Priority Competencies for Designated Education Officers in the Veterans Health Administration.

INTRODUCTION: Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. MATERIALS AND METHODS: Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs. RESULTS: The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains. CONCLUSIONS: Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.

In Search of a "Metric System" for Measuring Faculty Effort: A Qualitative Study on Educational Value Units at U.S. Medical Schools.

PURPOSE: Faculty at academic health centers (AHCs) are charged with engaging in educational activities. Some faculty have developed educational value units (EVUs) to track the time and effort dedicated to these activities. Although several AHCs have adopted EVUs, there is limited description of how AHCs engage with EVU development and implementation. This study aimed to understand the collective experiences of AHCs with EVUs to illuminate benefits and barriers to their development, use, and sustainability. METHOD: Eleven faculty members based at 10 AHCs were interviewed between July and November 2022 to understand their experiences developing and implementing EVUs. Participants were asked to describe their experiences with EVUs and to reflect on benefits and barriers to their development, use, and sustainability. Transcripts were analyzed using thematic analysis. RESULTS: EVU initiatives have been designed and implemented in a variety of ways, with no AHCs engaging alike. Despite differences, the authors identified shared themes that highlighted benefits and barriers to EVU development and implementation. Within and between these themes, a series of tensions were identified in conjunction with the ways in which AHCs attempted to mitigate them. Related to barriers, the majority of participants abandoned or paused their EVU initiatives; however, no differences were identified between those AHCs that retained EVUs and those that did not. CONCLUSIONS: The collective themes identified suggest that AHCs implementing or sustaining an EVU initiative would need to balance benefits and barriers in light of their unique context. Study findings align with reviews on EVUs and provide additional nuance related to faculty motivation to engage in education and the difficulties of defining EVUs. The lack of differences observed between those AHCs that retained EVUs and those that did not suggests that EVUs may be challenging to implement because of the complexity of AHCs and their faculty.

Supporting the Transition to Distance Education During the Pandemic and Beyond.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic affected almost every country around the world, and various forms of lockdown or quarantine measures were implemented. The lockdowns forced medical educators to step beyond traditional educational approaches and adopt distance education technologies to maintain continuity in the curriculum. This article presents selected strategies implemented by the Distance Learning Lab (DLL) at the Uniformed Services University of Health Sciences (USU), School of Medicine (SOM), in transitioning their instruction to an emergency distance education format during the COVID-19 pandemic. MATERIALS AND METHODS: When moving programs/courses to a distance education format, it is important to recognize that two primary stakeholders are involved in the process: faculty members and students. Therefore, to be successful in transitioning to distance education, strategies must address the needs of both groups and provide support and resources for both.The DLL used two lenses of adult learning and targeted needs assessment to design faculty and student support during the pandemic. The DLL adopted a learner-centered approach to education, focusing on meeting the faculty members and students where they are. This translated into three specific support strategies for faculty: (1) workshops, (2) individualized support, and (3) just-in-time self-paced support. For students, DLL faculty members conducted orientation sessions and provided just-in-time self-paced support. RESULTS: The DLL has conducted 440 consultations and 120 workshops for faculty members since March 2020, serving 626 faculty members (above 70% of SOM faculty members locally) at USU. In addition, the faculty support website has had 633 visitors and 3,455 pageviews. Feedback comments provided by faculty members have specifically highlighted the personalized approach and the active, participatory elements of the workshops and consultations.Evaluations of the student orientation sessions showed that they felt more confident in using the technologies after the orientation. The biggest increase in confidence levels was seen in the topic areas and technology tools unfamiliar to them. However, even for tools that students were familiar with before the orientation, there was an increase in confidence ratings. CONCLUSION: Post-pandemic, the potential to use distance education remains. It is important to have support units that recognize and cater to the singular needs of medical faculty members and students as they continue to use distance technologies to facilitate student learning.

Evaluating a Competency-Based Blended Health Professions Education Program: A Programmatic Approach.

