Occupying liminal spaces: The figured worlds of student affairs senior leaders in the United States.

INTRODUCTION: Student Affairs Senior Leaders (SASLs) in the United States lead offices responsible for academic advising, administrative documentation, scheduling, student health, financial aid, and transition to residency, yet they infrequently draw attention in the field's literature. We explore the role of SASLs and how they describe the social space of medical education. METHODS: Using a constructivist approach informed by Figured Worlds theory, we conducted a sequential narrative and thematic analysis of the stories SASLs tell about their roles and experiences in the world of medical education. RESULTS: SASLs inhabit complex roles centred on advocating for medical students' academic, personal and social well-being. Their unique position within the medical school allows them to see the harm to vulnerable students made possible by misalignments inherent within medical education. Yet even with the challenges inherent in the environment, SASLs find reasons for hope. CONCLUSION: SASLs' identities are full of potential contradictions, but they have a unique view into the often-chaotic world of medical education.

The figured world of medical education senior leaders: Making meaning and enacting agency.

INTRODUCTION: The field of medical education is relatively new, and its boundaries are not firmly established. If we had a better understanding of the intricacies of the domain, we might be better equipped to navigate the ever-changing demands we must address. To that end, we explore medical education as a world wherein leaders harness agency, improvisation, discourse, positionality and power to act. METHODS: Using the constructivist theory of figured worlds (FW), we conducted a narrative analysis of the stories medical education senior leaders tell about their roles and experiences in the world of medical education (n = 9). RESULTS: We identified four foundational premises about the world of medical education: (i) medical education stands at the intersection of three interrelated worlds of clinical medicine, hospital administration and university administration; (ii) medical education is shaped by and shapes the clinical learning environment at the local level; (iii) medical education experiences ubiquitous change which is a source of power; and (iv) medical education is energised by relationships between individuals. DISCUSSION: Focusing on the FW theory's notions of agency, improvisation, discourse, positionality and power enabled us to describe the world of medical education as a complex domain existing in a space of conflicting power hierarchies, identities and discourses. Using FW allowed us to see the powerful affordances offered to medical education due to its position between worlds amid unceasing change.

Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study.

PURPOSE: The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students. METHOD: Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses. RESULTS: Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty. CONCLUSIONS: This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

How to use theory as method in HPE research.

Recognising that scholars in health professions education (HPE) are often unfamiliar with theory-informed research, we provide guidance on a robust method for using theory as a method to inform every aspect of research design from research question formation to data analysis and reporting. Using the Figured Worlds theory to illustrate the process, we mapped six concepts of particular importance to HPE: the figured world, agency, improvisation, discourse, positionality and power. Together the concepts were helpful analytic tools for our topic of interest. The concept of the figured world informed the construction of our program of research. Agency was useful in exploring the ways that subjects acted or did not act. We crafted interview questions to illustrate participants' unique improvisations. Discourse, or the world's artefacts both verbal and embodied, informed our understanding of the world's norms. Positionality allowed us to compare the agentic action of different participants. Finally, power offered an opportunity to recognise the intersection of the positional identities of participants and their stories of action or inaction. While theory-informed analytic tools offer an opportunity to construct nuanced understanding, generating new insights into study subjects and their worlds, caution is necessary as qualitative inquiry is an evolving process of give and take. Everything from the study's questions, methods and even theories might need to flex in response to the data. Ultimately, though initially intimidating, theories offer concrete methodological tools HPE scholars can rely on.

Graduating Medical Students' Experiences with Away (In-Person and Virtual) Rotations During COVID-19: Analysis of the Association of American Medical Colleges (AAMC) 2021 Graduation Questionnaire (GQ).

OBJECTIVE: The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates. DESIGN: Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models. SETTING: Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis. PARTICIPANTS: Our study included data for 15,451 GQ respondents (74% of all 2021 graduates). RESULTS: Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3). CONCLUSIONS: The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard.

RIME 60 Years: Celebration and Future Horizons.

This year marks the 60th anniversary (1961-2021) of Research in Medical Education (RIME). Over the past 6 decades, RIME has selected medical education research to be presented each year at the Association of American Medical Colleges Annual Meeting: Learn Serve Lead and published in a supplement of Academic Medicine. In this article, the authors surveyed RIME chairs from the past 20 years to identify ways that RIME has advanced medical education research and to generate ideas for future directions. RIME chairs described advancements in the rigor and impact of RIME research and the timeliness of the topics, often serving as a driver for cutting-edge research. They highlighted RIME's role in promoting qualitative research, introducing new epistemologies, and encouraging networking as a means of career advancement. Going forward, RIME chairs suggested (1) strengthening collaborations with formal advanced MEd and PhD degree programs, (2) creating formal mentorship channels for junior and minority faculty, and (3) promoting research related to knowledge translation.

