Academic medicine : journal of the Association of American Medical Colleges
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The authors describe the importance of trust in health care, while noting with concern the documented decline in Americans' trust in the medical system, its leaders, and to a lesser degree, physicians themselves. They examine a number of reasons for this decline, including both larger societal trends and elements that are specific to health care. They then link trust to medical professionalism, explaining why the ABIM Foundation has decided to champion trust as an issue in the coming years. Finally, they offer thoughts on the specific actions the ABIM Foundation may take, including the launch of a Trust Practice Challenge designed to uncover practices that are currently working to build trust in a variety of practice settings and health care relationships, and the exploration of potential avenues to combat medical misinformation.
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The process of translating academic biomedical advances into clinical care improvements is difficult, risky, expensive, and poorly understood. Notably, many clinicians who identify health care problems do not have the time or expertise to solve the problems, and many academic researchers are unaware of important gaps in clinical care to which their expertise may apply. Recognizing an opportunity to connect people who can identify health care problems with those who can solve them, the Yale Center for Biomedical Innovation and Technology (CBIT) was established in 2014 to educate and enhance the impact of health care innovators. ⋯ Over 200 projects have been submitted to CBIT for mentorship, and some of those projects have been commercialized and raised millions of dollars of follow-on funding. The authors present Yale CBIT as one model of accelerating the impact of academic medicine on clinical practice and outcomes. The project advising strategy is intended to be a template to maximize the efficiency of biomedical innovation and ultimately improve the outcomes and experiences of future patients.
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Diagnostic errors contribute to as many as 70% of medical errors. Prevention of diagnostic errors is more complex than building safety checks into health care systems; it requires an understanding of critical thinking, of clinical reasoning, and of the cognitive processes through which diagnoses are made. When a diagnostic error is recognized, it is imperative to identify where and how the mistake in clinical reasoning occurred. ⋯ Recent literature questioning whether teaching critical thinking skills increases diagnostic accuracy is critically examined, as are studies suggesting that metacognitive practices result in better patient care and outcomes. Instruction in metacognition, reflective practice, and cognitive bias awareness may help learners move toward adaptive expertise and help clinicians improve diagnostic accuracy. The authors argue that explicit instruction in metacognition in medical education, including awareness of cognitive biases, has the potential to reduce diagnostic errors and thus improve patient safety.
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Competing risk methodology was used to identify variables associated with promotion and attrition of newly appointed full-time instructors or assistant professors in U.S. MD-granting medical schools. ⋯ This study adds new knowledge about career trajectories of academic medicine faculty initially appointed as full-time instructors. Career development interventions and research mentoring during and after medical school and debt reduction programs could help increase academic medicine faculty retention and promotion.
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Entrustment has become a popular assessment framework in recent years. Most research in this area has focused on how frontline assessors determine when a learner can be entrusted. However, less work has focused on how these entrustment decisions are made. The authors sought to understand the key factors that pediatric residency program clinical competency committee (CCC) members consider when recommending residents to a supervisory role. ⋯ CCC members considered resident and environmental factors in their summative entrustment decision making. The interplay between these factors should be considered as CCC processes are optimized and studied further.