Academic medicine : journal of the Association of American Medical Colleges
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Multicenter Study
The influence of academic discourses on medical students' identification with the discipline of family medicine.
To understand the influence of academic discourses about family medicine on medical students' professional identity construction during undergraduate training. ⋯ These results stress the influence of academic discourses on medical students' ability to identify with the practice of family medicine. Educators must consider processes of professional identity formation during undergraduate medical training as they develop and reform medical education.
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The discipline of family medicine is essential to improving quality and reducing the cost of care in an effective health care system. Yet the slow growth of this field has not kept pace with national demand. In their study, Rodríguez and colleagues report on the influence of the social environment and academic discourses on medical students' identification with family medicine in four countries-the United Kingdom, Canada, France, and Spain. ⋯ National education initiatives highlight the importance of social determinants in medical education and the integration of public health and medicine in practice. Other initiatives expose students to family medicine role models and practice during their undergraduate training and promote primary care practice through new graduate medical education funding models. Together, these initiatives can reduce the negative effects of the social environment and create a more positive discourse about family medicine.
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Comparative Study Observational Study
Seasonal variation in family member perceptions of physician competence in the intensive care unit: findings from one academic medical center.
Researchers have found mixed results about the risk to patient safety in July, when newly minted physicians enter U.S. hospitals to begin their clinical training, the so-called "July effect." However, patient and family satisfaction and perception of physician competence during summer months remain unknown. ⋯ Seasonal variation exists in family perception of physician competence in the ICU, but opposite to the "July effect." The reasons for this variation are not well understood. Further research is necessary to explore the role of senior provider involvement, trainee factors, system factors such as handoffs, or other possible contributors.
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Inpatient rotations remain a central component in residency training, particularly in specialties such as internal medicine. However, maintaining the quality of this important learning experience has become a challenge. Recent approaches to redesigning the inpatient rounding experience have included reductions in the number of admissions and in patient census, which may not be feasible or desirable for many programs. ⋯ A robust evaluation process is under way; initial impressions from attendings, learners, and patients have been positive. Several educational outcomes also are being measured and compared with those of the standard inpatient medical teams. Further evaluations will guide modifications to the CS program and direct plans for dissemination within the institution and to other institutions.
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Many graduate medical education (GME) programs have started to consider and adopt entrustable professional activities (EPAs) in their competency frameworks. Do EPAs also have a place in undergraduate medical education (UME)? In this Perspective article, the authors discuss arguments in favor of the use of EPAs in UME. A competency framework that aligns UME and GME outcome expectations would allow for better integration across the educational continuum. ⋯ UME EPAs would be defined as essential health care activities with which one would expect to entrust a resident at the beginning of residency to perform without direct supervision. Finally, the authors recommend a refinement and expansion of the entrustment and supervision scale previously developed for GME to better incorporate the supervision expectations for UME learners. They suggest that EPAs could be operationalized for UME if UME-specific EPAs were developed and the entrustment scale were expanded.