Assessing medical students' confidence in promoting high value care in clinical practice.

Background: Medical students who are exposed to value-based care early in their education may be more likely to practice it. Our study aimed to understand medical students' knowledge of and ability to implement the principles of high-value care in clinical settings. Additionally, we assessed students' confidence in using high-value care practices to both influence care decisions and educate patients. Methods: We surveyed third-year medical students at Texas A&M School of Medicine during their clerkship rotations using a 7-question Likert-scale survey. Students were asked to evaluate their confidence in performing cost-conscious high-value care behaviors. Results: Of the 114 students offered the survey, 34 (30%) completed it fully. The greatest variance in response occurred in students' attitudes toward their role in controlling healthcare costs. Half of respondents agreed or strongly agreed that they played a part in cost control as medical students, with 35% somewhat or strongly disagreeing. A majority of students felt confident initiating a conversation about costs with patients, while 21% somewhat or strongly disagreed that they were confident. Conclusion: Overall, our results reveal that the main area lacking in students' education in value-based care is instilling the belief that they, as medical students, have a role to play in controlling healthcare costs.

The Effects of Humor in Clinical Settings on Medical Trainees and the Implications for Medical Educators: A Scoping Review.

Background: Clinical settings represent the site of patient care and clinical training for medical students and residents. Both processes involve social interaction, and humor is a fundamental component of social interaction that remains underexplored in medical education. This study investigated the impact of humor on medical trainees in the context of the clinical learning environment and examined the implications for medical educators. Methods: Following scoping review methodology, the authors systematically searched six databases and Google Scholar in February 2021 and March 2022. Articles were screened and selected according to inclusion/exclusion criteria, and findings from included articles were synthesized using procedures of metasynthesis. Results: Fifteen articles met inclusion criteria. Six themes emerged relating to the functions and effects of humor in clinical training settings: (1) managing emotions; (2) demarcating insider vs outsider status; (3) facilitating camaraderie; (4) ensuring conformity; (5) negotiating power differentials; and (6) fostering discrimination. Conclusions: The use of humor by medical educators plays an integral role in trainees' everyday experiences. Positive humor helps with coping and communication, while negative humor serves as an indirect medium for communicating ridicule and prejudice. Further research drawing on social psychology theories may identify ways to reduce effects of negative humor and promote well-being and diversity in medical education. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01769-0.

Demise of the USMLE Step-2 CS exam: Rationalizing a way forward.

The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE's fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship.

A Novel Curricular Design Exposing Clinical Medical Students to the Hidden Curriculum.

BACKGROUNDS: The Curriculum Committee of a medical school introduced a longitudinal course for clinical medical students addressing the hidden curriculum as a way to enhance the overall learning environment in undergraduate medical education. METHODS: This novel design included podcasts, virtual online sessions, and self-reflection videos. OUTCOMES: Students and faculty viewed it as successful.