach. 2014;36:216-222.
                                                       research projects to assess the value of
This article reviews the potential of                  medical student contributions in patient care
educational analytics and big data in health           and health care settings in which they train
professional education and makes                       and participate. A few challenges to
recommendations for how these techniques               measuring value are a lack of a shared
can be developed to serve all stakeholders.            understanding of how to define either value
Big data involves the aggregation of large             or contributions and understanding the
and heterogeneous datasets. A few examples             contributions of a single team member. This
of how big data can be used are increasing             article proposes that it would be helpful to
personalized competency data at the                    define nomenclature around medical student

                                                  13
contributions. This article sets a foundation           gain longitudinal experience in each of six
in medical education to enable stakeholders             core clerkships; promote continuity with
to quantify contributions across settings and           patients and their care environments;
roles. This work would solidify faculty                 integrate population health with clinical
expectations of students and inform                     medicine; longitudinally follow and
appropriate assessments of their                        participate in treatments of patients across
contributions.                                          specialties; and complete a quality
                                                        improvement and/or patient safety project
Epstein-Lubow G, Cineas S, Yess J,                      focused on population medicine. For the
Anthony D, Fagan M, George P.                           2015-2016 academic year the LIC was a
Development of a longitudinal integrated                pilot and was the required core clinical
clerkship at the Warren Alpert Medical                  education for medical training for eight
School of Brown University. R I Med J.                  selected students. Based on assessments of
2015;98:27-31.                                          the program and students’ performance, the
This article describes the introduction of a            LIC will be adjusted to better aid student
longitudinal integrated clerkship (LIC) by              learning and overall functioning of the LIC
the Warren Alpert Medical School of Brown               program within affiliated health care
University. The LIC is a method of clinical             systems. This article informs medical
medical education in which traditional                  schools interested in implementing a LIC
specialty-specific block rotations lasting              while deliberately integrating topics related
several weeks and occurring sequentially are            to population medicine.
replaced by longitudinal experiences for all            Erlich M, Blake R, Dumenco L, White J,
core specialties occurring concurrently over            Dollase RH, George P. Health disparity
many months and largely in the outpatient               curriculum at the Warren Alpert Medical
setting. The LIC is for third year students in          School of Brown University. R I Med J.
the primary care-population medicine                    2014;97:22-25.
program. In developing the LIC, program
faculty incorporated a historical perspective           This article discusses the health disparity
of medical education, modern knowledge                  curriculum that has been implemented at
about students’ development of clinical                 Warren Alpert Medical School of Brown
skills, and educational science as it relates to        University. In addition to acquiring
faculty development and learner evaluation.             knowledge of basic sciences and clinical
The clerkship is being tailored to fit the              skills, medical students must gain an
Brown University system as it will be                   understanding of health disparities and
unique in its attention to population                   develop a defined skill set to address these
medicine, including exposure of students to             inequalities. Using Kern’s six-step approach
several distinct health care systems within a           to curriculum development along with
single geographic region, and integration of            principles of experiential and active
clinical training with completion of a Master           learning, student champions and the office
in Population Medicine. The goals are to                of medical education developed a

                                                   14
multimodal health disparities curriculum.             educators in using OMP as an effective
This curriculum includes required                     clinical teaching method with multiple
experiences for medical students in the first,        benefits. In utilizing the OMP, teachers are
second and third years, along with elective           able to identify gaps in the student’s
experiences throughout medical school.                learning, engage the learner in higher level
Students are examined on their knowledge,             clinical thinking, contextualize learning
skills and attitudes toward health disparities        about specific issues, improve the level of
prior to graduation. The goal of this                 feedback given to the learner, as well as
curriculum is to empower students with the            address the patient’s needs. Lastly, the
knowledge, skills and attitudes to help               authors use a case to illustrate how the OMP
patients navigate the socio-economic and              method may be applied in emergency
cultural issues that may affect their health.         medicine. This article articulates the
This article describes the challenges moving          potential for OMP to be used in a new
forward in creating a broader interest in             clinical setting and context. This article
health disparities to strike the appropriate          informs medical education programs that
balance between providing students with a             seek to incorporate new assessment methods
strong biomedical foundation of knowledge             by demonstrating the use of the OMP in
and gaining deep understanding of social              settings that are not common for this
influences that often drive health outcomes.          assessment method.
This article informs the consortium’s work
on understanding this balance, as well as             Favreau MA, Tewksbury L, Lupi C, et al.
                                                      Constructing a shared mental model for
providing additional strategies for teaching
health disparities.                                   faculty development for the Core
                                                      Entrustable Professional Activities for
Farrell SE, Hopson LR, Wolff M,                       Entering Residency. Acad Med.
Hemphill RR, Santen SA. What’s the                    2017;92:759-764.
evidence: A review of the one-minute
preceptor model of clinical teaching and              This article provides an analysis of the
                                                      current literature on entrustable professional
implications for teaching in the
emergency department. J Emerg Med.                    activities (EPA) and entrustment to
                                                      determine a framework for developing
2016;51:278-283.
