Article of the Month

April’s article explores the process of creating the Clinician Educator Milestone (CEM) framework. The authors report on creation of a single foundational domain with four domains of competence and 20 subcompetencies that can be used to inform learning, improvement, and faculty development efforts.

Highlights:

• Clinician educators are professionals whose major responsibilities serve both the academic and patient care missions.
• The skills needed to teach medicine are different from the skills needed to practice medicine.
• There is no formal system for identifying when clinician educators have the knowledge, skills, and attitudes to be successful in their role.
• Successful educators are committed to reflection, self-assessment, and lifelong learning.
• Competency-based medical education (CBME) is considered the gold standard despite design and implementation challenges.
• Assessment of clinician educators is not standardized and often not linked to objective learner outcome measures.
• Uses of CEMs include defining a developmental plan for clinician educators, assessing teaching behaviors and performance, and assessing leadership skills.
• The four domains of competency include 1) educational theory and practice, 2) well-being, 3) diversity, equity, and inclusion, and 4) administration. The competencies are comprised of 20 subcompetencies.
• The authors recommend using the CEMs for external and self-assessment of CE skills, data for use in constructing learning and improvement plans, external and self-assessment of leadership skills, and assessment of gaps and weaknesses to inform faculty development programming.

Clinician Educator Milestones (PDF)

Mahan, John, et al. "Clinician Educator Milestones: Assessing and Improving Educators' Skills." Academic Medicine (2024): Journals@Ovid Full Text. Web. 03 April. 2024.

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March’s article examines the utility of a natural language processing (NLP) model to assess the quality of narrative comments from supervisors. The authors used the Quality of Assessment for Learning (QuAL) tool to evaluate the quality of narrative comments and train the natural language processing model.

Highlights:

• High-quality learner assessments are a key component in competency-based medical education (CBME), which requires integration of multiple assessments by various supervisors over time.
• Narrative assessment is rarely evaluated in day-to-day practice due to the scale required.
• The study used 50 raters to rate the quality of 2,500 Entrustable Professional Activity assessments from two separate programs using the QuAL tool, a validated method for assessing CBME.
• Score agreement was reached for approximately 50% of the 2,500 comments rated. Scores in disagreement were resolved by the raters before being considered a “true” score.
• Results from the QuAL rating process were used to develop and test a NLP model to predict QuAL scores and subscores.
• The trained NLP model predicted QuAL scores within 1 point in 87% of instances.
• As this approach provides high but not perfect accuracy, the authors recommend it not be used on its own for high-stakes decisions. Rather, they recommend using the data as a formative means to improve trainee experience.

Spadafore, Maxwell, et al. "Using Natural Language Processing to Evaluate the Quality of Supervisor Narrative Comments in Competency-Based Medical Education." Academic Medicine (2024): Journals@Ovid Full Text. Web. 06 March. 2024.

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February’s article examines assessment of medical student professionalism on clinical clerkships. A survey of Internal Medicine clerkship directors across the country sought to identify current practices in identifying and assessing professionalism.

Highlights:

• Professionalism is unique in that it lacks the standardized tools and assessment metrics used in other aspects of medical education.
• Evidence suggests that while other skills develop over the course of undergraduate medical training, professionalism can diminish.
• Lack of standardized assessment methods and definitions results in a reactive system that focuses on lapses in professionalism.
• The reactive nature of addressing professionalism considers behavior as professional or unprofessional rather than a spectrum of behaviors.
• Professionalism is mostly assessed through observation by faculty, residents, and educational leaders (such as clerkship directors) and recorded through written evaluations.
• Unprofessional behaviors were described in four categories: involvement, integrity, communication, and introspection.
• There is a deficit model of assessing and addressing professionalism rather than a developmental model that nurtures growth.
• The deficit model results in systems that foster uncertainty, concern for bias, and shame in trainees.
• The authors recommend adopting assessment strategies that view missteps in professionalism as opportunities to clarify expectations and develop curricula that foster aspirational behaviors.
• Clerkships may lack standardized assessment metrics and documentation practices related to professionalism.
• Logistical barriers, concerns regarding subjectivity, and fear of retribution inhibited the process of addressing lapses in professionalism.
• Faculty and students may benefit from professional development opportunities grounded in a shared understanding of professionalism.

Montgomery, M. , Petersen, E. , Weinstein, A. , Curren, C. , Hufmeyer, K. , Kisielewski, M. , Krupat, E. & Osman, N. (2024). Moving Beyond the Dichotomous Assessment of Professionalism in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors. Academic Medicine, 99 (2), 208-214. doi: 10.1097/ACM.0000000000005308.

January’s article examines an artificial intelligent’s examination performance and implications for USMLE examinations. In this study, ChatGPT performed reasonably well on sample USMLE questions, though performance was significantly worse on questions related to problem-based learning.

Highlights:

• Research findings on large language models (LLMs) show inconsistent results.
• None of the research studies conducted have involved actual USMLE questions, as those are secure and not available to external researchers.
• Research studies show significant progress in AI systems’ ability to answer multiple-choice questions with medical content.
• Studies vary in their interpretation of a passing score, which exacerbates uncertainty in determining AI’s performance.
• On average across study replications, ChatGPT’s performance is consistent with “passing” for Step 1 and Step 2CK.
• ChatGPT performance is lower on questions containing non-text elements, as it can only interpret text.
• ChatGPT performance on Step 3 is uncertain, as that examination contains a simulation component not assessed in the study.
• Promoting use of tools such as ChatGPT as learning aides should be avoided without expert review of outputs.

Yaneva, Victoria, Baldwin, Peter, Jurich, Daniel, Swygert, Kimberly, Clauser, Brian. Examining ChatGPT Performance on USMLE Sample Items and Implications for Assessment. [published online ahead of print December 28, 2023]. Acad Med. Available from: Journals@Ovid Full Text. Accessed January 09, 2024.

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December’s article compares the efficacy of an online self-training approach with traditional bedside training for medical students. The authors found that an online, self-directed approach to learning lung ultrasonography was at least as effective, and potentially more so, than traditional bedside training.

Highlights:

• Point-of-care ultrasonography (POCUS) has increasingly become integrated into the physical examination to evaluate patients.
• POCUS requires training and skill to perform effectively.
• POCUS training is limited by funding, faculty availability, and access to resources.
• Online training allows learners to access the material at any time, learn at their own pace, and engage with multimedia resources.
• Self-paced curriculum using multimedia, gamification, interactivity, and immediate feedback demonstrated significantly higher overall scores.
• Additional studies of online and simulator training are needed, but this and other studies show promise for incorporating these modalities into the overall curriculum.

Jedwab, Roni, Boas, Stefan, Potashner, Dana, et al. A Comparison of Online Self-Training and Standard Bedside Training in Lung Ultrasonography for Medical Students. [published online ahead of print November 27, 2023]. Acad Med. Available from: Journals@Ovid Full Text at http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovftz2&NEWS=N&AN=00001888-900000000-95853. Accessed December 06, 2023.

November’s article discusses the role of simulated participants (SPs) in the educational process. The study researched SP’s roles as educators, including their preparation, training, and feedback practices.

Highlights:

• SPs find their role in providing feedback challenging.
• SPs may have different perspectives on student performance, which may differ from faculty perspectives.
• Different backgrounds result in SPs coming to their role with differing experience, knowledge, and training. Backgrounds may include professional actors, volunteers from the community, and health professions educators.
• SP’s role portrayal and feedback support learners’ development of competence in communication skills.
• SPs found it helpful to know the learning objectives so they could align their role/performance with the objectives.
• SPs trigger both reflection-in-action, or reflection in the moment, and reflection-on-action, or reflecting on feedback following the encounter.

Clare Sullivan, Andrea Jane Doyle, Michelle O’Toole, Claire Mulhall, Nancy McNaughton & Walter Eppich (2023) ‘How can we help the students learn?’ A grounded theory study of simulated participants as educators, Medical Teacher, 45:9, 1047-1053, DOI: 10.1080/0142159X.2023.2171857

October’s article discusses generative artificial intelligence (AI) and its implications for medical education. Recent developments in generative AI have raised concerns regarding cheating and plagiarism. However, there is also the potential for AI to transform the way we teach, learn, and research.

Highlights:

• Educators need to increase their AI literacy to foster social responsibility and ethical awareness around the use of AI.
• While generative AI can create text and images, human judgement is required to evaluate its credibility, accuracy, and adequacy.
• Bias in the sources from which generative AI draws its information may result in inaccurate and insufficient responses.
• Most students lack an understanding of the ethical implications and intellectual property considerations related to AI use.
• The ability to evaluate the proper use of AI is a new competency for health care professionals.

