Trainees' Perspectives on the Next Era of Assessment and Precision Education.

ABSTRACT: The next era of assessment in medical education promises new assessment systems, increased focus on ensuring high-quality equitable patient care, and precision education to drive learning and improvement. The potential benefits of using learning analytics and technology to augment medical training abound. To ensure that the ideals of this future for medical education are realized, educators should partner with trainees to build and implement new assessment systems. Coproduction of assessment systems by educators and trainees will help to ensure that new educational interventions are feasible and sustainable. In this paper, the authors provide a trainee perspective on 5 key areas that affect trainees in the next era of assessment: (1) precision education, (2) assessor education, (3) transparency in assessment development and implementation, (4) ongoing evaluation of the consequences of assessment, and (5) patient care data as sources of education outcomes.As precision education is developed, it is critical that trainees understand how their educational data are collected, stored, and ultimately utilized for educational outcomes. Since assessors play a key role in generating assessment data, it is important that they are prepared to give high-quality assessments and are continuously evaluated on their abilities. Transparency in the development and implementation of assessments requires communicating how assessments are created, the evidence behind them, and their intended uses. Furthermore, ongoing evaluation of the intended and unintended consequences that new assessments have on trainees should be conducted and communicated to trainees. Finally, trainees should participate in determining what patient care data are used to inform educational outcomes. The authors believe that trainee coproduction is critical to building stronger assessment systems that utilize evidence-based educational theories for improved learning and ultimately better patient care.

Delayed breast cancer relapse with pleural metastasis and malignant pleural effusion after long periods of disease-free survival.

Breast cancer relapse remains a common cause of morbidity and mortality in patients who undergo initial treatment with surgery and with or without concurrent chemotherapy or radiation. Relapse rates remain high within the first decade after initial treatment, after which the risk of relapse decreases. While common within the first year of breast cancer diagnosis, pleural metastasis with malignant pleural effusion (MPE) after 10-12 years of a disease-free period is rare. Here, we present two uncommon cases of delayed breast cancer relapses with pleural metastasis, which caused MPEs.