INTRODUCTION: Competency-based education (CBE) programs usually evaluate student learning outcomes at a course level. However, a more comprehensive evaluation of student achievement of competencies requires evaluation at a programmatic level across all courses. There is currently insufficient literature on accomplishing this type of evaluation. In this article, we present an evaluation strategy adopted by the competency-based master's degree program at the Center for Health Professions Education at the Uniformed Services University of Health Sciences to assess student achievement of competencies. We hypothesized that (1) learners would grow in the competencies through their time in the program and (2) learners would exhibit a behavioristic change as a result of their participation in the program. MATERIALS AND METHODS: The degree program at the Center for Health Professions Education conducts an annual student self-assessment of competencies using a competency survey. The competency survey data from graduated master's students were collected, providing data from three time points: initial (pre-program survey), middle, and final (end-of-program survey). Open-ended responses from these three surveys were also analyzed. A general linear model for repeated measures was conducted. Significant effects were followed by post hoc tests across time. We also conducted post hoc analysis across domains to better understand the comparative levels of the domains at each time point. The responses to the open-ended prompt were thematically analyzed. RESULTS: Analysis of the quantitative data revealed that (1) learners reported significant growth across time, (2) learners had different perceptions of their competencies in each of the domains, and (3) not all domains experienced similar changes over time. Analysis of the free responses highlighted the impact of coursework on competency attainment and the behavioristic change in learners. CONCLUSIONS: This study presents a strategic evaluation tool for course-based CBE programs that follow a traditional credit hour model. Programmatic evaluation of CBE programs should enable the inclusion of the learner's voice and provide evaluation data that go beyond individual course evaluations.

Addressing HPSP Learner Needs: A Pilot Study of a "Fundamentals of Military Medicine" Course.

INTRODUCTION: Military medicine is uniquely different from civilian medicine, and military physicians in the USA are primarily recruited through the Health Professions Scholarship Program (HPSP) and the Uniformed Services University of the Health Sciences (USUHS). Medical students at the USUHS receive more than 650 hours of military-specific curriculum and spend 21 days engaged in field exercises. HPSP students complete two 4-week officer training sessions during their 4 years of medical school. There is a clear discrepancy in preparation for military medicine between HPSP and USUHS students. The USUHS School of Medicine undertook an initiative to develop a fully online self-paced course on the fundamentals of military medicine topics to help HPSP students bridge the gap in their preparation. This article will describe how the online self-paced course was designed and present feedback from the pilot offering of this course. MATERIALS AND METHODS: As proof of concept of the effectiveness of an online self-paced course for teaching the fundamentals of military medicine to HPSP students, two chapters from the "Fundamentals of Military Medicine" published by the Borden Institute were transferred to an online format. Each chapter was offered as a module. In addition to the chapters, an introduction and closing module were added to the pilot course. The pilot course was offered over 6 weeks. Data for this study were obtained from module feedback surveys, pre- and post-course quizzes, participant focus groups, and course evaluation surveys. Pre- and post-test scores were analyzed to evaluate content knowledge. The open-ended survey questions on the feedback forms and focus group transcripts were collated and analyzed as textual data. RESULTS: Fifty-six volunteers enrolled in the study, and 42 completed the pre- and post-course quizzes. This participant pool included HPSP students (79%, n = 44) and military residents in civilian graduate medical education programs (21%, n = 12). The module feedback surveys showed that most participants spent 1 to 3 hours on each of the modules, which they rated as extremely or quite reasonable (Module 1: 64%, Module 2: 86%, Module 3: 83%). There was not much difference between the overall quality of the three modules. The participants found content on application to the military-specific context very valuable. Of the different course elements, video content was rated as the most effective. Participant feedback clearly highlighted that HPSP students want a course that informs them about the fundamentals of military medicine and demonstrates how the information would apply to their lives. Overall, the course was effective. HPSP students showed knowledge gains and self-reported satisfaction with the course's objectives. They were able to locate information easily and understand the course expectations. CONCLUSIONS: This pilot study has shown that there is a need for a course that provides the fundamentals of military medicine to HPSP students. A fully online self-paced course provides flexibility for the students and improves access.

Successful Surgical Airway Performance in the Combat Prehospital Setting: A Qualitative Study of Experienced Military Prehospital Providers.