Boscardin, Christy, Gin, Brian, MD, PhD, Golde, Polo, Hauer, Karen, MD, PhD. ChatGPT and Generative Artificial Intelligence for Medical Education: Potential Impact and Opportunity. [published online ahead of print September 27, 2023]. Acad Med. Available from: Journals@Ovid. Accessed October 09, 2023.

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September’s article discusses the co-production of online educational content. The authors assert that co-production of curriculum planning and design should include stakeholders such as students and learning technologists when implementing digital learning strategies.

Highlights:

• Establish equal partnerships amongst stakeholders, including students and learning technologists, with shared responsibilities and recognition.
• Use learning technologists in the identification of a variety of digital learning tools to accomplish educational objectives.
• Take advantage of online educator communities to learn and share experiences.
• Apply pedagogical considerations when exploring various digital options. Question how tools enhance teaching outcomes, promote deep learning, and can be integrated into existing teaching and learning experiences.

Raihan Jumat, Sally Loan-Ng Bee Lan, Sreenivasulu Reddy Mogali, Kian Bee Ng, Bei Yi Leong & Siew Ping Han (2023) Twelve tips for co-production of online learning, Medical Teacher, 45:9, 966-971, DOI: 10.1080/0142159X.2023.2206533

August’s article discusses the role of the hidden curriculum on faculty teaching. This study explores the influence hidden curriculum has on faculty development, teaching experiences, and satisfaction in their educational role.

Highlights:

• Hidden curriculum for faculty has been suggested to influence individuals’ socialization into academic careers.
• The hidden curriculum for faculty was found to operate in three ways: undervaluing teaching expertise, undermining teaching goals, and perpetuating feelings of isolation.
• Four domains of the hidden curriculum are explored: motivational-psychological, interpersonal-social, institutional-organizational, and contextual-cultural.
• Researchers found a mismatch between the value teachers placed on teaching and the value placed on teaching by their institutions. Part of this was explained as the expectation to teach without the support of formal training.
• Organizational structure and timing could make it more difficult to teach valued skills such as collaboration and critical thinking.
• Limited information about student needs or progress could contribute to faculty feelings of isolation.

Lee, Ciara, et al. "Revealing the impact of the hidden curriculum on faculty teaching". Medical Education, vol. 57, no. 8, August 2023, pp. 761-769. doi: 10.1111/medu.15026.

April’s article discusses the use of concept maps as a teaching, learning, and assessment resource in medical education. Concept maps provide a graphical representation of information that explore relationships and connections between concepts. Based on constructivist theory, use of concept maps can aid in connecting pre-existing knowledge with new information.

Highlights:

• Construction of a concept map involves four steps: identification of general/central concepts, identification of secondary concepts, linkage of concepts, and identification of cross-linkages.
• Creating meaningful relationships among concepts allows for discrimination of information, fostering meaningful learning rather than rote learning.
• Concept mapping has been found to promote integration of basic and clinical sciences but can be time consuming.
• Introducing learners to concept mapping is an important first step, focusing on purpose, relevance, and construction.
• Collaborative concept mapping improves learning, enhances communication, and facilitates critical thinking.

Dario Torre, Deborah German, Barbara Daley & David Taylor (2023) Concept mapping: An aid to teaching and learning: AMEE Guide No. 157, Medical Teacher, DOI: 10.1080/0142159X.2023.2182176

March’s article discusses using internal quality assurance (IQA) processes to develop a quality culture. Beyond merely checking boxes for accreditation purposes, IQA fosters psychological aspects that create a collective conscious and institutional commitment to quality education.

Highlights:

• IQA involves a combination of quality control, monitoring, improvement, and enhancement.
• Developing a quality culture requires attention to managerial processes and institutional culture/psychology.
• Managerial efforts should delineate clear procedures and processes based on sound educational theory.
• Cultural efforts should focus on faculty development, reflection, dialogue, and fostering communities of practice.

Renée E. Stalmeijer, Jill R. D. Whittingham, Guy W. G. Bendermacher, Ineke H. A. P. Wolfhagen, Diana H. J. M. Dolmans & Carolin Sehlbach (2023) Continuous enhancement of educational quality – fostering a quality culture: AMEE Guide No. 147, Medical Teacher, 45:1, 6-16, DOI: 10.1080/0142159X.2022.2057285

February’s article explores narrative feedback in student performance evaluations.

Highlights:

• Evaluation comments are often vague, non-specific, and include writer idiosyncrasies.
• Narrative comments may introduce bias into the process, with high marks often associated with traditionally masculine gendered characteristics around assertiveness, autonomy, and leadership.
• The quality of narrative feedback decreases the longer the gap between learning experience and submission of the feedback. Composing narrative feedback closer to the experience may result in higher quality comments.
• Clinical teaching experience and annual time on service were not associated with better quality comments.

Mooney, CJ, Pascoe, JM, Blatt, AE, et al. Predictors of faculty narrative evaluation quality in medical school clerkships. Med Educ. 2022; 56( 12): 1223- 1231. doi:10.1111/medu.14911

January’s article is a commentary on using quality improvement (QI) tools for planning curriculum. The authors assert that using QI tools reduces evaluation fatigue and may increase faculty and student ownership in the process.

Highlights:

• Quality Improvement involves using tools and methods to reduce the gaps between performance and standards.
• Actively involving learners is fundamental when improving education quality.
• Involving students may result in survey and feedback-fatigue and diminish uptake.
• Teaching students about QI in health care may translate to improved QI projects in medical education.
• Quality Planning may be an underutilized activity in medical education, requiring us to ask where student and faculty involvement may best be focused to make the greatest impact.

Alexander, K, Shearer, H. Teaching the tools: Focusing effort and engagement when improving medical education. Med Educ. 2023; 57(1): 12- 14. doi:10.1111/medu.14947

December’s article discusses the use of teaching an interprofessional education session using virtual reality (VR). Focused on social determinants of health, physician assistant and allopathic medical students experienced clinical scenarios in a VR setting.

Highlights:

• Despite being identified as an important aspect of patient care, health professions education often lacks skill development in addressing social determinants of health.
• Barriers to effective interprofessional education (IPE) include logistical constraints (such as geographical distance and scheduling) and difficulty in providing realistic clinical settings in which to learn and practice skills.
• VR can be used to address logistical constraints and provide high-quality educational experiences.
• VR offers an opportunity to multiple disciplines to interact and engage in problem-solving activities.

Buitron de la Vega, Pablo, et al. "Virtual Reality Simulated Learning Environments: A Strategy to Teach Interprofessional Students About Social Determinants of Health." Academic Medicine 97.12 (2022): 1799-1803. Journals@Ovid Full Text. Web. 09 December. 2022.

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November’s article discusses the effectiveness of student learning techniques for long-term retention. Learning techniques are one of the determinants of student learning, and the ways in which students engage in study influences their success.

Highlights:

• Practice testing and distributed practice (reviewing information after a period has elapsed) were the most promising techniques for long-term retention of information.
• Techniques such as rereading, highlighting, mnemonics, and summarization were less effective for learning.
• Retrieval, metacognition, and setting goals are promising areas that warrant additional research.
• Students do not receive training on various learning techniques and their benefits.
• The least effective learning techniques were the ones most used by medical students.
• Metacognition demonstrated the greatest effectiveness; however, most students don’t know what it is.
• Metacognition should be taught as a skill, particularly when trying to develop self-directed learning skills.

Amaia Urrizola, Raúl Santiago & Leire Arbea (2022) Learning techniques that medical students use for long-term retention: A cross-sectional analysis, Medical Teacher, DOI: 10.1080/0142159X.2022.2137016

October’s article discusses the various roles faculty play in Interprofessional Education (IPE). While much of the IPE literature focuses on innovations, this article seeks to understand faculty IPE roles and their experiences in them. Three main struggles were identified as personal (confidence), interpersonal (co-teaching), and institutional (logistical support).

Highlights:

• Facilitator: The most common role for faculty in IPE. With the use of pre-briefing and debriefing, faculty in this role mediate large and small group discussions using skills such as mentoring, advocating, reflecting, and encouraging.
• Planner: The second most cited role for faculty in IPE. Faculty in this role plan IPE programming, such as curriculum, course content, and implementation strategies.
• Information Provider: Faculty in this role serve as lecturers in a didactic setting or educators in the clinical setting.
• Examiner: Faculty in this role plan and implement assessments and evaluations.
• Role Model: A rare role for faculty to play in IPE. Faculty in this role engage in classroom or clinical role modeling.
• Resource Developer: This role is also infrequently cited in the literature. Faculty in this role develop educational materials for use in IPE programming.
• Manager: Faculty in this role are responsible for supporting logistical aspects of the IPE curriculum, such as securing funding, advocating for support, and supporting faculty.

