Explore the vast range of titles available.

Background Preclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as “efficient” if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency). Methods We conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017–2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials. Results The average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes ( p  < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall. Conclusions Cognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.

Background Medical educators have promoted self-directed learning (SDL) as an important means of enabling students to take responsibility for their own learning throughout their training and practice. While SDL has been well-studied in classroom settings, it remains a story half told: barriers to and facilitators of SDL in the clinical setting are not yet well described. The goals of this study were to explicate student experiences of SDL in their clinical training and to identify the roles that local social and cultural contexts play in shaping their experiences of SDL. Methods To understand students’ conceptualization and experiences of SDL in the clinical setting, we carried out a qualitative study with 15 medical students at Harvard Medical School. The semi-structured interviews were recorded and transcribed. Using an interpretivist approach, data were analyzed both deductively and inductively using the Framework method of content analysis. Results Participants described patient care activities as primary motivators for engagement in SDL in the clinical setting. Participants’ descriptions of SDL aligned with Knowles’ steps in SDL, with an additional step of consolidation of learning related to their patients’ diagnosis and management. Participants described using a range of cognitive, social-emotional, and peer learning strategies to enhance their SDL. Participants who described a growth mindset appeared to engage in SDL more easily. Learning environments that fostered SDL were those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, and invited student engagement. Teams with perceived excessive work demands were perceived to be less supportive of SDL. Conclusions Our study enhances previous classroom-based models of SDL by providing specific, practical implications for both students and faculty in the clinical training setting. Participants described SDL in the clinical setting as patient-centered, and when effectively implemented, SDL appears to support a mastery rather than performance orientation. Our study paves the way for improving medical students’ clinical SDL and helping them become lifelong learners in the field of medicine.

Background Interprofessional education (IPE), defined as when students from two or more professions learn about, from, and with each other, has been widely espoused as a way to promote collaborative and high-quality patient care. IPE initiatives are now commonplace in undergraduate medical education, but it is unclear whether the principles of IPE are reinforced during clinical rotations. Specifically, little is known about whether, when, and how interprofessional providers (IPPs), including nurses (RN), pharmacists (PharmD), and respiratory therapists (RT), participate in teaching medical students. This study aimed to elucidate the perspective of medical students about how IPPs impacted their education during clinical rotations in the intensive care unit (ICU). Methods Surveys were distributed to medical students who rotated in the medical ICUs at three academic medical centers over a 12-month period. Survey questions focused on three major domains: IPP roles during daily rounds, interprofessional teaching (IPT) outside of rounds, and students’ attitudes about IPT. Survey data were analyzed with descriptive and comparative statistics. Free text comments were analyzed using qualitative thematic analysis. Results Twenty five out of 53 medical students completed the survey (47%). Students reported that IPPs were commonly present on ICU rounds. Students’ reports of IPP teaching varied across professions. On a 5-point Likert scale, pharmacists were perceived to teach most frequently (mean 3.58, SD 0.81), compared to RTs (mean 2.88, SD 1.01) and nurses (mean 2.17, SD 0.80) (one-way ANOVA, F(2, 69) = [14.89], p  < 0.005). On a 7-point Likert scale, IPPs were described as teaching a moderate amount outside of rounds [RN (mean 3.46, SD 1.71), PharmD (mean 4.04, SD 1.49), RT (mean 4.00, SD 1.35)], with the majority of RN and RT teaching occurring at the bedside. Students reported generally positive attitudes about IPT, with most endorsing confidence in IPP knowledge base (92%) and teaching abilities (88%); 67% would have a positive reaction if attending physicians invited more IPT on rounds. Conclusions Medical students report variable levels of teaching from IPPs on ICU rounds, but similar levels of teaching outside of rounds. Students endorsed positive attitudes toward the idea of enhancing interprofessional teaching in the ICU.

Introduction: Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. Methods: We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method. Results: From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). Conclusions: Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.

Medical professionalism has traditionally been defined by core standards for practitioners, yet consensus on its defining elements remains limited. Shifts in society, medical practice, and trainee perspectives have influenced how professionalism is understood and applied. This study aimed to establish a contemporary, consensus-based framework for medical educators and learners. Using a modified Delphi approach, 39 medical education experts from eight U.S. medical schools participated in three survey rounds and one in-person session. Participants rated 51 behaviorally-based items categorized under four domains: commitments to patients, colleagues, institutions/society, and self. Items were rated \"essential,\" \"important but not essential,\" or \"not important,\" with consensus defined as 70% agreement. Consensus was reached on 24 \"essential\" elements emphasizing patient-centered care, ethical practice, equitable care, communication, and cultural humility. Participants highlighted the importance of a shared framework while recognizing the risks of bias and the need for contextual sensitivity. Items related to physician self-sacrifice, attire, and social justice failed to reach consensus, reflecting concerns about burnout, subjectivity, and scope. Emphasis was placed on fostering professionalism through dialog, reflection, and context-aware evaluation. The resulting framework captures evolving perspectives on professionalism, offering educators practical, adaptable guidance for teaching, reflection, and assessment across diverse educational settings.