INTRODUCTION: Military first responders are in a unique category of the healthcare delivery system. They range in skill sets from combat medic and corpsman to nurses, physician assistants, and occasionally, doctors. Airway obstruction is the second leading cause of preventable battlefield death, and the decision for intervention to obtain an airway depends on the casualty's presentation, the provider's comfort level, and the available equipment, among many other variables. In the civilian prehospital setting cricothyroidotomy (cric) success rates are over 90%, but in the US military combat environment success rates range from 0-82%. This discrepancy in success rates may be due to training, environment, equipment, patient factors and/or a combination of these. Many presumed causes have been assumed to be the root of the variability, but no research has been conducted evaluating the first-person point of view. This research study is focused on interviewing military first responders with real-life combat placement of a surgical airway to identify the underlying influences which contribute to their perception of success or failure. MATERIALS AND METHODS: We conducted a qualitative study with in-depth semi-structured interviews to understand participants' real-life cric experiences. The interview questions were developed based on the Critical Incident Questionnaire. In total, there were 11 participants-4 retired military and 7 active-duty service members. RESULTS: Nine themes were generated from the 11 interviews conducted. These themes can be categorized into 2 groups: factors internal to the provider, which we have called intrinsic influences, and factors external to the provider, which we call extrinsic influences. Intrinsic influences include personal well-being, confidence, experience, and decision-making. Extrinsic influences include training, equipment, assistance, environment, and patient factors. CONCLUSIONS: This study revealed practitioners in combat settings felt the need to train more frequently in a stepwise fashion while following a well-understood airway management algorithm. More focus must be on utilizing live tissue with biological feedback, but only after anatomy and geospatial orientation are well understood on models, mannequins, and cadavers. The equipment utilized in training must be the equipment available in the field. Lastly, the focus of the training should be on scenarios which stress the physical and mental capabilities of the providers. A true test of both self-efficacy and deliberate practice is forced through the intrinsic and extrinsic findings from the qualitative data. All of these steps must be overseen by expert practitioners. Another key is providing more time to focus on medical skills development, which is critical to overall confidence and overcoming hesitation in the decision-making process. This is even more specific to those who are least medically trained and the most likely to encounter the casualty first, EMT-Basic level providers. If possible, increasing the number of medical providers at the point of injury would achieve multiple goals under the self-efficacy learning theory. Assistance would instill confidence in the practitioner, help with the ability to prioritize patients quickly, decrease anxiety, and decrease hesitation to perform in the combat environment.

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010-2020.

BACKGROUND: Quality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM). Research on increasing diversity within the academic medicine student body or faculty notes the important role of leadership. Yet, there is a scarcity in research into diversity in leadership. OBJECTIVE: The purpose of this study is to go beyond aggregate numbers and answer the question: What is the level of parity representation, by gender and race, at department chair positions in academic IM departments? DESIGN: A cross-sectional analysis of race/ethnicity and gender in IM medical school departments from 2010 to 2020 was conducted using data from the American Association of Medical College's (AAMC) Faculty Roster. The proportion of IM department chairs to IM faculty by race/ethnicity for each year (2010-2020) was used to calculate the Leadership Parity Index (LPI) in this study. LPI by gender and by gender and race/ethnicity were also calculated for each year. RESULTS: In aggregate numbers, Black or African American and Hispanic, Latino, or of Spanish Origin faculty remain under-represented in academic IM each making up, on average, approximately 4% of the total IM faculty. The LPI calculations revealed that faculty who identified as White were consistently over-represented as department chairs while Asian faculty were consistently under-represented in leadership and ranked lowest in leadership parity among the ethnic groups studied. The leadership parity index also showed that women faculty across all races were under-represented. CONCLUSION: Women and Asian faculty encounter a ceiling effect that may be at play in IM departments. While significant progress still needs to be made in the representation of under-represented minorities, the findings of this study show that aggregate data does not provide a true picture of equity and parity in Internal Medicine faculties.

Corneal Laser Refractive Surgery Curriculum Development in the Military: Using the Nominal Group Technique.

INTRODUCTION: Corneal laser refractive surgery (CRS) has emerged over the past three decades as a surgical method for correcting or improving vision. In the military, CRS helps warfighters achieve weapon grade vision, which offers a tactical advantage in the deployed environment. As refractive surgery has become more prevalent in both the military and civilian sector, more ophthalmologists need to learn about treatment options as well as management of complications in order to meet increasing patient demand. Currently, little is known about the most effective curriculum for teaching refractive surgery in training programs, and a standardized curriculum does not exist. Since unification of training programs is a Defense Health Agency priority, this study aimed to collect expert consensus on a standardized curriculum for CRS training in the military. MATERIALS AND METHODS: To achieve this goal, the Nominal Group Technique (NGT) was used wherein a panel of experts, currently practicing refractive surgeons involved in military refractive surgery training programs, arrived at consensus on a standardized CRS curriculum. The framework for developing this curriculum is based on Kern's Six-Step Approach to Curriculum Development. The International Council of Ophthalmology refractive surgery curriculum, National Curriculum for Ophthalmology Residency Training, Accreditation Council for Graduate Medical Education competencies and surgical minimums, and American Academy of Ophthalmology Refractive Surgery Preferred Practice Guidelines were used as the starting materials from which panelists' consensus was drawn. This consensus-building method allowed for equal representation of experts' ideas and fostered collaboration to aid in the creation of a robust and standardized curriculum for refractive surgery training programs in the military. RESULTS: The panelist experts from this NGT were able to reach consensus on the components of a standardized military refractive surgery curriculum to include generalized and targeted needs assessment, goals and objectives, educational strategies, and curriculum implementation. CONCLUSION: A standardized CRS curriculum is warranted in military training programs. This NGT achieved expert consensus on the goals, objectives, educational methods, and implementation strategies for a standardized CRS curriculum in military ophthalmology residency.