Medical Education in the United States and Canada, 2020.

For the third time this century, the Association of American Medical Colleges has coordinated a collection of reports from their member medical schools that collectively reflect the state of medical education in the United States and Canada. This introduction to the September 2020 supplement to Academic Medicine provides an overview of the collection, with 145 out of 171 eligible medical schools participating in the project. The authors observe trends and similarities across the reports from participating schools, structuring the introduction to mirror the main questions posed to the schools: highlights of each school's medical education program, curriculum description, curricular governance, education staff, faculty development and support in medical education, regional medical campuses, and initiatives in progress. Key findings from the authors include expansion of student enrichment tracks, early clinical encounters, focus on wellness, expansion in competency-based medical education, and continued evolution of approaches to assessment. The authors note that this supplement was produced before COVID-19, and although it robustly chronicles the prepandemic state of medical education, medical education has already evolved and will continue to do so. This view offers important opportunities to observe and study changes in the curricula.

Regional medical campuses: a new classification system.

There is burgeoning belief that regional medical campuses (RMCs) are a significant part of the narrative about medical education and the health care workforce in the United States and Canada. Although RMCs are not new, in the recent years of medical education enrollment expansion, they have seen their numbers increase. Class expansion explains the rapid growth of RMCs in the past 10 years, but it does not adequately describe their function. Often, RMCs have missions that differ from their main campus, especially in the areas of rural and community medicine. The absence of an easy-to-use classification system has led to a lack of current research about RMCs as evidenced by the small number of articles in the current literature. The authors describe the process of the Group on Regional Medical Campuses used to develop attributes of a campus separate from the main campus that constitute a "classification" of a campus as an RMC. The system is broken into four models-basic science, clinical, longitudinal, and combined-and is linked to Liaison Committee on Medical Education standards. It is applicable to all schools and can be applied by any medical school dean or medical education researcher. The classification system paves the way for stakeholders to agree on a denominator of RMCs and conduct future research about their impact on medical education.

Including resident photographs on electronic evaluations: is a picture worth a thousand words?

BACKGROUND: Trends toward electronic course evaluation make it possible to personalize evaluations in many ways, such as including resident photographs. The purpose of the present project was to explore the impact of adding photos to electronic evaluations of residents by faculty. DESCRIPTION: T tests were used to examine faculty responses to determine if resident outcomes were affected by the inclusion/exclusion of photographs from the perspective of the resident receiving the evaluation and the faculty giving the evaluation. A qualitative analysis of comments was performed. EVALUATION: Almost no significant differences were found on the level of resident or faculty (all but one p> .05) Qualitative analysis of the comments did reveal common themes, but no significant differences were apparent between groups with/without photographs (all ps > .05). CONCLUSION: Including or excluding photographs on evaluation forms did not impact resident outcomes. Future study should explore the effect of elapsed completion time on resident evaluation.

The development and implementation of a health-system-wide evaluation system for education activities: build it and they will come.

Academic health centers (AHCs) use education evaluation data for multiple purposes, and they also use multiple methods to collect data in an effort to evaluate the quality of student and faculty performance. Collecting evaluation data in a standardized manner enabling collation and subsequent assessment and interpretation is critically important if the information is to be maximally useful. A case study is presented of PENN Medicine's education evaluation program and the complicated mission of developing a multiprogram, multipurpose evaluation system, developed and implemented from 2003 to 2007. The proposed solution is generalizable to other comparable AHCs. The article begins with a structured analysis of needs, continues with a description of the conceptual evaluation model guiding the system, and offers a summary of the amounts and types of data collected in the years leading to full implementation. The article concludes with a brief list of needs that emerged during implementation and suggestions for future growth. The resulting system is described as supporting the evaluation of clinical teaching of more than 1,200 clinical faculty, students, residents, and fellows across 18 clinical departments with a common set of items. For the 2006-2007 academic year, more than 30,000 faculty evaluations were collected, combined, and then presented in a Web-based teaching dossier. A by-product of this effort was the creation of an ever-expanding data set that supports medical education research.

Are successful resident clinicians good teachers? Multidimensional resident assessment.

