Correction to: Implementing a Blood Pressure Measurement Curriculum for First-Year Medical Students.

[This corrects the article DOI: 10.1007/s40670-023-01825-9.].

Academic performance of students in an accelerated medical pathway.

Accelerated medical school curricula, such as three-year programs, have gained attention in recent years but studies evaluating their impact are still scarce. This study examines the Fully Integrated Readiness for Service Training (FIRST) program, a three-year accelerated pathway, to assess its impact on students' academic performance preparedness for residency. In this observational study, we compared the academic outcomes of FIRST program students to traditional four-year curriculum students from 2018 to 2023. We analyzed multiple metrics, including exam performance (United States Medical Licensing Examination Step scores, shelf exam scores, and pre-clinical course scores) and clinical performance scores during the application and individualization phases. Analysis of Variance was used to examine the effect of accelerated pathway program experience relative to traditional 4-year medical school curriculum on the learning outcomes. FIRST program students were on average 1.5 years younger upon graduation than their traditional peers. While FIRST program students scored slightly lower on Step 2 Clinical Knowledge (CK), they exhibited no significant differences in other exam scores or clinical performance relative to the traditional students. Notably, FIRST students achieved equivalent clinical performance ratings during critical clerkships and rotations. Our findings suggest that a three-year medical school curriculum can effectively prepare students for residency and produce graduates with comparable medical knowledge and clinical skills, offering potential benefits in terms of financial relief and personal well-being for medical students.

Implementing a Blood Pressure Measurement Curriculum for First-Year Medical Students.

A core clinical skill medical students need to learn is obtaining an accurate blood pressure (BP) reading. We developed a standardized BP curriculum for first-year medical students. Medical students completed online modules and a hands-on skills session to learn BP skills. Pre- and post-surveys and an observed structured clinical encounter (OSCE) assessed student confidence and ability to accurately measure BP. Student confidence and mean OSCE scores (pre = 2.63, post = 6.51; p < 0.001) improved upon completion of the curriculum. The curriculum was feasible, well received, and improved student's skills for taking an accurate BP.

Mentoring Medical Education Research: Guidelines from a Narrative Review.

Mentorship is critical to develop research scholars. Current literature provides mentorship guidance for biomedical research; however, mentorship for educational research is scarce. We explored literature to offer evidence-based guidance for medical education research mentors. A librarian searched peer-reviewed literature from 2001 to 2021 to identify guidelines for research mentors. Thirty-five articles were included in this narrative review. Our results identified attributes of mentors, overlapping roles, and barriers and benefits of mentoring. The structures and processes related to mentoring are reviewed and applicability to medical education research mentorship is summarized. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01565-2.

Evaluating Family Medicine Resident Narrative Comments Using the RIME Scheme.

Background: In 2013, the Accreditation Council on Graduate Medical Education (ACGME) launched the Next Accreditation System, which required explicit documentation of trainee competence in six domains. To document narrative comments, the University of North Carolina Family Medicine Residency Program developed a mobile application to document real time observations. Objective: The objective of this work was to assess if the Reporter, Interpreter, Manager, Expert (RIME) framework could be applied to the narrative comments in order to convey a degree of competency. Methods: From August to December 2020, 7 individuals analyzed narrative comments of four family medicine residents. The narrative comments were collected from July to December 2019. Each individual applied the RIME framework to the comments and the team met to discuss. Comments where 5/7 individuals agreed were not further discussed. All other comments were discussed until consensus was achieved. Results: 102 unique comments were assessed. Of those comments, 25 (25.5%) met threshold for assessor agreement after independent review. Group discussion about discrepancies led to consensus about the appropriate classification for 92 (90.2%). General comments on performance were difficult to fit into the RIME framework. Conclusions: Application of the RIME framework to narrative comments may add insight into trainee progress. Further faculty development is needed to ensure comments have discrete elements needed to apply the RIME framework and contribute to overall evaluation of competence.

Accelerated 3-Year MD Pathway Programs: Graduates' Perspectives on Education Quality, the Learning Environment, Residency Readiness, Debt, Burnout, and Career Plans.

PURPOSE: To compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans. METHOD: Customized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools. RESULTS: GQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student-faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons). CONCLUSIONS: These findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.

Fully Integrated Readiness for Service Training (FIRST): An Accelerated Medical Training Program for Rural and Underserved North Carolina.

PROBLEM: The U.S. primary care workforce remains inadequate to meet the health needs of the U.S. population. Effective programs are needed to provide workforce development for rural and other underserved areas. APPROACH: At the University of North Carolina (UNC) School of Medicine (SOM), between November 2014 and July 2015, the authors developed and implemented the Fully Integrated Readiness for Service Training (FIRST) Program, an accelerated curriculum focused on rural and underserved care that links 3 years of medical school with a conditional acceptance into UNC's 3-year family medicine residency, followed by 3 years of practice support post-graduation. Students are recruited to the FIRST Program during the fall of their first year of medical school. The FIRST Program promotes close faculty mentorship and familiarity with the health care system, includes a longitudinal quality improvement project with an assigned patient panel, includes early integration into the clinic, and fosters a close cohort of fellow students. OUTCOMES: As of March 2020, the FIRST Program had successfully recruited 5 classes of medical students, and 3 of those classes had matched into residency. In total, as of March 2020, 18 students had participated in the FIRST Program. NEXT STEPS: The FIRST Program will be expanded to additional clinical sites across North Carolina and to specialties beyond family medicine, including pediatrics, general surgery, and psychiatry.

