Steven L. Kanter

Medical education in the United States and Canada, 2010.

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.

Required vs. Elective Research and In-Depth Scholarship Programs in the Medical Student Curriculum

The ability to understand and integrate new knowledge into clinical practice is a necessary quality of good physicians. Student participation in in-depth scholarship could enhance this skill in physicians while also creating a larger cadre of physician-scientists prepared to advance the field of medicine. However, because no definitive data exist demonstrating that in-depth scholarship in medical school leads to improved patient care or to productive academic careers, whether such scholarship should be required as part of the medical school curriculum is unclear. In this article, the authors present both sides of this debate. Theoretical benefits to students of a required scholarly program include closer mentorship by individual faculty, enhanced capabilities in critical interpretation of research findings, and increased confidence to investigate conundrums encountered in clinical care. Society may also benefit by having physicians available to create and apply new knowledge related to biomedicine. These theoretical benefits must be balanced, however, by pragmatic considerations of required scholarly projects including their impact on medical school applications, their effect on the medical curriculum, their costs, the availability of mentors, and their effects on the schools educational culture.

Toward Better Descriptions of Innovations

This question leads to even more questions, both general and specific. Is it better to publish brief descriptions of a large number of promising ideas or, instead, in-depth case studies of major ideas? What are the most important questions to ask about an innovation? Must an author demonstrate the generalizability of an innovation? Is it necessary to have evaluation data that show that patients are satisfied or that students have learned something or that residents’ or physicians’ performance in a particular area has improved?

The Scholarly Project Initiative: introducing scholarship in medicine through a longitudinal, mentored curricular program.

Many U.S. medical schools offer students the opportunity to undertake laboratory or clinical research or another form of scholarly project over the summer months, yet few require this as a prerequisite for graduation, and even fewer provide comprehensive didactic material in preparation for the performance of such a project as an integrated component of their curricula. The authors describe the Scholarly Project Initiative of the University of Pittsburgh School of Medicine, a novel, longitudinal, and required program. The program will aim to provide all students with structured preparatory coursework, foster critical analytical and communication skills, and introduce the breadth and depth of the research and scholarly enterprise engendered by modern academic medicine in the contexts of both the classroom and an individual, mentored experience. The initiative has two goals: encouraging an interest in academic medicine in an era marked by the continuing decline in the number of physician–investigators, and fostering the development of physicians who have confidence in their abilities to practice medicine with creativity, original and analytical thought, and relentless attention to the scientific method. Planning for the Scholarly Project Initiative began officially at the University of Pittsburgh School of Medicines Curriculum Colloquium in May 2003. The initiative was implemented with the first-year class of July 2004 as part of the new “Scientific Reasoning and Medicine” block of the School of Medicines curriculum. The block as a whole includes traditional lectures, small-group laboratory and problem-based sessions, and mentored independent study components.

Perspective: Educating physicians to lead hospitals.

The percentage of hospitals that are physician led has been steadily declining and now stands at or near an all-time low. What price do the health care system and the people it serves pay for this decline in physician leadership? What might health care look like if medical educators devoted more time and attention to developing future physicians as organizational leaders? What changes would medical schools need to make to prepare medical students to play such a role? What advantages might accrue for patients, communities, and physicians themselves if more hospitals were physician led? Because hospitals are a vital resource in caring for the sick, promoting health, and addressing the challenges facing the U.S. health care system, it is now more important than ever before to explore how medical education can complement its traditional focus on the molecular, cellular, and organismal levels of health and disease with insight into the organizational dimensions of patient care. The authors believe the time is ripe to rethink medical education’s role in preparing tomorrow’s physicians as leaders.

Reproducibility of literature search reporting in medical education reviews.

Purpose Medical education literature has been found to lack key components of scientific reporting, including adequate descriptions of literature searches, thus preventing medical educators from replicating and building on previous scholarship. The purpose of this study was to examine the reproducibility of search strategies as reported in medical education literature reviews. Method The authors searched for and identified literature reviews published in 2009 in Academic Medicine, Teaching and Learning in Medicine, and Medical Education. They searched for citations whose titles included the words “meta-analysis,” “systematic literature review,” “systematic review,” or “literature review,” or whose publication type MEDLINE listed as “meta-analysis” or “review.” The authors created a checklist to identify key characteristics of literature searches and of literature search reporting within the full text of the reviews. The authors deemed searches reproducible only if the review reported both a search date and Boolean operators. Results Of the 34 reviews meeting the inclusion criteria, 19 (56%) explicitly described a literature search and mentioned MEDLINE; however, only 14 (41%) also mentioned searches of nonmedical databases. Eighteen reviews (53%) listed search terms, but only 6 (18%) listed Medical Subject Headings, and only 2 (6%) mentioned Boolean operators. Fifteen (44%) noted the use of limits. None of the reviews included reproducible searches. Conclusions According to this analysis, literature search strategies in medical education reviews are highly variable and generally not reproducible. The authors provide recommendations to facilitate future high-quality, transparent, and reproducible literature searches.