BACKGROUND: GME training programs must demonstrate residents are prepared as both teachers and clinicians. We examined the relationship between faculty evaluations of residents' clinical performance and student evaluations of residents' teaching performance. METHOD: Concordance tables for mean ratings and qualitative analysis of comments among 95 residents receiving evaluations by 267 faculty and 106 students. RESULTS: A total of 88% of residents received concordant ratings from faculty and students. When discordant, faculty gave higher ratings (P = .003). Ninety and ninety-one percent of faculty and student comments exhibited a positive tone. CONCLUSIONS: Faculty and students tended to agree on the successful and unsuccessful residents, supporting the validity of rating scale evaluations. Future research might focus on how to tailor resident remediation when discordant ratings or comments occur.

Setting standards for teaching evaluation data: an application of the contrasting groups method.

BACKGROUND: Teaching evaluations are widely used in retention and remediation decisions. Typically evaluations are reviewed in a global manner and some gestalt is reached. PURPOSE: Apply the Contrasting Groups standard setting methodology to faculty teaching dossiers, to examine resulting "pass-rates" and precision of the decisions. METHODS: Ten faculty judges set standards for teaching dossiers using a Contrasting Groups approach. Blinded dossiers summarizing clinical (N = 47) and classroom teaching (N = 37) were sorted into piles labeled Unsatisfactory, Satisfactory, Excellent, and Superior. Cut-points were the midpoints between aggregated judge-level mean performances of dossiers placed within adjacent levels. RESULTS: For the total faculty, the percentage assigned to groups labeled Unsatisfactory through Superior, were 4.1%, 5.9%, 26.1%, and 63.9% and 6.6%, 24.8%, 44.1%, and 24.5% for clinical and classroom teaching respectively. Standard error of measurement was between .20 and .25 with 5 to 7 judges. CONCLUSIONS: Standard setting methods applied to faculty evaluation data produce precise results. Future work can examine standard stability and acceptability, and methods to combine across teaching venues.

Elapsed time between teaching and evaluation: does it matter?

BACKGROUND: Web-based course evaluation systems offer the potential advantage of timely evaluations. The authors examined whether elapsed time between teaching and student evaluation of teaching impacts preclinical courses' quality ratings. METHOD: The overall relationship of elapsed time with evaluation rating was explored with regression and ANOVA. Time between teaching event and evaluation was categorized by weeks. Within-teaching-events means and variances in evaluations related to elapsed weeks were compared using repeated-measures ANOVA. RESULTS: With more elapsed weeks, quality mean ratings increased (P < .001) and variability decreased (P < .001); effect sizes were small (average effect size = 0.06). Trends were similar in regression analysis and for data aggregated by event. CONCLUSIONS: Summaries of event quality are negligibly impacted by evaluation timing. Future studies should examine the impact of other Web-based evaluation features on evaluation.

Residents' ratings of clinical excellence and teaching effectiveness: is there a relationship?

BACKGROUND: Assessment of faculty teaching and clinical skills is often based on learners' ratings. It is not clear that differences between the constructs are detectable in the results. PURPOSE: The purpose is to examine relationships between (a) residents' ratings of faculty clinical excellence and teaching effectiveness and (b) track-related performance differences. METHODS: There were 3,713 evaluations for 399 faculty provided by 436 different residents. Eight items assess teaching effectiveness (5-point scale); five items assess clinical excellence (dichotomous scale). Each scale included a global item. RESULTS: Teaching effectiveness and clinical excellence ratings were correlated: .59 (p<.0001) for global scores and .55 (p<.0001) for scale scores. Teaching effectiveness ratings were not related to faculty track. Clinical excellence ratings showed differences of medium magnitude. CONCLUSIONS: The moderate correlations between teaching and clinical domain scores suggests more thought be given about how to use both types of data for identifying the lowest and highest performing faculty.

Evaluation of clinical faculty: gender and minority implications.

BACKGROUND: Learner ratings are an important source of data regarding teaching effectiveness. We examine ratings of faculty teaching for the effects of faculty-resident gender and underrepresented minority (URM) status concordance. METHOD: Factorial ANOVAS and t tests were used to examine gender and URM status in 10,443 teaching effectiveness evaluations for 720 faculty members, provided by 516 residents across 18 clinical departments. RESULTS: Significant interaction effects were found for gender (P < .001) and URM status (P < .05) on the individual evaluation record level. Analyses of faculty-level data showed effect sizes were small except for large positive effects for URM faculty evaluated by URM residents (ES = 0.61). CONCLUSIONS: Overall, gender and minority status seem to have a negligible role in residents' evaluations of clinical faculty. However, the apparent beneficial effects for URM-URM pairs need more study.