Cimino, Francesca, et al. "Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education." Academic Medicine (2022): Journals@Ovid Full Text. Web. 04 October. 2022

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September’s article discusses the logic behind entrustable professional activities (EPA) frameworks. This study sought to identify the logics used to create EPA frameworks in postgraduate medical education. The findings may be helpful to future EPA framework developers.

Highlights:

• EPAs as ‘units of professional practice’ differ from competencies and are used to conceptualize professional tasks
• Average of 14 EPAs per framework
• Logics included service provision, procedures, and disease or patient groups
• Most programs use a mix of logics to develop their EPA framework
• Not all published EPAs were found suitable for summative entrustment decisions

Hennus, Marije, P., et al. "The logic behind entrustable professional activity frameworks". Medical Education, vol. 56, no. 9, September 2022, pp. 881-891. doi: 10.1111/medu.14806

May’s article discusses entrustable professional activities (EPAs) for health sciences educators. EPAs for educators offer opportunities for faculty development and recognition. Health sciences educators typically have extensive training in their discipline but have limited training in education. The authors argue that existing frameworks on what makes a quality educator fail to support development and recognition of health sciences educators and propose a system of nine EPAs to address the issue.

EPAs for Health Professions Teachers:

• Lecturing
• Teaching small groups
• Teaching lab classes and skills education
• Bedside teaching
• Mentoring and tutoring
• Supervising (clinical) interns
• Assessing written work of students
• Designing and developing a course
• Developing and administering tests and establishing results

Lisette van Bruggen, Esther E. van Dijk, Marieke van der Schaaf, Manon Kluijtmans & Olle ten Cate (2022) Developing entrustable professional activities for university teachers in the health professions, Medical Teacher, 44:4, 425-432, DOI: 10.1080/0142159X.2021.1998402

April’s article discusses facilitation of online discussions. As programs incorporate asynchronous learning opportunities for students, skill development is needed for faculty to foster deeper learning in these environments. Faculty roles include validating ideas and participation, facilitating feedback and the exchange of ideas, and posing probing questions to encourage deep thinking.

Highlights include:

• Set boundaries and expectations for discussions to occur. These guidelines include using appropriate tone, respecting the thoughts and feelings of others, and who “owns” the discussion (students or instructors).
• Design discussion assignments to encourage participation. Use open-ended questioning or prompts that stimulate thought and discussion rather than eliciting simple yes or no answers.
• Establish criteria for responding to discussion posts. Common criteria focus on quality of the student’s post and faculty expertise in the topic being discussed. When discussion veers to an area outside of your own expertise, draw other faculty into the conversation as appropriate.
• Use your contributions to foster additional discussion rather than end the conversation. Help learners to reflect and integrate new information.
• Challenge learners’ thinking and understanding. Provide direct instruction to identify misconceptions and push learners to higher orders of thinking.

Fereshte Goshtasbpour, Bronwen J. Swinnerton & James D. Pickering (2022) Twelve tips for engaging learners in online discussions, Medical Teacher, 44:3, 244-248, DOI: 10.1080/0142159X.2021.1898571

March’s article discusses student perceptions regarding grading and formative feedback in core clerkships. Fairness of tiered grades (Honors, High Pass, etc.) are often in question, as they may not be representative of the student’s full performance. Students report that honors grading during core clerkships impact their motivation and well-being. This study explores how changing to a Pass/Fail grading system, along with increased formative feedback, affected students.

Highlights include:

• Tiered grading systems often place more emphasis on medical knowledge than other important clinical skills, such as providing compassionate patient care.
• Performance goal orientation focuses on appearing competent and avoiding mistakes.
• Mastery goal orientation focuses on gaining knowledge and skills, which results in deeper learning.
• Summative assessment encourages a performance orientation and may hinder deeper learning.
• Tiered grading is an extrinsic motivator that may decrease intrinsic motivation. Intrinsic motivation is associated with learning quality and enhanced well-being.
• Changes to a Pass/Fail grading system in pre-clinical courses has resulted in decreased student stress and improved well-being.
• Changing from an assessment of learning to an assessment for learning approach requires buy-in from all stakeholders in the process.
• In the absence of Honors grading, students reported feeling more motivation to learn for the sake of learning and development.
• Students reported feeling empowered to choose which competency areas to focus on at any given time following the change to Pass/Fail grading.
• Increased emphasis on formative feedback resulted in students shifting their focus from impressing supervisors to providing high quality patient care.

Lee Seligman, Abdikarin Abdullahi, Arianne Teherani & Karen E. Hauer (2021) From Grading to Assessment for Learning: A Qualitative Study of Student Perceptions Surrounding Elimination of Core Clerkship Grades and Enhanced Formative Feedback, Teaching and Learning in Medicine, 33:3, 314-325, DOI: 10.1080/10401334.2020.1847654

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February’s article discusses noncognitive skills in medical competency. Assessment strategies often focus on medical knowledge and neglect to capture noncognitive skill development. The authors suggest a list of Observable Practice Activities, or OPAs, that focus on attributes outside of medical knowledge and ways to assess them.

Highlights include:

• Tacit knowledge is significantly harder to assess than cognitive knowledge and represents a gap in assessment programs.
• Undergraduate to graduate medical handovers often rely on standardized test scores and data that are not predictive of clinical performance.
• Competency-based assessment programs fail to capture complex behaviors such as humility, open-mindedness, and self-awareness.
• Noncognitive deficiencies may be masked under a cognitive “cloak of competence.”
• OPAs are discrete, work-based elements that can be mapped to competencies, entrustable professional activities (EPAs), and milestones.
• Collecting OPA data over time and through interaction with multiple assessors may result in a clearer picture of an individual's true nature as a healthcare practitioner.

Warm, Eric, et al. "What Behaviors Define a Good Physician? Assessing and Communicating About Noncognitive Skills." Academic Medicine 97.2 (2022): 193-199.

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January’s article discusses implicit bias in medical education. Approaches to addressing this issue are often based on opinion rather than grounded in theoretical frameworks, lack opportunities for students to develop related skills, and fall short in faculty training. The authors provide twelve tips to improve approaches to this issue.

Highlights include:

• Work to create a safe learning environment by setting ground rules and role modeling empathy and vulnerability.
• Flatten the hierarchy, taking advantage of other learners and their ability to co-facilitate sensitive discussions.
• Normalize bias by presenting examples both within and outside of the healthcare environment.
• Describe the neuroscience behind implicit bias, appealing to learners’ desire to develop into competent practitioners who provide high quality patient care.
• Use ‘disorienting dilemmas’ to create discomfort and foster critical reflection.
• Incorporate identity or narrative exercises to explore influences on individual implicit biases.
• Reinforce implicit bias training as a lifelong process.

Cristina M. Gonzalez, Monica L. Lypson & Javeed Sukhera (2021) Twelve tips for teaching implicit bias recognition and management, Medical Teacher, 43:12, 1368-1373, DOI: 10.1080/0142159X.2021.1879378

December’s article discusses interfacing with a new generation of students, Generation Z (or iGen). Students in this generation are considered digital natives, having grown up interacting with technology. This generation presents new opportunities for pedagogical approaches to enhance the learning environment and develop lifelong learners.

Highlights include:

• Support life skills development. This generation may be slower to develop independent life skills than previous generations, needing additional support outside of the classroom.
• Foster time management skill development. This generation has less experience in balancing multiple tasks, such as work and school, and may need additional guidance in these areas. Scaffolding deadlines is one approach to helping develop these skills.
• Encourage personal and mental wellness. Growing up with smart devices has decreased interpersonal contact and increased depression and loneliness in this generation.
• Incorporate opportunities to develop literacy. Help students develop their reading stamina and ensure transparency in the value of reading assignments by assigning shorter readings and written reflections.
• Teach information management skills. While students have fairly unlimited access to information, they are less likely to have the ability to critically appraise information. Require students to evaluate the appropriateness of sources and provide exemplary sources of information to foster development in this area.
• Provide timely feedback. This generation is used to receiving instant gratification, and therefore expects timely formative feedback to aid in their continual improvement.

Sarah Lerchenfeldt, Stefanie M. Attardi, Rebecca L. Pratt, Kara E. Sawarynski & Tracey A. H. Taylor (2021) Twelve tips for interfacing with the new generation of medical students: iGen, Medical Teacher, 43:11, 1249-1254, DOI: 10.1080/0142159X.2020.1845305

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Use of current best evidence has been shown to result in improved patient outcomes. Evidence-based practice requires skill development in information literacy. Student-based approaches, such as case-based learning and problem-based learning, help students to develop necessary skills to help them navigate a vast world of information.

Inquiry-based learning uses complex case examples and scenarios to foster self-directed learning. In this environment, students learn to formulate and answer their own questions. Use of cases allows for easier transfer of knowledge and skills to real life practice and helps students understand the importance of using current evidence for decision making.