Content Analysis of Family Medicine Resident Peer Observations.

BACKGROUND AND OBJECTIVES: Direct observation is a critical part of assessing learners' achievement of the Accreditation Council for Graduate Medical Education (ACGME) Milestones and subcompetencies. Little research exists identifying the content of peer feedback among residents; this study explored the content of residents' peer assessments as they relate to ACGME Milestone subcompetencies in a family medicine residency program. METHODS: Using content from a mobile app-based observation tool (M3App), we examined resident peer observations recorded between June 2014 and November 2017, tabulating frequency of observation for each ACGME subcompetency and calculating the proportion of observations categorized under each subcompetency, as well as for each postgraduate year (PGY) class. We also coded each observation on three separate dimensions: "positive," "constructive," and "actionable." We used the χ2 test for independence, and estimated odds ratios and 95% confidence intervals for two-by-two comparisons to compare numbers of observations within each category. RESULTS: Our data include 886 peer observations made by 54 individual residents. The most frequently observed competencies were in patient care, communication, and professionalism (56%, 47%, and 38% of observations, respectively). Practice-based learning and improvement was observed least frequently (16% of observations). On average, 97.25% of the observations were positive, 85% were actionable, and 6% were constructive. CONCLUSIONS: When asked to review their peers, residents provide comments that are primarily positive and actionable. In addition, residents tend to provide more feedback on certain subcompetencies compared to others, suggesting that programs may rely on peer feedback for specific subcompetencies. Peers can provide perspective on the behaviors and skills of fellow residents.

Leadership Pathways in Academic Family Medicine: Focus on Underrepresented Minorities and Women.

BACKGROUND AND OBJECTIVES: Leadership positions in academic medicine lack racial and gender diversity. In 2016, the Council of Academic Family Medicine (CAFM) established a Leadership Development Task Force to specifically address the lack of diversity among leadership in academic family medicine, particularly for underrepresented minorities and women. APPROACH: The task force was formed in August 2016 with members from each of the CAFM organizations representing diversity of race, gender, and academic position. The group met from August 2016 to December 2017. The task force reviewed available leadership development programming, and through consensus identified common pathways toward key leadership positions in academic family medicine-department chairs, program directors, medical student education directors, and research directors. consensus development: The task force developed a model that describes possible pathways to several leadership positions within academic family medicine. Additionally, we identified the intentional use of a multidimensional mentoring team as critically important for successfully navigating the path to leadership. CONCLUSIONS: There are ample opportunities available for leadership development both within family medicine organizations and outside. That said, individuals may require assistance in identifying and accessing appropriate opportunities. The path to leadership is not linear and leaders will likely hold more than one position in each of the domains of family medicine. Development as a leader is greatly enhanced by forming a multidimensional team of mentors.

How do these 3 diabetes agents compare in reducing mortality?

A meta-analysis reveals that there may be advantages associated with SGLT-2 inhibitors and GLP-1 agonists that are not associated with DPP-4 inhibitors.

PURLs: Which combined OC to prescribe with CV safety in mind?

With various formulations available, which combined OC should you recommend to minimize not only the risk of PE, but also the risk of stroke and MI?

Piloting the Mobile Medical Milestones Application (M3App©): A Multi-Institution Evaluation.

BACKGROUND AND OBJECTIVES: Competency-based evaluation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones requires the development of new evaluation tools that can better capture learners' behavior. This study describes the implementation and initial assessment of an innovative point-of-care mobile application, the M3App,© linked to the Family Medicine Milestones. METHODS: Seven family medicine residency programs in North Carolina implemented the M3App.© Program faculty and residents were surveyed prior to implementation regarding current evaluation methods and their quality and use and acceptability of electronic evaluation tools. Surveys were repeated after implementation for comparison. RESULTS: All seven programs successfully implemented the M3App. Most faculty members found the tool well designed, easy to use, beneficial to the quality and efficiency of feedback they provide, and to their knowledge of Milestones. Residents reported significant increases in the volume and quality of written feedback they receive. CONCLUSIONS: The M3App provides an efficient, convenient tool for assessing Milestones that can improve the quantity and quality of feedback residents receive from faculty. Improved faculty perception of knowledge of Milestones after M3App implementation suggests that the tool is also effective for faculty development.

Learnings From the Pilot Implementation of Mobile Medical Milestones Application.

BACKGROUND: Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs. OBJECTIVE: We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool. METHODS: Residents and faculty completed presurveys and postsurveys about the tool and the evaluation process in their program. Program directors were interviewed individually. Interviews and open-ended survey responses were analyzed and coded using the constant comparative method, and responses were tabulated under themes. RESULTS: Common perceptions included increased data collection, enhanced efficiency, and increased perceived quality of the information gathered with the M3App. Residents appreciated the timely, high-quality feedback they received. Faculty reported becoming more comfortable with the tool over time, and a more favorable evaluation of the tool was associated with higher utilization. Program directors reported improvements in faculty knowledge of the milestones and resident satisfaction with feedback. CONCLUSIONS: Faculty and residents credited the M3App with improving the quality and efficiency of resident feedback. Residents appreciated the frequency, proximity, and specificity of feedback, and faculty reported the app improved their familiarity with the milestones. Implementation challenges included lack of a physician champion and competing demands on faculty time.