Reimagining Physician Development and Lifelong Learning: An Ecological Framework.

ABSTRACT: Learners and leaders in medical education recognize the remarkable growth in clinically relevant information, persistent changes in the organization of health care, and the need to develop physicians able to adapt successfully to changes in their lives and practices. The success of those physicians and of those who facilitate their learning depends on a careful understanding of the psychological, social, and biological factors that influence physician development and lifelong learning. To improve research and policy, development and learning must be explored for finer understandings of physicians in relation to other beings and to the physical and social surroundings most conducive to better learning and outcomes.

Train for the Game: What Is the Learning Environment of Deployed Navy Emergency Medicine Physicians?

OBJECTIVES: Medicine is a practice characterized by ongoing learning, and unique qualities of the operational learning environment (LE) may affect learner needs. When physicians move between differing practice environments learners may encounter situations for which they are unprepared. Using a conceptual framework specific to the LE, we therefore asked the following research question: what is the difference in LE for Navy emergency medicine (EM) physicians who practice in U.S. hospitals but serve an operational environment, and how do these differences shape their learning needs? METHODS: We interviewed Navy EM physicians who recently deployed to explore their perceptions of the deployed LE, how it differed from the LE they practice in stateside, and the perceived effect this difference had on their learning needs. We used the constant comparative method to gather and analyze data until thematic saturation was achieved. RESULTS: We interviewed 12 physicians and identified six interconnected themes consistent with the LE framework in the literature: 1) patient care is central to the learning experience; 2) professional isolation versus connectedness; 3) a sense of meaningful practice engages the learner in the LE; 4) physicians as educators shape the LE; 5) team trust impacts the LE; and 6) the larger military organization impacts the LE. CONCLUSIONS: Our themes span the conceptual framework put forth by previous work and did not find themes outside this framework. These interconnected themes describe the difference in LE between the stateside and deployed setting and impact the learning needs of Navy EM physicians. These results inform strategies to position the deployed medical unit for success.

Quantity and Quality of Physical Medicine and Rehabilitation Clerkships in US Medical Schools.

OBJECTIVE: The purpose of this study was to address two underreported issues in undergraduate physical medicine and rehabilitation medical education: quantity and quality of physical medicine and rehabilitation clerkships in US medical schools. DESIGN: A multimethod sequential design was used to evaluate the curricula of US medical schools. Quantity (N = 154) of physical medicine and rehabilitation clerkships was assessed by counting the number of required, selective, and elective clerkships in each medical school. Quality (n = 13) was assessed by conducting a thematic analysis on physical medicine and rehabilitation clerkship curricula to identify learning objectives. These objectives were then compared with learning objectives in a model standard. RESULTS: Whereas few medical schools required a physical medicine and rehabilitation clerkship, most offered elective rotations in physical medicine and rehabilitation. Most medical schools only included 6 of the 12 model standard learning objectives. Medical schools also included 29 learning objectives not present in the model standard. CONCLUSIONS: Physical medicine and rehabilitation clerkships are not underrepresented but are underemphasized, in undergraduate medical schools. Furthermore, these clerkships use inconsistent learning objectives. Thus, findings suggest the need to draw attention to physical medicine and rehabilitation clerkships by offering them as selectives and to develop a list of standardized learning objectives. This exploratory study developed such a groundbreaking list and invites the physical medicine and rehabilitation community to test it.

Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses.

PURPOSE: Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes? METHOD: In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4. RESULTS: Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. CONCLUSIONS: Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.

Primary Care Behavioral Health Training in Family Medicine Residencies: A Qualitative Study From a Large Health Care System.

BACKGROUND AND OBJECTIVES: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. METHODS: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs' current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. RESULTS: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. CONCLUSIONS: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.

Specialty Choices, Practice Characteristics, and Long-term Outcomes of Two Cohorts of USUHS Medical School Graduates Compared with National Data.