Frati FYE, Granikov V, Pluye P. Using an inquiry-based learning approach to support engagement with information and scholarship in health care education. Education for Information. 2020;36(1):59-67. doi:10.3233/EFI-190334

Diverse learning environments fall short when they are not inclusive, with microaggressions negatively impacting learning and performance. This study used focus groups to explore medical students’ perceptions of microaggressions and ideal supervisor responses.

Highlights include:

• Three types of microaggressions have been classified: microassaults, microinsults, and microinvalidations.
• Microaggressions are often subtle and contextually dependent, at times making them difficult to identify and address.
• Faculty are often “bystanders” to microaggressions against students, placing them in a position to advocate for and provide support to students.
• Students in the study promoted faculty asking how they should respond to microaggressions at the onset of the working relationship to empower the student to advocate for themselves.
• Faculty bystander responses can create an environment of educational safety for learners if handled appropriately.
• There is no one-size-fits-all approach to addressing microaggressions, but all aggressions should be addressed in some way.

Bullock, Justin, et al. "No One Size Fits All: A Qualitative Study of Clerkship Medical Students' Perceptions of Ideal Supervisor Responses to Microaggressions." Academic Medicine 96.11S (2021): S71-S80. Journals@Ovid Full Text. Web.

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Highlights include:

• Key elements of the proposed framework include building awareness, developing knowledge, embedding antiracist education in practice, dismantling oppressive structures, and measuring progress.
• The goal of faculty development in this area is to support faculty in learning, working, and educating in an antiracist environment.
• The 2020 AAMC call to action challenges all academic medicine leaders to address antiracism at the individual, interpersonal, institutional, and societal levels.
• Medical students are advocating for change, from adapting curricula to modifying learning environments.
• Current students and residents demonstrate greater awareness of social justice topics as compared to faculty.
• A goal of faculty development is to move faculty through their own process of (re)learning.
• To deliver antiracist education, faculty need professional development informed by the history and structure of racism.
• Building foundational awareness involves an understanding of one’s own biases, both explicit and implicit.
• Expanding foundational knowledge includes understanding the history of race and racism in medicine.
• Few faculty development programs allow adequate time and space to allow faculty to hone their skills in culturally responsive teaching.

Sotto-Santiago, Sylk, EdD, MBA, Poll-Hunter, Norma, et al. A Framework for Developing Antiracist Medical Educators and Practitioner-Scholars. [published online ahead of print October 5, 2021]. Acad Med.

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Highlights include:

• LC’s offer a sense of membership, personal influence, integration and fulfillment of personal needs, and shared emotional connections.
• LC’s provide students with the opportunity to explore themes and concepts on a deeper level.
• Students participating in LC’s demonstrate higher engagement, enhanced academic performance, and higher retention rates.
• LC’s in undergraduate medical education are often formed to foster faculty-student communication, building support networks, and developing teamwork.

Shochet, R., Fleming, A., Wagner, J., Colbert-Getz, A., Bhutiani, M., Moynahan, K., and Keeley, M. (2019) Defining learning communities in undergraduate medical education: A national study. Journal of Medical Education and Curricular Development, 6: 1-9.

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While a reported 50% of medical students experience some form of mistreatment during training, relatively few report their experiences to school administration. The authors seek to understand medical student experiences to identify ways administration can create a safe environment in which reporting can occur.

Highlights include:

• Mistreatment is associated with trainee depression, suicidality, declining empathy, and compassion fatigue that are in turn associated with sub-optimal patient care.
• Medical students who are mistreated are more likely to mistreat future trainees themselves, creating a cycle of abuse.
• Significant differences are noted between students reporting mistreatment on anonymous surveys and reporting mistreatment to leadership who can effect change.
• Reasons cited by students for not reporting mistreatment include considering the event not significant enough to report, fear of reprisal, feeling reporting will not effect change, or choosing to manage the situation themselves.
• Understanding and addressing student reporting is important in preventing students from normalizing the cycle of abuse.
• Students who experience mistreatment go through iterative cycles of experiencing and appraising, reacting, deciding, and moving forward.
• The support, feedback, and responses students receive during each phase of the cycle informs subsequent experiences and responses.
• Administrators need to focus on building trust, encouraging bystanders to intervene when witnessing mistreatment, and creating a culture that encourages continuous professional and personal growth in students and educators.

Bell, A., Cavanaugh, A., Connelly, C.E., Walsh, A., and Vanstone, M. (2020) Why do few medical students report their experiences of mistreatment to administration? Medical Education, 462-4760.

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May’s article discusses fostering development of the next generation of clinical educators. Despite many students expressing an interest in teaching, many curricula do not include formal training in this area. The article suggests tips for creating an in-depth elective to foster the next generation of medical teachers.

Highlights include:

• Start early. Offer opportunities to learn about medical education and develop teaching skills early in the training program.
• Allow learners to explore their beliefs about teaching. Asking questions such as, “How do we learn?” “What is knowledge?” and other theoretical queries allows the students to begin learning about theoretical underpinnings of education in relation to their own skills and values.
• Role model. Provide a positive learning environment, demonstrate an understanding of the curriculum, and support the learning needs of individuals. Explain why you are doing these things to develop conscious awareness in the students.
• Show the bigger picture. Education is a complex process, often involving teams of professionals in interconnected structures to organize and deliver. Help students see the complexity of curricular development and implementation from various perspectives.
• Introduce the basics of educational design, principles, and theories. Familiarize students with constructive alignment of learning objectives, educational activities, and assessment. Discuss and reflect on important learning theories to shape future teaching behaviors.
• Integrate designing for learning. Have students design learning experiences for one another based on educational theories and principles.
• Provide near-peer teaching experiences. Allow students to apply their new knowledge through practice in educating near-peer students, or those who are earlier in the training program.
• Prepare students for technology-enhanced learning. Teach students how to educate in a digital environment, engaging learners in synchronous and asynchronous online learning activities. Virtual reality, educational gaming, and open access resources should be explored.
• Focus on reflection. Move students from experiencing to understanding using reflection. Include opportunities for observation and feedback. Ask student to link their reflections to class activities and educational theories and principles.
• Introduce medical education research. Expose students to the world of medical education research, which is grounded in social sciences rather than biomedical sciences. Have students write an educational research proposal or literature review. Offer journal clubs, training in qualitative and quantitative research, and literature search strategies.
• Involve students in teaching activities. Following completion of this in-depth training, use students as teaching assistants in your program, fostering involvement in near-peer teaching and further developing their skills as educators.

den Bakker, C.R., Hendriks, R.A., Houtlosser, M., Dekker, F.W., and Norbart, A.F. (2021) Twelve tips for fostering the next generation of medical teachers. Medical Teacher, Ahead-of-Print, 1-5. https://doi.org/10.1080/0142159X.2021.1912311

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April’s article discusses designing assignments that foster independence in learning. The reality of highly structured curriculum in health sciences education poses a challenge for incorporating independent learning activities. The authors suggest tips for successful integration of activities that foster skill development for self-directed and lifelong learning.

Highlights include:

• Become familiar with the experiential and procedural knowledge of your learners. Knowing previous curricular and life experiences will allow you to design learning experiences that gradually build on existing knowledge and skills.
• Decide on appropriate topics to use in fostering independent learning. Topics with which learners have some prior knowledge or experience lend themselves more readily to independent learning activities.
• Develop learning objectives that promote independent learning. Include objectives that involve the knowledge, skills, and attitudes needed for self-directed and lifelong learning.
• Select or create resources that align with your learning objectives. Include authentic learning tasks that reflect the knowledge, skills, and/or attitudes learners need to demonstrate in professional practice.
• Provide opportunities for learners to develop skills and strategies for independent learning. Expose learners to different written, visual, and kinesthetic forms of learning to foster learning skill development.
• Be cognizant of the time learning tasks take for learners based on their level of knowledge and experience. New concepts and unfamiliar formats will take longer for the learners to navigate than those with which they have previous experience.
• Provide guidance appropriate to learners’ knowledge and experience. Newer learners may require more guidance than those with more experience.
• Provide context for what is to be learned. Learners benefit from understanding the “why” of what they are to learn in addition to the “what.”
• Format content to facilitate learning. Make written materials more explicit about the relevance and context of the information so they don’t require additional guidance or explanation.
• Use active learning techniques. Start with lower order thinking skills earlier in the program and progress to higher order skills as learners develop. For a brief definition of Bloom’s Taxonomy, see the December 2019 Knowledge Now Brief in the OEI Teaching Toolbox.
• Incorporate opportunities for self-assessment. For independent learning activities, self-assessment allows the learner to know whether they have met the learning objectives in a way that fosters continual growth.
• Be consistent. Providing consistency in your approach to independent learning tasks allows learners to focus on their learning rather than the directions for a given activity. Structure, format, and intent of independent learning activities should maintain consistency across a course of instruction that ensures instructors and learners share an understanding of expectations.

