Self-Directed Learning among Internal Medicine Residents in the Information Age.

OBJECTIVES: The revolution in information technology and a rapidly expanding evidence base are changing residency training. Understanding the habits and preferences of trainees' self-directed learning (SDL) has never been more important. Our goal was to provide a contemporary description of residents' SDL practices. METHODS: Internal medicine residents at four university-affiliated programs were surveyed in Spring 2017. Residents estimated the number of hours in their typical week spent in SDL on service and after hours when on inpatient and noninpatient rotations, how often they used specific educational resources for SDL, and the percentage of time that they used four different modes to access resources. RESULTS: Of 384 residents, a total of 254 (66%) responded. Residents spent more total hours in SDL on noninpatient services (median 11, interquartile range 8-17) than on inpatient services (median 7, interquartile range 4-10) and the same median number of hours in SDL on clinical duty as off hours for both inpatient (median 3 hours) and noninpatient (median 5 hours) rotations. Nearly all of the respondents (99%) reported using online point-of-care resources for SDL at least once per week. Most (77%) never used printed textbooks. Desktop/laptop was the most commonly used (47% of the time) medium to access resources. CONCLUSIONS: Although the resident learning environment and resource use are changing, residents engage in as much or more time in SDL as in previous studies, with a large proportion occurring during clinical service. Understanding residents' current SDL habits will better prepare educators to support and guide our trainees.

Rethinking the Match: A Proposal for Modern Matchmaking.

Since the 1950s, the National Resident Matching Program, or "the Match," has governed the placement of medical students into residencies. The Match was created to protect students in an era when residency positions outnumbered applicants and hospitals pressured students early in their academic careers to commit to a residency position. Now, however, applicants outnumber positions, applicants are applying to increasing numbers of programs, and the costs of the Match for applicants and programs are high. Meanwhile, medical education is evolving toward a competency-based approach, a U.S. physician shortage is predicted, and some researchers describe a "July effect"-worse clinical outcomes correlated with the mass entry of new residents.Against this background, the authors argue for adopting a more modern, free-market approach to residency matchmaking that might better suit the needs of applicants, programs, and the public. They propose allowing students who have been identified by their medical schools as having achieved graduation-level competency to apply to residency programs at any point during the year. Residency programs would set their own application timetables and extend offers in an ongoing fashion. Students, counseled by their schools, would accept or decline offers as desired. The authors argue this approach would better support competency-based education while allowing applicants and programs more choice regarding how they engage and adapt within the selection process. The approach's staggered start times for new residents might attenuate the July effect and improve outcomes for patients. Medical students might also enter and thereby complete residency earlier, increasing the physician workforce.

Charlottesville Health Access: a locality-based model of health care navigation for the homeless.

The authors describe Charlottesville Health Access (CHA), an initiative to get people who are homeless into the health care system. A community homeless shelter worked with faculty and students from the Univ. of Virginia Schools of Medicine and Nursing to create and run the program.