                                                      faculty to make entrustment decisions. The
This article reviews the evidence for the             authors determined that such a framework is
effectiveness of the one-minute preceptor             composed of four dimensions. First,
(OMP) teaching method and provides                    observation skills in authentic work
suggestions for its use in emergency                  environments should be developed in order
medicine. The OMP was first introduced in             for assessment and entrustment to occur as a
the family medicine literature as a method to         partnership between the faculty and learner
simultaneously teach clinical skills and              in order to facilitate the learner’s
provide patient care. Existing experimental           development. Second, feedback and
studies support faculty and resident                  coaching skills should be included as part of

                                                 15
faculty development programs to assist                 non-white students are more likely than
faculty in creating longitudinal coaching              white students to provide care in
relationships in which the faculty and                 underserved communities after medical
learner reciprocate trust. Third, faculty              training. Third, a diverse physician
development should include opportunities to            workforce may help address racial/ethnic
continuously improve their understanding               and socioeconomic disparities in health
and ability to self-assess and reflect in order        status, health care quality, and in patient
to demonstrate these behaviors and skills to           recruitment for health research. Lastly,
learners throughout the entrustment process.           medical students value diversity. The
Lastly, it is necessary to create a community          authors also discuss the legal restrictions
of practice in which all individuals involved          that constrain the extent to which medical
in the entrustment process are given                   schools may use race/ethnicity in admissions
opportunities to learn from other faculty              decisions and outlines simulations
through a collaborative process fostering              conducted using academic metrics and
optimal contributions from faculty and an              socioeconomic data from applicants to a
EPA culture. In addition, the authors                  California public medical school from 2011
describe factors related to organizational             to 2013. These results indicated
structure that make it more difficult to               socioeconomic and under-represented
establish such a culture within a medical              minority disparities in admissions could be
school environment compared to residency.              eliminated while maintaining academic
Medical schools may use the suggestions                readiness. Adjusting applicant academic
and framework described in this article to             metrics using socioeconomic information on
develop an EPA culture at their institution            medical school applications may be a race-
by focusing on faculty development efforts             neutral means of increasing the
that are necessary for successful                      socioeconomic and racial/ethnic diversity of
implementation.                                        the physician workforce. This article offers
                                                       an approach that other medical schools may
Fenton JJ, Fiscella K, Jerant AF, et al.               use to mitigate disparities in admissions.
Reducing medical school admissions
disparities in an era of legal restrictions:             NEW
Adjusting for applicant socioeconomic
disadvantage. J Health Care Poor                       Gay SE, Santen SA, Mangrulkar RS,
                                                       Sisson TH, Ross PT, Bibler Zaidi NL. The
Underserved. 2016;27:22-34.
                                                       influence of MCAT and GPA
This article discusses the need for a diverse          preadmission academic metrics on
physician workforce in order to increase               interview scores. Adv in Health Sci Educ
access to care for underserved populations.            Theory Pract. 2018;23(1):151-158.
Medical schools have compelling reasons
for achieving class diversity. First, student          This article analyzes whether preadmission
diversity enhances the education of all                academic metrics such as the Medical
students. Second, in workforce analyses,               College Admission Test (MCAT) scores and
                                                       undergraduate grade point averages (uGPA)
                                                  16
on interview scores significantly influence            a consortium school and may help inform
interviewers’ scores in a holistic admissions          the work of other schools working to
process. The authors examined academic                 improve the holistic admissions process and
and demographic predictors of interview                increase diversity in the medical student
scores for two applicant cohorts at the                body.
University of Michigan Medical School. In
                                                       George P, Tunkel AR, Dollase R, et al.
2012, interviewers were provided
applicants’ uGPA and MCAT scores; in                   The primary care-population medicine
                                                       program at the Warren Alpert Medical
2013, these academic metrics were withheld
from interviewers’ files. Hierarchical                 School of Brown University. R I Med J.
                                                       2015;98:16-21.
regression analysis was conducted to
examine the influence of academic and                  This article discusses the primary care-
demographic variables on overall cohort                population medicine (PC-PM) program
interview scores. When interviewers were               developed by the Warren Alpert Medical
provided uGPA and MCAT scores,                         School of Brown University. The program
academic metrics explained more variation              builds upon the traditional curriculum with
in interview scores (7.9%) than when                   major integrated curricular innovations. The
interviewers were blinded to these metrics             first innovation is the Master of Science in
(4.1%). Further analysis showed a                      Population Medicine that requires students
statistically significant interaction between          to take nine additional courses over four
cohort and uGPA, indicating that the                   years, complete a thesis project focused on
association between uGPA and interview                 an area of population medicine, and take
scores was significantly stronger for the              part in significant leadership training. The
2012 unblinded cohort compared to the 2013             second is the development of the
blinded cohort (β = .573, P
NEW                                                 fourth theme was the need for faculty to be
                                                      aware of challenges in the culture of AHCs
Gonzalo JD, Ahluwalia A, Hamilton M,                  as an influential context for change. This
Wolf H, Wolpaw DR, Thompson BM.                       article outlines a strategy to better align
Aligning education with health care                   faculty education with the real-time needs of
transformation: Identifying a shared                  health systems and can be used to inform
mental model of “new” faculty                         local, national, and international faculty
competencies for academic faculty. Acad               development efforts to further enhance
Med. 2018;93(2):256-264.                              undergraduate, graduate and continuing
This article outlines the development of a            medical education programs in health
potential competency framework for faculty            systems science.