Christen Rachul, Benjamin Collins, Mariam Ahmed & George Cai (2021) Twelve tips for designing assignments that foster independence in learning, Medical Teacher, 43:1, 75-79, DOI: 10.1080/0142159X.2020.1752914

March’s article discusses integrating cultural humility into medical education curriculum. Cultural humility strives to understand the historical context in which cultures exist and address issues related to implicit bias.

Highlights include:

• Cultural humility-based care fosters a mutually respectful patient-provider relationship and helps providers understand social determinants of health (SDOH).
• Student assessment is a challenge in humility-based curricula, as the skills don’t lend themselves to traditional assessment methods.
• Humility-based curricula emphasize self-reflection and curiosity over mastery and problem-solving.
• Cultural humility requires a balance between acknowledging one’s own knowledge and skill proficiency with the recognition that one will never be an expert on any individual patient’s personal and cultural experiences.
• A curiosity approach shifts the power dynamic, turning the provider into a student of the patient.
• Educators must pay attention to creating a safe learning environment in which divergent views are accepted and encouraged.
• Initiating sensitive discussions in an online environment may allow learners to gain comfort in exploring the topic; discussions can then be continued in the classroom with skillful instructors to facilitate.
• Clinical simulations and role playing may offer ways to incorporate cultural humility training.
• Incorporating medical humanities courses offers a way to increase student understanding of cultural humility and develop their empathy.
• Student rotations with community health workers and social workers may help students gain a better understanding of SDOH.
• Mandatory lectures and cultural humility discussions may invoke negative feelings about the curriculum, while optional programs may fail to reach future providers who need training the most. A hybrid approach may offer the best approach.
• Culturally-based OSCEs may offer a way to assess humility-based principles and identify gaps in the curriculum.

Solchanyk, D., et al. "Integrating cultural humility into the medical education curriculum: Strategies for educators." Teaching and Learning in Medicine (2021) 1-7.

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February’s article discusses medical education’s failure to evolve to address issues of race, racism, and heath care. Implicit bias amongst physicians perpetuates false beliefs regarding differences between races. These biases are found in medical students and may be reinforced by medical school curriculum. This month’s article reports the audit of one institution’s preclinical medical school curriculum and its findings regarding propagation of bias.

Highlights include:

• Race is not a meaningful scientific construct in the absence of context. It is a social category.
• Misrepresentation of race occurred in five domains: semantics, prevalence without context, race-based diagnostic bias, pathologizing race, and race-based clinical guidelines.
• Recommendations include standardizing the language used to describe race/ethnicity, appropriately contextualizing racial/ethnic differences in disease burden, and generating and imparting evidence-based medical knowledge when it comes to race.
• Medical educators should impart an adequate and accurate understanding of the complexity between factors affecting disease prevalence, diagnosis, and treatment.

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January’s article discusses the Socratic method and its role in healthcare education. When conducted properly, Socratic questioning should engage critical thinking skills and foster self-directed learning. When done poorly, it may be viewed as a form of “pimping,” or ill-intentioned questioning to embarrass or degrade the learner.

Highlights include:

• Faculty may be hesitant to engage learners with questioning for fear of it being perceived with ill-intent.
• Faculty and students report that questioning is a beneficial tool for learning.
• Faculty undervalued students’ desire to be asked probing questions that foster their learning.
• Failure to ask probing questions may make it difficult to assess a learner’s knowledge base.
• Students perceive that questions are used for assessment more often than they are for learning.

Abou-Hanna, Jacob, et al. "Resuscitating the Socratic Method: Student and Faculty Perspectives on Posing Probing Questions During Clinical Teaching." Academic Medicine 96.1 (2021): 113-117. Journals@Ovid Full Text. Web. 05 January. 2021.

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December 2020: Twelve Tips for Interfacing with the New Generation of Medical Students: iGen
This article discusses working with medical trainees from Generation Z, or iGen. This generation was raised with technology present throughout all aspects of their lives. Through recognizing the unique characteristics of this generation, educators can foster positive learning environments and lifelong learning skills.

Highlights include:

• Educators need to foster life development skills in iGen students.
• iGen students need guidance in development of time management skills.
• This generation needs help in developing their professional communication skills.
• Be open to exploring new learning spaces and resources, such as digital platforms, with this generation of learners.
• iGen students need regular and timely feedback.

Lerchenfeldt, S., Attardi, S.M., Pratt, R.L., Sawarynski, K.E., and Taylor, T.A.H. (2020) Twelve tips for interfacing with the new generation of medical students: iGen. Medical Teacher, 1-6, DOI:10.1080/0142159X.2020.1845305

November 2020: The Educators' Experience: Learning Environments that Support the Master Adaptive Learner
This article discusses the importance of learning environment in developing master adaptive learners. Master adaptive learners utilize self-regulated theory and quality improvement techniques to continually engage in cycles of learning, adapting, and testing new knowledge. The authors assert that creating master adaptive learners requires careful attention to the learning environment.

Highlights include:

• The learning environment should support learning experiences that encourage active learning.
• Attention to the learning environment should include classrooms and diverse clinical experiences.
• Adaptive educators adapt to the needs of their students while providing consistency to develop trust between themselves and their learners.
• Approaches to teaching may often look like coaching, with cycles of direct observation and feedback.
• Institutional support is required in the form of a productive culture and adequate resources, such as time, space, and access to information.

Lisa Auerbach , Sally A. Santen , William B. Cutrer , Michelle Daniel, Amy L. Wilson-Delfosse & Nicole K. Roberts (2020) The educators’ experience: Learning environments that support the master adaptive learner. Medical Teacher, 42:11, 1270-1274, DOI:10.1080/0142159X.2020.1801998

October 2020: The Transition from Medical School to Residency
This article discusses the transition from medical school to residency. Professional identity formation is reported as the core to a successful transition. Residents report not feeling as if their training prepared them for the scope and volume of tasks required to provide proper clinical care to patients.

Highlights include:

• Residency directors worry that graduating medical students are not adequately prepared for their responsibilities in caring for patients.
• Educational interventions have included formal programming at the end of medical school and beginning of residency to help ease the transition, including enhanced handoffs between programs.
• While capstone programs for medical school focus on clinical skills and confidence, transitioning to residency may require focus on skills such as time management, communication, and identifying personal limits.
• Residents report “feeling more like a doctor” comes from immersion in the clinical experience and their new roles and responsibilities. 
• Work such as administrative tasks and developing clinical efficiency are not part of the medical school experience.
• Residents report struggling to develop skills to balance their professional and personal lives.

Chang, Lucy, MD, MSc, Eliasz, Kinga, PhD, MSc, Cacciatore, Danielle, Winkel, Abigail, et al. (2020). The Transition From Medical Student to Resident: A Qualitative Study of New Residents' Perspectives. Academic Medicine, 95, 1421-1427. https://doi.org/10.1097/ACM.0000000000003474

September 2020: The Lecture-Free Curriculum
This article discusses the concept of a lecture-free curriculum. The authors argue that a lecture-free approach takes advantage of advances in the science of learning along with our understanding of how to learn science and clinical reasoning. Lecture-free curricula take advantage of active, engaged learning techniques, availability of learning technologies, and best-practice instructional design.

Highlights include:

• Lecture is a deep traditional approach designed for information that is not intended for deep learning.
• There are many approaches to active learning that can replace traditional lecture.
• Lecture-free experiences in the pre-clinical years can create meaningful experiences that address measurable competencies and non-cognitive domains viewed as critical to development for future clinical practice.
• Learning of biomedical science and clinical reasoning should involve integrative clinical problem-solving, collaborative activities, frequent feedback, and sufficient out of class time for reading and metacognitive activities.
• Classroom time is better used for application activities of content learned outside of the classroom.
• “Lectures deprive students of the challenges needed to learn how to learn.”

Dean Parmelee, Brenda Roman, Irina Overman & Maryam Alizadeh (2020) The lecture-free curriculum: Setting the stage for life-long learning: AMEE Guide No. 135, Medical Teacher, 42:9, 962-969, DOI: 10.1080/0142159X.2020.1789083

August 2020: Social Networks in Faculty Development
This article discusses the role of social networks in faculty development. Recent research suggests that faculty development may be more effective when viewed as a social enterprise rooted within the greater practice community.

