State-of-the-art review of medical improvisation curricula to teach health professional learners communication.

Medical improvisation (improv) applies theater principles and techniques to improve communication and teamwork with health professionals (HP). Improv curricula have increased over time, but little is known about best practices in curricula development, implementation, and assessment. We sought to complete a state-of-the-art review of medical improv curricula to teach HP learners communication skills. A literature search of MEDLINE and 8 other databases on HP medical education and medical improv communication curricula occurred. We screened 1869 articles published from 2012 to 2022. Seventeen articles were selected for extraction and synthesis. Common curricular goals included improving interprofessional, interpersonal, and empathetic communication. Curricula often lacked alignment between learning objectives and improv exercises. Sessions occurred once (65%) or were longitudinal (35%). Only 24% reported a full description of their intervention. Few reported details on the content of curricula. Evaluations often focused on feasibility and acceptability. Heterogeneity exists in the development, implementation, and assessment of improv curricula. Low-quality evidence was provided to support the use of medical improv to teach communication skills to HP learners. Improv curricula were feasible, and acceptable to learners. We offer recommendations to guide future medical improv curricula development.

The pipeline starts in medical school: characterizing clinician-educator training programs for U.S. medical students.

In the past forty years, clinician-educators have become indispensable to academic medicine. Numerous clinician-educator-training programs exist within graduate medical education (GME) as clinician-educator tracks (CETs). However, there is a call for the clinician-educator pipeline to begin earlier. This work aims to identify and characterize clinician-educator track-like programs (CETLs) available in undergraduate medical education (UME). We developed an algorithm of 20 individual keyword queries to search the website of each U.S. allopathic medical school for CETLs. We performed the web search between March to April 2021 and repeated the search between July and September 2021. The search identified CETLs for 79 (51%) of the 155 U.S. allopathic medical schools. The identified CETLs commonly address the clinician-educator competency of educational theory (86%, 68/79), are formally organized as concentrations or analogous structures (52%, 41/79), and span all four years of medical school (37%, 29/79). The prevalence of CETLs varies with geography and medical school ranking. We provide an overview of the current state of CETLs as assessed from institutional websites. To create a future with a sustainable output of skilled clinician-educators, UME must continue to increase the number and quality of CETLs.

Structure and impact of longitudinal Graduate Medical Education curricula designed to prepare future clinician-educators: A systematic scoping review: BEME Guide No. 74.

BACKGROUND: Many Graduate Medical Education (GME) programs offer clinician-educator curricula. The specific instructional methods employed and current best practices for clinician-educator curricula are unknown. We aimed to characterize the structure, curriculum content, instructional methods, and outcomes of longitudinal GME clinician-educator curricula. METHODS: We conducted a scoping review, registered with BEME, by comprehensively searching health science databases and related grey literature from January 2008 to January 2021 for studies involving longitudinal GME curricula aimed to train future clinician-educators. RESULTS: From 9437 articles, 36 unique curricula were included in our review. Most curricula were designed for residents (n = 26) but were heterogeneous in structure, instructional methods, and content. Several curricular themes emerged, including: 1) duration ≥ 12 months, 2) application of theory-based didactics with experiential activities, 3) independent projects, 4) exposure to faculty mentorship and educator communities, 5) strengthening competencies beyond teaching and scholarship, and 6) protected time and funding. Most outcomes were positive and focused on learner satisfaction or behavior change related to scholarly output and career tracking. CONCLUSIONS: Curricula in our review included important skills including experiential teaching, scholarly projects, and exposure to educator communities. Future curricula should build on these competencies and include more assessment of learner and program outcomes.

Relationship-Centered Care in the Physician-Patient Interaction: Improving Your Understanding of Metacognitive Interventions.

The concept of relationship-centered care was first introduced approximately 20 years ago, but this important concept has not yet been widely disseminated in clinical practice. Relationship-centered care in the health profession focuses on all relevant relationships in health care, not only between health care professionals and patients but also among colleagues, staff members, students, community, and self. This review summarizes the key literature to date on relationship-centered care as it pertains to the physician-patient relationship. Becoming more aware of the physician (self) and patient is a form of metacognition, thinking about what is happening in the moment as physicians and patients come together. Considering the complexity of the physician-patient relationship, we can implement simple metacognitive techniques toward the daily habitual practice of relationship-centered care.

Intergenerational trauma in Latinxs: A scoping review.

RATIONALE: Intergenerational trauma refers to emotional and psychological wounding that is transmitted across generations. Latinxs-individuals who have migrated from Latin America to the United States or Canada and their descendants-are particularly vulnerable to intergenerational trauma due to legacies of colonialism, political violence, and migration-related stressors. OBJECTIVE: This scoping review aims to survey and synthesize the extant literature on intergenerational trauma in Latinxs, the ways that the literature conceptualizes and operationalizes intergenerational trauma, and the mechanisms of transmission that it proposes. METHOD: We identified and screened 7788 abstracts using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement and checklist. RESULTS: We synthesized 44 articles published between 1994 and 2020, including 10 qualitative and 34 quantitative or mixed-methods studies. Qualitative studies more frequently placed intergenerational trauma within frameworks of structural vulnerability and historical and political violence, whereas quantitative studies tended to conceptualize trauma as discrete events or individual-level distress. CONCLUSIONS: Our findings suggest that current paradigms within this field are constrained by their focus on individual risk factors and parenting-particularly mothering-behaviors, at the expense of cultural, structural, and historical context. We highlight multiple gaps in the literature and call for further research that (1) geographically represents Latinx communities; (2) includes individuals with intersectional identities; (3) deploys culturally-adapted instruments and measures; (4) focuses on caregivers and factors outside the maternal-child relationship; (5) examines the concept of biological embedding; and (6) more thoroughly considers the impacts of historical trauma and structural violence on Latinx communities.