development programs aligned with the                 Gonzalo JD, Baxley E, Borkan J, et al.
needs of faculty in academic health centers
                                                      Priority areas and potential solutions for
(AHCs). In 2014 and 2015, the authors                 successful integration and sustainment of
interviewed 23 health system leaders and              health systems science in undergraduate
analyzed transcripts using constant                   medical education. Acad Med. 2017;92:63-
comparative and thematic analysis. They               69.
coded competencies and curricular concepts
into subcategories. Lead investigators                This article discusses the call for significant
reviewed drafts of the categorization themes          reform to undergraduate medical education
and subthemes related to gaps in faculty              (UME) and graduate medical education
knowledge and skills, collapsed and                   (GME) programs to meet the evolving needs
combined competency domains, and                      of the health care system. Nationally, several
resolved disagreements via discussion.                schools have initiated innovative curricula to
Through analysis, the authors identified four         promote education in health systems science
themes. The first was core functional                 (HSS). However, the successful
competencies and curricular domains for               implementation of HSS curricula is
conceptual learning, including patient-               challenged by issues of curriculum design,
centered care, health care processes, clinical        assessment, culture, and accreditation. The
informatics, population and public health,            authors describe seven priority areas for the
policy and payment, value-based care, and             successful integration and sustainment of
health system improvement. The second was             HSS in educational programs, associated
the need for foundational competency                  challenges, and potential solutions. The
domains, including systems thinking, change           authors identified these priority areas:
agency/management, teaming, and                       partner with licensing, certifying, and
leadership. The third theme was paradigm              accrediting bodies; develop comprehensive,
shifts in how academic faculty should                 standardized, and integrated curricula;
approach health care, categorized into four           develop standardize, and align assessments;
areas: delivery, transformation, provider             improve the UME to GME transition;
characteristics and skills, and education. The        enhance faculty knowledge and skills, and

                                                 18
incentives; demonstrate value-added to the             scarcity of faculty educators with expertise,
health system; and address the hidden                  lack of support from accreditation agencies
curriculum. This article may serve as a                and licensing boards, and unpreparedness of
blueprint for health professions education             evolving health care systems to partner with
programs interested in developing HSS                  schools with HSS curricula. The authors
curricula locally, as well as for national             recommend the initiation and continuation
efforts focused on promoting HSS-related               of discussions between educators, clinicians,
knowledge, skills, and attitudes through               basic science faculty, health system leaders,
national initiatives.                                  and accrediting and regulatory bodies about
                                                       the goals and priorities of medical
 NEW                                                   education, as well as about the need to
Gonzalo JD, Caverzagie KJ, Hawkins RE,                 collaborate on new methods of education to
Lawson L, Wolpaw DR, Chang A.                          reach these goals. The resolution of potential
Concerns and responses for integrating                 and perceived challenges to intregrating
health systems science into medical                    HSS into medical school curricula requires
education. Acad Med. 2017 Oct 24. [Epub                candid exploration of educational goals,
ahead of print].                                       competing priorities, and continuous
                                                       reevaluation of current educational
This article identifies several widely                 strategies. This article informs the work of
perceived challenges to integrating health             the consortium on strategies to increase the
systems science (HSS) into medical school              implementation of HSS.
curricula, responds to each concern and
provides potential strategies to address these           NEW
concerns, based on the authors’ experiences            Gonzalo JD, Dekhtyar M, Hawkins RE,
with designing and integrating HSS                     Wolpaw DR. How can medical students
curricula. The authors explored the limited            add value? Identifying roles, barriers,
uptake and adoption of HSS through                     and strategies to advance the value of
meetings and conversations with educators,             undergraduate medical education to
clinicians, scientists, health systems leaders,        patient care and the health system. Acad
and journal reviewers, from about                      Med. 2017;92:1294-1301.
September 2013 to September 2016. This
process identified two broad categories of             This article identifies potential stakeholders
concerns: the (1) relevance and importance             regarding the value of student work, and
of learning HSS—including the perception               roles and tasks students could perform to
that there is inadequate urgency for change;           add value to the health system, including
HSS education is too complex and should                key barriers and associated strategies to
occur in later years; early students would not         promote value-added roles in undergraduate
be able to contribute, and the roles already           medical education. In 2016, 32 U.S. medical
exist; and the science is too nascent—and              schools in the Accelerating Change in
(2) logistics and practicality of teaching             Medical Education Consortium met for a
HSS—including limited curricular time,                 two-day national meeting to explore value-
                                                  19
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