Highlights include:

• Social networks influence faculty development in four dimensions: enabling knowledge acquisition, shaping identity formation, expressing vulnerability, and scaffolding learning.
• Peer influence may determine whether faculty attend development sessions, how they learn within the sessions, and what they apply to practice.
• Discussing faculty development sessions with colleagues helped broaden perspectives and solidify learning.
• Associating with other faculty who have a teaching role may help develop the educator’s professional identity as a teacher.
• Peers seen as credible and reliable may make individuals feel more comfortable receiving feedback and sharing sensitive or uncomfortable information.

Buckley, Heather MD, MHPE; Nimmon, Laura PhD. Learning in Faculty Development, Academic Medicine: August 4, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/ACM.0000000000003627

May 2020: Managing the Tension: From Innovation to Application in Health Professions Education
This article explores the tensions that exist when working to implement innovations to health professions education. The article focuses on five educational domains that play a role: curriculum, instruction, assessment, accreditation, and faculty development.

Highlights include:

• Curricular tensions can arise from failure to involve the parties involved, lack of a supportive environment, and misunderstandings regarding the innovation itself.
• Every curriculum is unique to its environment. What works for one program may not be appropriate for another.
• Using conceptual frameworks to guide instruction helps educators bridge what is known to work in one situation to another, new situation.
• Educators often fail to capitalize on what is known about effective instruction, continuing to employ more comfortable but less effective strategies.
• Use of educational technologies and strategies because they are novel, rather than to solve an existing problem, may inflate costs without improving outcomes.

Tekian, A., Harden, R.M., Cook, D. A., Steinert, Y., Hunt, D., and Norcini, J. (2020). Managing the tension: From innovation to application in health professions education. Medical Teacher, 42(3), 333-339

April 2020: The Difference Between Emergency Remote Teaching and Online Learning
This article discusses the differences between emergency remote teaching and online learning. Making this distinction separates decisions made in response to a crisis, such as the COVID-19 pandemic, from instructional design related to teaching and learning in an online environment.

Highlights include:

• Rapid transition to teaching and learning online may lack the rigorous planning and support normally afforded to delivering online content.
• Online learning faces a stigma of being lower quality than face-to-face instruction, despite research indicating this is not the case.
• Effective online learning requires thoughtful instructional design informed by a systematic model for design and development.
• Careful planning for online learning focuses not only on content delivery but mindful attention to how interactions will foster the learning environment, recognizing learning as both a social and cognitive process.

Hodges, C., Moore, S., Lockee, B., Trust, T., and Bond, A. (2020, March 27). The difference between emergency remote teaching and online learning. Educause Review, Retrieved April 9, 2020

March 2020: Defining Learning Communities in Undergraduate Medical Education: A National Study
This article discusses the incorporation of learning communities into undergraduate medical education. Learning communities provide a longitudinal opportunity for students and faculty to work on issues such as academic goals, socialization into the medical school environment, and professionalism.

Highlights include:

• Longitudinal relationships between students and faculty are a mainstay of learning communities.
• Learning community objectives often include advising or mentoring, professional development, coursework, social connection, and wellness.
• Students participating in learning communities have reported greater satisfaction with the learning environment than their non-learning community peers.
• Learning communities have been shown to promote greater academic and social success in higher education.

Shichet, R., Fleming, A., Wagner, J., Colbert-Getz, J., Bhutiani, M., Moynahan, K., and Keeley, M. (2019). Defining learning communities in undergraduate medical education: A national study (PDF). Journal of Medical Education and Curricular Development, 6, 1-9.

February 2020: Beyond ‘Driving’: The Relationship Between Assessment, Performance, and Learning
This article challenges the assumption that assessment drives the learning process. The author asserts that many practices reward performance over learning and jeopardize our trainees’ attitudes toward long-term, meaningful learning. The author then offers suggestions for how we can mitigate this affect and enable assessments that encourage learning.

Highlights include:

• Assessment practices have only a tenuous relationship with the process of learning. However, we must be cautious to think that assessment never drives learning.
• Learning generates a stable change in knowledge or behavior resulting from practice or other forms of experience.
• Purposeful seeking of reward over learning is an undesired consequence of assessment.
• Infrequent, high-stakes assessments reward performance through ‘cramming’ over long-term recall.
• Assessing student participation as a proxy for demonstration of learning rewards performance over true learning.

Scott, I.M. (2020). Beyond ‘driving’: The relationship between assessment, performance, and learning. Medical Education, 54(1), 54-59.

January 2020: The Stress Paradox: How Stress Can Be Good for Learning
This article explores the subject of stress and its influence on the learning process. Rejecting the myth that stress is always bad for the learning environment, the authors assert that positive stress is a necessary part of the learning process.

Highlights include:

• The term “stress” is typically equated with “distress,” the negative type of stress. Doing so ignores the positive role of “eustress.”
• “Stressors” in learning are defined as a learning expectation or challenge experienced by the learner.
• Stressors prompt learning to take place.
• Certain “distress,” such as bullying or humiliating learners, is harmful and has no place in the learning process.
• Stress has been found to improve mental function and boost memory capabilities.
• Stressors and stress are important for learning and should be used carefully and deliberately.

Rudland, J.R., Golding, C., and Wilkinson, T.J. (2020). The stress paradox: How stress can be good for learning. Medical Education, 54(1), 40-45.

December 2019: Twelve Tips for Clinicians Dealing with Uncertainty When Assessing Learners
This article addresses the issue of uncertainty when assessing learners. Part of Medical Teacher’s “Twelve Tips” series, the authors draw parallels between handling uncertainty in the clinical environment and doing so in an educational environment.

Highlights include:

• Adopting a learner-centered approach to assessment is much like practicing patient-centered care. Learners can be responsible for their learning, manage their learning experience, and demonstrate knowledge construction with the instructor assuming a facilitator role.
• Clear communication and shared decision-making engage learners in hearing the feedback they receive.
• Ongoing assessment provides a full picture of learners’ knowledge, skills, and attitudes, allowing the instructor to adjust their facilitation in support of the learner’s well-being and success.
• Good record keeping is essential when assessing learners. Just like the medical record, educational records should be recorded in a continuous and timely manner.

Scott, I., Gingerich, A., and Eva, K.W. (2019). Twelve tips for clinicians dealing with uncertainty when assessing learners. Medical Teacher, 41(8), 888-894.

November 2019: Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education
This article introduces the conceptual framework of Master Adaptive Learners used by medical educators to develop “adaptive expertise” in trainees. Adaptive expertise is described as a way to balance effortful learning, innovative problem solving, and efficient routine expertise. It is based on the concept that learning and innovation are spurred by challenges in practice.

Highlights include:

• Preparation for future learning, or PFL, is essential for effectively learning in practice and combines effective use of resources, the ability to learn new information, and the creation of new procedures in support of problem solving in practice.
• PFL allows practitioners to access prior knowledge in the development of innovative problem solving.
• Undergraduate medical training must prepare future clinicians with the skills and processes necessary to foster effective workplace learning

Cutrer, W.B., Miller, B., Pusic, M.V., Mejicano, G., Mangrulkar, R.S., Gruppen, L.D., Hawkins, R.E., Skochelak, S.E., and Moore, D.E. (2017). Fostering the development of master adaptive learners: A conceptual model to guide skill acquisition in medical education. Academic Medicine, 92(1), 70-75.

October 2019: Learning to Learn: A Qualitative Study to Uncover Strategies Used by Master Adaptive Learners in the Planning of Learning
This article discusses Master Adaptive Learners, a conceptual framework used by medical educators to develop “adaptive expertise” in trainees. The authors found that the Master Adaptive Learners, or MALs, they studied in residency were intrinsically motivated by a drive to provide quality care for their patients rather than being motivated by external sources such as feedback or assessment.

Highlights include:

• The authors propose the “brick wall” concept, in which a resident will continue to work through the details of a case until they consciously realize they don’t know what to do next and begin to engage in intense self-reflection.
• Intentionally seeking feedback from multiple members of the healthcare team, including ancillary staff and trainees junior to them in the hierarchy, was a knowledge gap identification skill residents became more comfortable with over time.
• Study participants almost universally responded “no” when asked whether they received formal training on how to learn.
• Participants reported that relying on workplace learning alone resulted in superficial learning, with deep learning requiring additional effort and study during personal time.
• Discussions with learners about “trial and error” and “productive struggle” may aid them in viewing such experiences as formative and better support development of resilience and adaptive expertise.
• The authors found that MALs in their study did not set short-term learning goals. Rather, they triaged the learning opportunities available to them in the clinical setting, suggesting a significant influence of immediacy of learning needs.
• “Intentional adaptation” should be encouraged during the transition from medical school to residency, with trainees being aware that struggles will take time and iterative development to overcome.

Read the abstract.