Librarians as methodological peer reviewers for systematic reviews: results of an online survey.

BACKGROUND: Developing a comprehensive, reproducible literature search is the basis for a high-quality systematic review (SR). Librarians and information professionals, as expert searchers, can improve the quality of systematic review searches, methodology, and reporting. Likewise, journal editors and authors often seek to improve the quality of published SRs and other evidence syntheses through peer review. Health sciences librarians contribute to systematic review production but little is known about their involvement in peer reviewing SR manuscripts. METHODS: This survey aimed to assess how frequently librarians are asked to peer review systematic review manuscripts and to determine characteristics associated with those invited to review. The survey was distributed to a purposive sample through three health sciences information professional listservs. RESULTS: There were 291 complete survey responses. Results indicated that 22% (n = 63) of respondents had been asked by journal editors to peer review systematic review or meta-analysis manuscripts. Of the 78% (n = 228) of respondents who had not already been asked, 54% (n = 122) would peer review, and 41% (n = 93) might peer review. Only 4% (n = 9) would not review a manuscript. Respondents had peer reviewed manuscripts for 38 unique journals and believed they were asked because of their professional expertise. Of respondents who had declined to peer review (32%, n = 20), the most common explanation was "not enough time" (60%, n = 12) followed by "lack of expertise" (50%, n = 10).The vast majority of respondents (95%, n = 40) had "rejected or recommended a revision of a manuscript| after peer review. They based their decision on the "search methodology" (57%, n = 36), "search write-up" (46%, n = 29), or "entire article" (54%, n = 34). Those who selected "other" (37%, n = 23) listed a variety of reasons for rejection, including problems or errors in the PRISMA flow diagram; tables of included, excluded, and ongoing studies; data extraction; reporting; and pooling methods. CONCLUSIONS: Despite being experts in conducting literature searches and supporting SR teams through the review process, few librarians have been asked to review SR manuscripts, or even just search strategies; yet many are willing to provide this service. Editors should involve experienced librarians with peer review and we suggest some strategies to consider.

Entrustable professional activity 7: opportunities to collaborate on evidence-based medicine teaching and assessment of medical students.

BACKGROUND: This study was conducted to examine gaps and opportunities for involvement of librarians in medical education and patient care as well as improve the teaching and assessment of Entrustable Professional Activity 7 (EPA 7) -- the ability to form clinical questions and retrieve evidence to advance patient care. METHODS: The Association of Academic Health Sciences Libraries (AAHSL) Competency-Based Medical Education Task Force surveyed all AAHSL member libraries in October 2016 on health sciences librarian awareness and involvement in teaching and assessing EPA 7. RESULTS: The survey response rate was 54% (88/164 member libraries). While 90% (n = 76) of respondents were regularly engaged in teaching or assessing aspects of EPA 7 only 34 (39%) were involved explicitly in a Core EPA 7 project, 44% (15/34) of these projects were librarian initiated. CONCLUSIONS: Involvement in teaching and assessment of EPA 7 is an untapped opportunity for librarians to collaborate in medical education and patient care. Although librarians are already deeply involved in teaching and assessment of EPA 7 related knowledge, skills, and behaviors, further librarian collaboration can help bolster the planning or updating of existing curricula and assessments of this entrustable professional activity.

Transformative learning as pedagogy for the health professions: a scoping review.

CONTEXT: Transformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field. METHODS: Arksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis. RESULTS: A mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists. CONCLUSIONS: The training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.

Test-enhanced learning in health professions education: A systematic review: BEME Guide No. 48.

BACKGROUND: Cognitive psychology studies demonstrate that subjects who attempt to recall information show better learning, retention, and transfer than subjects who spend the same time studying the same material (test-enhanced learning, TEL). We systematically reviewed TEL interventions in health professions education. METHODS: We searched 13 databases, 14 medical education journals, and reference lists. Inclusion criteria included controlled studies of TEL that compared TEL to studying the same material or to a different TEL strategy. Two raters screened articles for inclusion, abstracted information, determined quality scores, and calculated the standardized mean difference (SMD) for the learning outcomes. RESULTS: Inter-rater agreement was excellent for all comparisons. The 19 included studies reported 41 outcomes with data sufficient to determine a SMD. TEL interventions included short answer questions, multiple choice questions, simulation, and standardized patients. Five of six immediate learning outcomes (SMD 0.09-0.44), 21 of 23 retention outcomes (SMD 0.12-2.5), and all seven transfer outcomes (SMD 0.33-1.1) favored TEL over studying. CONCLUSIONS: TEL demonstrates robust effects across health professions, learners, TEL formats, and learning outcomes. The effectiveness of TEL extends beyond knowledge assessed by examinations to clinical applications. Educators should include TEL in health professions curricula to enhance recall, retention, and transfer.

The personal librarian program: an evaluation of a Cushing/Whitney Medical Library outreach initiative.

The Cushing/Whitney Medical Library (CWML) at the Yale School of Medicine has offered a "Personal Librarian" (PL) program to medical center students since 1996. This outreach program matches students to a professional librarian as they matriculate, a relationship that is maintained until the student graduates. PLs offer individualized assistance for almost anything-from interpreting library policies and procedures to helping locate materials to assisting with thesis research. The program requires nominal effort on the part of the librarians, making it possible to expand the program to include other student groups. A recent survey revealed that students are extremely satisfied with the program and would generally welcome more contact from their PL.