Abstract Objectives: To describe doctors' emotional reactions to the recent death of an “average” patient and to explore the effects of level of training on doctors' reactions. Design: Cross sectional study using quantitative and qualitative data. Setting: Two academic teaching hospitals in the United States. Participants: 188 doctors (attending physicians (equivalent to UK consultants), residents (equivalent to UK senior house officers), and interns (equivalent to UK junior house officers)) who cared for 68 patients who died in the hospital. Main outcome measures: Doctors' experiences in providing care, their emotional reactions to the patient's death, and their use of coping and social resources to manage their emotions. Results: Most doctors (139/188, 74%) reported satisfying experiences in caring for a dying patient. Doctors reported moderate levels of emotional impact (mean 4.7 (SD 2.4) on a 0-10 scale) from the death. Women and those doctors who had cared for the patient for a longer time experienced stronger emotional reactions. Level of training was not related to emotional reactions, but interns reported needing significantly more emotional support than attending physicians. Although most junior doctors discussed the patient's death with an attending physician, less than a quarter of interns and residents found senior teaching staff (attending physicians) to be the most helpful source of support. Conclusions: Doctors who spend a longer time caring for their patients get to know them better but this also makes them more vulnerable to feelings of loss when these patients die. Medical teams may benefit from debriefing within the department to give junior doctors an opportunity to share emotional responses and reflect on the patient's death.

Introduction The learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners’ development of critical thinking. Methods We took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions. Results Three major themes emerged regarding participants’ descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1)  Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2)  Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3)  Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning). Discussion An optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.

Many programs designed to improve feedback to students focus on faculty's ability to provide a safe learning environment, and specific, actionable suggestions for improvement. Little attention has been paid to improving students' attitudes and skills in accepting and responding to feedback effectively. Effective \"real-time\" feedback in the clinical setting is dependent on both the skill of the teacher and the learner's ability to receive the feedback. Medical students entering their clinical clerkships are not formally trained in receiving feedback, despite the significant amount of feedback received during this time. We developed and implemented a one-hour workshop to teach medical students strategies for effectively receiving and responding to \"real-time\" (formative) feedback in the clinical environment. Subjective confidence and skill in receiving real-time feedback were assessed in pre- and post-workshop surveys. Objective performance of receiving feedback was evaluated before and after the workshop using a simulated feedback encounter designed to re-create common clinical and cognitive pitfalls for medical students, called an objective structured teaching exercise (OSTE). After a single workshop, students self-reported increased confidence (mean 6.0 to 7.4 out of 10, <0.01) and skill (mean 6.0 to 7.0 out of 10, =0.10). Compared to pre-workshop OSTE scores, post-workshop OSTE scores objectively measuring skill in receiving feedback were also significantly higher (mean 28.8 to 34.5 out of 40, =0.0131). A one-hour workshop dedicated to strategies in receiving real-time feedback may improve effective feedback reception as well as self-perceived skill and confidence in receiving feedback. Providing strategies to trainees to improve their ability to effectively receive feedback may be a high-yield approach to both strengthen the power of feedback in the clinical environment and enrich the clinical experience of the medical student.

BackgroundOperating room (OR) fires are rare but devastating events requiring immediate and effective response. Virtual Reality (VR) simulation training can provide a safe environment for practice of skills in such highly stressful situation. This study assessed interprofessional participants’ ability to respond to VR-simulated OR fire scenarios, attitudes, numbers of attempt of the VR simulation do participants need to successfully respond to OR fires and does prior experience, confidence level, or professional role predict the number of attempts needed to demonstrate safety and pass the simulation.Methods180 surgical team members volunteered to participate in this study at Beth Israel Deaconess Medical Center, Boston, MA. Each participant completed five VR OR simulation trials; the final two trials incorporated AI assistance. Primary outcomes were performance scores, number of attempts needed to pass, and pre- and post-survey results describing participant confidence and experiences. Differences across professional or training role were assessed using chi-square tests and analyses of variance. Differences in pass rates over time were assessed using repeated measures logistic regression.ResultsOne hundred eighty participants completed simulation testing; 170 (94.4%) completed surveys. Participants included surgeons (17.2%), anesthesiologists (10.0%), allied health professionals (41.7%), and medical trainees (31.1%). Prior to training, 45.4% of participants reported feeling moderately or very confident in their ability to respond to an OR fire. Eight participants (4.4%) responded safely on the first simulation attempt. Forty-three participants (23.9%) passed by the third attempt (VR only); an additional 97 participants (53.9%) passed within the 4–5th attempt (VR with AI assistance).ConclusionsProviders are unprepared to respond to OR fires. VR-based simulation training provides a practical platform for individuals to improve their knowledge and performance in the management of OR fires with a 79% pass rate in our study. A VR AI approach to teaching this essential skill is innovative, feasible, and effective.

This study sought to determine the long-term impact of multidisciplinary simulated operating room (OR) team training. Two-wave survey study (immediate post-training survey 2010–2017, follow-up 2018). Differences across time, specialty, and experience with adverse events were assessed using chi-square and t -tests. Immediately after training, more than 90% of respondents found simulation scenarios realistic and reported team training would provide safer patient care. However, follow-up participants reported less enthusiasm toward training, with 58% stating they would like to take similar training again. A majority of participants (77%) experienced adverse events after training; those reporting adverse events reported more positive long-term evaluations. Simulated OR team training is initially highly valued by participants and is perceived as contributing to patient safety. Diminution of participant enthusiasm over time suggests that repeat training requirements be reconsidered, and less costly, alternative methods (such as asynchronous learning or virtual reality) should be explored. •Simulated operating room team training is perceived as realistic and beneficial.•Value of simulated operating room team training decreases over time.•Operating room adverse events occurred more commonly than expected.•Operating room simulation training plays a critical role in surgical crisis training.