50 years of publication in the field of medical education

Background: The advent of new medical education (ME) journals makes evident the growth of the field of ME. However, the nature and context of growth is undefined. Aim: To analyze the evolution of publication in ME. Methods: MEDLINE retrieval using medical subject headings was used to analyze patterns of ME publications from 1960–2010: changes in number of ME publications; number of journals publishing ME articles; co-topics occurring frequently in ME articles; differences among journals’ publication of co-topics. Results: Annual publication of ME articles increased from 279 in 1960 to 3760 in 2010. 81 531 articles were published in 4208 different journals. 104 journals published ME articles in 1960, 855 in 2010. Despite an increase in journals in all fields, ME journals now account for a larger proportion of all journals indexed in MEDLINE than in 1960. One-quarter of all ME articles were indexed as internship/residency; 16% as graduate ME; 15% as undergraduate ME; and 14% as continuing ME. The five journals that published the most ME articles distinguished themselves by publishing some topics with greater or less frequency. Conclusions: The increase in the number of ME publications and in the number of journals publishing ME articles suggests a supportive environment for a growing field; but variation in journals’ foci has implications for readers, editors and authors.

How we develop and sustain innovation in medical education technology: Keys to success

The use of information technology to support the educational mission of academic medical centers is nearly universal; however, the scope and methods employed vary greatly (Souza et al. ). This article reviews the methods, processes, and specific techniques needed to conceive, develop, implement, and assess technology-based educational programs across healthcare disciplines. We discuss the core concepts, structure, and techniques that enable growth, productivity, and sustainability within an academic setting. Herein are specific keys to success with examples including project selection, theory-based design, the technology development process, implementation, and evaluation that can lead to broad participation and positive learning outcomes. Most importantly, this article shares methods to involve students, faculty, and stakeholders in technology design and the development process that fosters a sustainable culture of educational innovation.

Online "spaced education progress-testing" of students to confront two upcoming challenges to medical schools.

Purpose U.S. medical students will soon complete only one licensure examination sequence, given near the end of medical school. Thus, schools are challenged to identify poorly performing students before this high-stakes test and help them retain knowledge across the duration of medical school. The authors investigated whether online spaced education progress-testing (SEPT) could achieve both aims. Method Participants were 2,648 students from four U.S. medical schools; 120 multiple-choice questions and explanations in preclinical and clinical domains were developed and validated. For 34 weeks, students randomized to longitudinal progress-testing alone (LPTA) received four new questions (with answers/ explanations) each week. Students randomized to SEPT received the identical four questions each week, plus two-week and six-week cycled reviews of the questions/explanations. During weeks 31–34, the initial 40 questions were re-sent to students to assess longer-term retention. Results Of the 1,067 students enrolled, the 120-question progress-test was completed by 446 (84%) and 392 (74%) of the LPTA and SEPT students, respectively. Cronbach alpha reliability was 0.87. Scores were 39.9%, 51.9%, 58.7%, and 58.8% for students in years 1–4, respectively. Performance correlated with Step 1 and Step 2 Clinical Knowledge scores (r = 0.52 and 0.57, respectively; P < .001) and prospectively identified students scoring below the mean on Step 1 with 75% sensitivity, 77% specificity, and 41% positive predictive value. Cycled reviews generated a 170% increase in learning retention relative to baseline (P < .001, effect size 0.95). Conclusions SEPT can identify poorly performing students and improve their longer-term knowledge retention.

Teaching techniques in the operating room: the importance of perceptual motor teaching.

Purpose To identify sucessful teaching techniques in the operating room environment through examining the teaching of the midurethral sling (MUS) surgery. Method The authors distributed questionnaires with open-ended questions about teaching and learning MUS to 5 urogynecology attendings and 16 obstetrics–gynecology residents in spring 2010. In an effort to identify qualities of an effective sling teacher, the authors used grounded theory to determine common themes and to code participant responses for examples. Results Of 21 potential respondents, 14 (67%) returned questionnaires. The authors analyzed these and identified seven commonalities among effective sling teachers: they (1) emphasize anatomical landmarks (as determined by 64 total comments); (2) use perceptual-motor teaching (PMT; 38 comments); (3) encourage repetition (28); (4) promote early independence (34); (5) demonstrate confident competence (23); (6) maintain a calm demeanor in the operating room (20); and (7) exhibit a willingness to accept responsibility for mistakes and consequences (9). The second-most common attribute, using PMT, requires the teaching attending to emphasize the motor and tactile aspects of operating and involves incorporating not only what learners see but also what they feel. Conclusions The authors report seven qualities or techniques fundamental to good teaching practice in a high-stress, high-technology surgical environment, and they have identified the use of PMT, which to their knowledge has not been previously described. Teachers and learners in this study characterized PMT, which is likely generalizable to surgical procedures other than the MUS, as important. Future research should focus on exploring this technique in other surgeries.