September 2019: Pedagogical Validity: The Key to Understanding Different Forms of 'Good' Teaching
This article discusses ‘pedagogical validity,’ a combination of skills, goals, and values held by an educator. The authors assert that meaningful reflection and improvement of educational skills require an understanding of one’s pedagogical validity and describe four types of pedagogical validity instructors can use to define their understanding of ‘good’ teaching.

Highlights include:

• Limiting the definition of ‘good teaching’ to a toolbox of pedagogical skills is flawed.
• Assessing good teaching requires an understanding of the values and assumptions that influence teaching goals.
• Intellectual validity seeks to explain core concepts and expand learners’ mastery of content into the ability to think and reason through conditions of uncertainty. This is the most commonly used form of pedagogical validity in medical training.
• Relational validity views learning as the product of a relationship between the educator and learner, in which learners seek explanations and role modeling from their educators. Relational validity is particularly important in the context of giving and receiving feedback, a process requiring trust and respect.
• Moral validity involves making judgements and decisions in complex environments in which rules and guidelines are insufficient to address situations. Moral validity requires educators to not only role model behavior but also articulate the reasons for thinking and acting in certain ways.
• Cultural validity relies on awareness of how values and norms influence the way we view and think about the world around us. Teaching is a role that is culturally defined, requiring us to both enculturate learners and foster critical reflection on the culture(s) involved in learning and practicing in a healthcare environment.

Pratt, D.D., Schrewe, B., & Pusic, M.V. (2019, June). Pedagogical validity: The key to understanding different forms of ‘good’ teaching. Medical Teacher, 41(6), 638-640.

August 2019: Defining Trainee Competence: Value is in the Eye of the Stakeholder
This article is an editorial emphasizing the need to carefully define competence for developing and implementing assessment programs. The author asserts there are risks and limitations to applying stakeholder theory, a business framework, to educational assessment in the training of physicians. She proposes involving multiple stakeholders in the design and development of workplace-based assessment programs to better understand stakeholder values and what competence really means in our environment.

Highlights include:

• We may be rushing into developing assessment programs based on a construct we don’t fully understand (competence).
• Our collective values in medical education shape trainee characteristics.
• Programs of assessment should be inclusive of different stakeholders and their values.

Yarris, L.M (2019, June). Defining trainee competence: Value is in the eye of the stakeholder. Academic Medicine, 94(6), 760-762.

May 2019: Trust as a Scaffold for Competency-Based Medical Education
This article is an editorial and comment on trust in competency-based medical education, or CBME. The authors assert that trust is paramount in CBME and underpins the entire medical education system. Trusting relationships are essential between learner and supervisor, trainees and training programs, and training programs and society.

Highlights include:

• Entrustable Professional Activities, or EPAs, provide a shared model for the desired outcomes of our educational efforts. 
• We are entering a period of inquiry surrounding CBME, focusing on relationships that encompass the medical education system and emphasize the importance of trust.
• In CBME, feedback is essential to help learners understand their development and identify areas for growth.
• A productive feedback process relies on trusting relationships.
• Building an effective CBME system is dependent on attention to relationship development and may best be designed with longitudinal, continuity experiences.

Young, E., and Elnicki, D.M. (2019, April). Trust as a scaffold for competency-based medical education (PDF). J Gen Intern Med, 34(5), 647-8. DOI: 10.1007/s11606-019-04927-6

April 2019: Psychology and Learning: The Role of the Clinical Learning Environment
This article discusses the psychological environment and its influence on learning. The authors emphasize the importance of creating a safe environment in which trainees can learn. They recommend seven basic strategies: embrace learning as a core value, utilize the clinical care system as an education-rich environment, develop individual-level skills to optimize the learning process, incorporate rituals and rewards, establish a just culture, remove competing factors, and build communities of practice.

Highlights include:

• Cognitive Load Theory highlights three components that contribute to the formation of working memory: intrinsic load, extrinsic load, and germane load.
• Optimal learning experiences occur at an ideal intrinsic load (not too simple or complex) while minimizing extrinsic load (distractions) and facilitating the learner's use of germane load (active processing) to incorporate their learning into working memory.
• Clinical preceptors are essential to promoting learner self-efficacy, or their ability to operate with increasing autonomy.
• Learners become empowered in a psychologically safe environment that allows them to speak without fear of consequences, exploring new theories and testing assumptions.

Caverzagie, K.J., Goldenberg, M.G., Hall, J.M. (2019, February). Psychology and learning: The role of the clinical learning environment. Medical Teacher. DOI: 10.10080/0142159X.2019.1567910

March 2019: Matchmaker, Matchmaker, Make Me a Match: Is There a Better Way?
This article is a letter from the editor of Academic Medicine on the Match process. The author asserts that the current Match process is expensive, inefficient, and encourages excessive focus on USMLE examination scores, making it an overall unfair system. The National Resident Matching Program, or NRMP, was founded in 1952 to address problems in the residency selection process and make the system “fair, efficient, transparent, and reliable (1).” However, many of the problems the Match was created to solve have resurfaced in recent years, leading to a “system with perverse outcomes (1).”

Highlights include:

• USMLE Step 1 scores have been increasingly used as an initial screen for the ever-growing number of residency program applicants.
• Medical students have increasingly focused their learning on preparatory materials for Step 1 rather than other important curricular activities, undermining the medical school curriculum and ceding medical education authority to commercial resources.
• A range of suggestions to improve the process exist, including, but not limited to, improving the information provided by medical schools to residency programs and realigning the Step 1 exam to reflect competencies of interest to program directors.
• Fixing the Match will require medical educators to ask difficult questions about the process and desired outcomes.

Sklar, D.P. (2019, March). Matchmaker, matchmaker, make me a match: Is there a better way? Academic Medicine, 94(3), 295-297. DOI: 10.1097/ACM.0000000000002553

February 2019: Improving Trust Between Learners and Teachers in Medicine
This article focuses on the trust relationship between teachers and learners.

Highlights include:

• Without trust in the teacher-learner relationship, learners may reject or resist information and teachers may be unlikely to share in patient care responsibilities.
• Teachers are increasingly called to assess competence while lacking control over the learning environment or a longitudinal relationship with the learner.
• Learning is based on exploring, adjusting, and improving based on feedback.
• Negotiating the power imbalance between teachers and learners is critical for development of a relationship that fosters trust.
• Commitment to a healthy working environment is important in creating a trusting relationship between teachers and learners.
• Social relationships between teachers and learners should be avoided during the time of active supervision.

Abruzzo, D., Skalr, D.P., and McMahon, G.T. (2019, February). Improving trust between learners and teachers in medicine. Academic Medicine, 94(2), 147-150. DOI: 10.1097/ACM.0000000000002514

January 2019: Choosing Our Own Pathway to Competency-Based Undergraduate Medical Education
This article focuses on competency-based medical education (CBME) and the determination of competency based on assessment of entrustable professional activities (EPAs). The authors assert that three major decisions are required to transition to CBME: defining the terminology to be used to describe constructs being evaluated, deciding which rating tools and raters to include in the assessment program, and determining how to make promotion decisions based on longitudinal EPA data.

Highlights include:

• Changing to a competency-based model in undergraduate medical education will likely meet with resistance and cynicism.
• We should not be threatened by the desire for a set level of competency, as this is meant to be a minimum requirement for entering post-graduate training.
• Programs can maintain some autonomy on deciding elements of CBME to incorporate into their own unique programs.
• UME programs are already evaluating individual behaviors within each of the defined EPAs, which means the task at hand is mapping EPAs to existing activities.
• A focus on preparing students for entering residency shifts focus from successful completion of individual clerkships to one of overall competency, requiring a change in how we collect and analyze performance data.

Veale, P., Busche, K., Touchie, C., Coderre, S., and McLaughlin, K. (2019, January). Choosing our own pathway to competency-based undergraduate medical education. Academic Medicine, 94(1), 25-30. DOI: 10.1097/ACM.0000000000002410

December 2018: Addressing Student Burnout: What Medical Schools Can Learn From Business Schools
This article shares the authors’ perspectives on how business schools provide inspiration for improving medical school curricula. The authors assert that focusing medical student activities on completing routine tasks obscures opportunities for intellectual creativity, and lack of effective career counseling denies students the opportunity to pursue meaningful career pathways.

Suggestions include:

• Provide opportunities for creativity and problem solving
• Increase resilience training
• Offer robust career counseling

October 2018: Twelve Tips for Clinicians Dealing with Uncertainty When Assessing Learners
This article shares the authors’ recommendations for how to deal with uncertainty when assessing learners in the clinical setting.

Tips include:

• Be learner-centered to understand the learner’s context and address their needs and concerns.
• Use clear communication to understand the learner’s values and concerns in the face of uncertainty.
• Engage in self-reflection to stay attuned to your own and the learner’s emotional reactions to the situation at hand.
• Seek input from your colleagues.
• Avoid premature closure on your assessment.
• Remember that every assessment opportunity does not have to end in a final judgement.