Introduction: The education of health professionals and the assessment of their long-term goals are essential. Additionally, in the military health system (MHS), such programs also have the goals of improving readiness, providing high-quality care and meeting the needs and challenges of the MHS. The Uniformed Services University F. Edward Hebert School of Medicine (USUHS) has existed for over 40 years and the assessment of the longer term outcomes of its medical school graduates is an important endeavor. The purpose of this study is to describe the relationship of USUHS on the care in the MHS by reporting specialty choices, practice characteristics and locations of two consecutive cohorts of USUHS graduates and to compare these cohort findings with national data. Two cohorts were chosen as the first cohort has reached retirement and we sought to describe the impact of our graduates following their military service commitment. Materials and Methods: We performed a retrospective analysis of our graduates (1980-2009) using data obtained from the American Medical Association Physician Masterfile in two 15-year cohorts. USU graduate data are described and compared with national allopathic medical school data in order to explore USUHS graduates' practice characteristics and how these contrast with national data. Results: Family medicine was the most commonly identified primary care specialty across both USUHS cohorts. Other primary care specialties such as Internal Medicine and Pediatrics became more popular among USUHS graduates over time. There were a lower percentage of inactive USUHS graduates from the 1980-1994 cohorts than the U.S. national sample (3.23% vs. 3.98%). The proportion of USUHS graduates working in an office-based practice increased from 34.8% (1980-1994) to 43.6% (1995-2009) yet still was lower than U.S. national data (1980-1994: 73.5%; 1995-2009: 73.8%). The type of practice in which the majority of USUHS and national graduates were involved was direct patient care (over 70% of the population). Practice locations for medical school graduates included all 50 states. Furthermore, though several states such as Mississippi, Nevada, South Carolina, and Utah were among the top 20 practice locations among USUHS graduates, they did not appear among the top 20 practicing states for U.S. graduates. Conclusions: USUHS can play a major role by training health care professionals needed to meet the large health care strategic goals of a transforming military health system. A high percentage of USUHS graduates had significant changes in practice characteristics over time, are staying in practice for longer time compared with U.S. graduates, and practice in all 50 states including those that are underserved.

Uniformed Services University Women's Enrollment and Career Choices in Military Medicine: A Retrospective Descriptive Analysis.

INTRODUCTION: The purpose of this study was to examine Uniformed Services University (USU) women graduates in terms of percent of graduates', specialty choices and practice choices as compared to civilian women who graduate and practice medicine in the USA. This is a perspective that is currently not well understood. MATERIALS AND METHODS: We conducted a retrospective cohort study of all USU women graduates (1980-2015) using the 2016 American Medical Association (AMA) Physician Masterfile that included data from the American Board of Medical Specialties (ABMS). To describe USU women graduates' current practice status we queried for: (1) medical school; (2) year of graduation; (3) practice state; (4) primary specialty board; and (5) major professional activity (office-based practice vs. full-time hospital staff). Data were analyzed using descriptive statistics. RESULTS: Our findings indicate that the percentage of USU women graduates has increased over time and stands at 29% for the 2010-2015 cohort as compared to 48% for women graduating from all U.S. medical schools. USU women graduates have a slightly higher board certification rate (89%) than the national cohort (88%). USU women graduates also have a higher percentage in family medicine (19%) than the national cohort (14%). USU women graduates practice in 48 states and were equally split between full-time hospital staff and office-based practice which differs from the national cohort that has a much higher proportion in office-based practice (85%). CONCLUSIONS: Women are making significant gains in enrollment at USU, obtaining board certification at similar, and in some cases, higher rates than their civilian peers, and practicing in diverse specialties. This study provides a descriptive picture of women's enrollment and practice characteristics from a military-based medical school. Future work could examine underlying factors that may influence their school choice, career experiences, and trajectories. Future research could also focus on women's experiences of mentoring and support to better understand these factors.

Training the Doctors: A Scoping Review of Interprofessional Education in Primary Care Behavioral Health (PCBH).

Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.

Untying the Interprofessional Gordian Knot: The National Collaborative for Improving the Clinical Learning Environment.

The National Collaborative for Improving the Clinical Learning Environment (NCICLE) is a growing group of over 40 organizations representing a variety of health professions. NCICLE is beginning a discussion of issues related to culture in health care, specifically how the current culture inhibits optimal outcomes, and the discordance between current early interprofessional education (IPE) curricula in health professions schools and traditional practice models in health care. In October 2017, the Accreditation Council for Graduate Medical Education and the Josiah Macy Jr. Foundation sponsored an NCICLE symposium on optimizing interprofessional clinical learning environments. In this Invited Commentary, the authors observe that interprofessional practice and education is a decades-long field that has presented a "Gordian knot" of intractable, complex problems to solve because medicine has often not been at the table for conversations about IPE. The NCICLE symposium represented an important opportunity for medicine to signal that finding new solutions for unraveling the interprofessional Gordian knot and creating optimal clinical learning environments requires meaningful participation from all health professions. Those solutions need to build on the long history of experience and research in IPE and collaborative practice. After the NCICLE symposium provided a promising beginning, the authors propose three essential issues and one key practical step forward to move the interprofessional agenda forward.