Scott, I., Gingerich, A., and Eva, K.W. (2018, October). Twelve tips for clinicians dealing with uncertainty when assessing learners. Medical Teacher, DOI: 10.1080/0142159X.2018.1494381

September 2018: Anticipating and Training the Physician of the Future
This article shares the author’s perspective on the importance of teaching caring in medical profession, especially in an age of rapid technological advancement.

Highlights include:

• While knowledge is more abundant and easier to access, the ability for a physician to retain and process all the information available is limited.
• Technological advancements provide opportunities for enhancing medical care but are incapable of replacing the humanistic art of medical practice.
• Most medical school curriculums devote a lot of time and attention to rote memorization and data analysis, skills that may be less relevant in the growing age of artificial intelligence.

Johnston, S.C. (2018, August). Anticipating and training the physician of the future: The importance of caring in an age of artificial intelligence. Academic Medicine, 93(8), 1105-1106.

July 2018: Twelve Tips for Creating an Academic Teaching Portfolio
This article discusses how to approach creating an academic teaching portfolio. The authors share twelve tips for organizing and reporting your teaching activities.

Tips include:

• Prepare in advance to allow yourself time to collect, collate, and reflect
• Review your CV to ensure it is updated
• Establish a “shoebox” to collect your information
• Collect evidence of the quality of your teaching
• Participate in peer review of your teaching
• Provide mentorship 
• Solicit letters of support
• Demonstrate evidence of scholarship
• Think about your goals and objectives
• Write down your educational philosophy
• Document your professional development
• Have an expert review your portfolio prior to submitting it

Little-Weinert, K., and Mazziotti, M. (2018). Twelve tips for creating an academic teaching portfolio. Medical Teacher, 40(1), 26-30.

June 2018: What to Do About Those Negative Comments on Course Evaluations
This article discusses how to respond to negative comments on course evaluations. The author discusses personal reactions to negative student comments and suggests ways to avoid over-reacting.

Suggestions include:

• Step back
• Look again later
• Decide what you’re going to do
• Talk to a trusted colleague
• Talk to a few students
• Recognize that you are not alone
• What to Do About Those Negative Comments on Course Evaluations

Weimer, M. (2018, May 30). What to do about those negative comments on course evaluations. Faculty Focus, Teaching Professor Blog.

May 2018: When I say ... resilience
This article defines the term “resilience” in the medical education context and discusses why resilience training is important to our learners. The authors discuss challenges healthcare learners face in a fast-paced, dynamic practice environment and the consequences of burnout.

Insights include:

• Protection against burnout requires development and promotion of interventions to foster resilience amongst trainees.
• Individual interventions are unlikely to be effective on their own in addressing the complex issue of resiliency and burnout.
• Prevention of burnout calls for defining resilience in the context of overcoming adversity rather than as an intrinsic personal attribute.

Teodorczuk, A., Thomson, R., Chan, K., and Rogers, G.D. (2017). When I say…resilience. Medical Education, 51(12): 1206-1208.

February 2018: Criterion-Based Assessment in a Norm-Based World: How Can We Move Past Grades?
This article discusses opportunities and challenges with transitioning to competency-based assessment and grading in undergraduate medical education (UME). The authors discuss progress made in graduate medical education with development and implementation of competencies and milestones.

Insights include:

• UME struggles with transitioning to competency-based medical education due to a continued reliance on grades.
• Reliance on proxy assessments rather than direct observation of learners continues to be problematic in UME.
• Use of norm-based criteria in the residency application process places pressure to provide this type of data to programs.
• Successful implementation of competency-based assessment will require consensus between UME and graduate medical education.

Pereira, A.G., Woods, M., Olson, A.P.J., van den Hoogenhof. S., Duffy, B.L., and Englander, R (2017). Criterion-based assessment in a norm-based world: Can we move past grades? Academic Medicine. doi: 10.1097/ACM.0000000000001939.

January 2018: Relationships between Academic and Community Physicians
This article shares one physician’s thoughts on the relationships between academic and community physicians. The author discusses medical schools’ increased reliance on community physicians to teach students and residents and suggests ways to enhance these relationships.

Insights include:

• Failure for academic and community physicians to work together could have serious consequences for medical education.
• Community physicians need access to high-quality, evidence-based training on teaching.
• Mutual respect and feedback are critical to building successful relationships between “town” and “gown” physicians.

Gundersen, E. (2017, October 10). The accidental academic: Bridging the gap between town and gown [Web log post]. Harvard Macy Institute. Retrieved January 26, 2018, from The Accidental Academic: Bridging the Gap between Town and Gown

December 2017: Promoting Deep Learning
This article focuses on deep learning and approaches to encourage it in coursework. Deep learning results in overall understanding of a concept, whereas surface learning focuses on rote memorization of information. Promoting deep learning means having students do something with the information, not just requiring them to remember it.

Highlights include:

• Deep learning results in the ability to not only understand information but transfer that knowledge to new and different situations.
• Cooperative learning experiences play a key role in deep learning, as interaction is a key characteristic.
• Efforts for deep learning should focus on key knowledge and skills essential for students to advance to the next course or practice in their chosen discipline.
• Deep learning is fostered through mindful sequencing of activities designed to promote thoughtful processing of and interaction with the course material.

Millis, B.J. (n.d.) Promoting Deep Learning: IDEA Paper #47 (PDF). Retrieved December 18, 2017, from The Idea Center

November 2017: Interprofessional Education – A Foundation for a New Approach to Health Care
This article focuses on interprofessional education (IPE) and its role in the future of healthcare. The authors discuss reasons for engaging in IPE, various approaches to incorporating it into health care curriculum, and IPE's potential to transform health care delivery in the future.

Highlights include:

• Longitudinal, patient-centered IPE experiences have the potential to increase students' knowledge and awareness of complex patient needs.
• IPE is rooted in the patient safety movement, an effort to improve multidisciplinary teamwork and communication.
• IPE as a field is still evolving, with research to be done on core concepts and curriculum integration.
• When done well, IPE has the power to develop health care teams better able to handle uncertainty and complexity.
• With movement toward value-based payment models in health care, the ability for providers to focus their problem solving in an integrated manner becomes increasingly important.

Dow, A., and Thibault, G. (2017, August 31) Interprofessional Education - A Foundation for a New Approach to Health Care. N Engl J Med, 377(9), 803-805.

October 2017: Active Learning Strategies in Face-to-Face Courses
This article focuses on active learning in the face-to-face classroom. The author discusses approaches to active learning and the research that supports adoption of active learning methods.

Highlights include:

• Metacognition, or awareness of one's own thought processes, is central to learning.
• Educators are responsible for designing learning experiences that will engage students.
• Educators should continually reinforce the value of active learning approaches, clarifying their expectations and emphasizing that the approaches will be reflected in graded activities (tests, quizzes, assignments).
• Educators should practice "transparent teaching," in which their methods and motives for active learning approaches are shared with the learners.
• Educators should create a supportive classroom climate to foster active student participation.

Millis, B.J. (n.d.) Active learning strategies in face-to-face courses. IDEA Paper #53 (PDF). Retrieved from The Idea Center

September 2017: No More Lectures?
This article shares two medical educators’ perspectives on efforts to move away from traditional lecture-based courses. The authors discuss approaches to education and the need to prepare medical students for future practice.

Highlights include:

• Content-heavy slides may be an efficient way to teach but are likely an ineffective way to learn.
• Learning can be facilitated by the instructor but must be driven by the student.
• Students aren’t learning when they are unengaged.
• Questioning, particularly using “why” and “how” questions, facilitates the transfer of knowledge.
• We should aim for a culture of continuous quality improvement in medical education, just as we do with clinical practice.

Schwartzstein, R.M., & Roberts, D.H. (2017, August 17). Saying goodbye to lectures in medical school – Paradigm shift or passing fad? N Engl J Med, 377: 605-607. DOI: 10.1056/NEJMp1706474

August 2017: Struggles with Teaching
This article shares a medical educator’s experiences with trying to teach in a time-constrained environment. The author discusses struggling to engage residents in active learning in the face of competing demands.

Insights include:

• Time constraints and clinical demands may divert attention away from formal teaching.
• Tension exists between fostering active learning and providing information to aid in the passage of high-stakes exams.
• Lack of objectives and related assessment may confuse the learning environment.
• Faculty development can help address the need for continual education of clinical preceptors.

Sklar, D.P. (2015). Just because I am teaching doesn’t mean they are learning: Improving our teaching for a new generation of learners. Academic Medicine, 92(8): 1061-1063. DOI: 10.1097/ACM.0000000000001808