Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71.

BACKGROUND: Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners. METHODS: Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned. RESULTS: Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment. CONCLUSIONS: This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.

Educational autopsy: An innovative structured debrief for residency didactic teaching.

BACKGROUND: Educational autopsy (EA) is an innovative technique designed to improve the quality of feedback provided to conference presenters. In response to survey fatigue and suboptimal feedback from online evaluations, this postlecture group debrief was adapted to emergency medicine residency didactics, with a goal of collecting timely, specific, and balanced feedback for presenters. Other aims include encouraging participants to think critically about educational methods and providing presenters with formal feedback for a portfolio or promotion packet. It was hypothesized that EA provides more specific and actionable feedback than traditional online evaluations deployed individually to conference attendees. METHODS: The authors analyzed 4 months of evaluations pre- and postimplementation of EA. Rate of completion, presence of comments, and types of comments were compared. Comments were coded as specific, nonspecific, and unrelated/unclear. Specific comments were further categorized as about audiovisual presentation design, speaker presentation style, and educational methods of the session. RESULTS: A total of 46 of 65 (71%) preimplementation presentations eligible for evaluation received comments through traditional online evaluations. A total of 44 of 75 (59%) eligible postimplementation presentations generated comments via EA. Among presentations that received comments, none received nonspecific comments via EA, compared to 46% of lectures through traditional evaluations. EA generated specific comments for more presentations regarding presentation design (91% vs. 63%), presentation style (66% vs. 24%), and educational methods (48% vs. 28%). EA produced no unclear comments; traditional evaluations resulted in unclear comments for 15% of lectures. CONCLUSIONS: EA generated more specific feedback for residency conference presenters, although there were a number of sessions not evaluated by EA. Although this limited analysis suggested that EA produced higher-quality presenter feedback, it also showed a drop-off in the proportion of didactic sessions that received narrative feedback.

Is It Learning or Scutwork? Medical Students Adding Value in the Emergency Department.

In busy emergency departments (EDs), it can be difficult for faculty to teach students amid pressure to provide patient care and conduct research. As a result, medical student teaching may be an afterthought rather than a priority, and there is a lack of focus on how students spend their time during clinical shifts in the ED. Students want to contribute to departmental workflow, but can be hampered by systems limitations and lack of clinical knowledge. One solution is for faculty and medical students to partner to add value to patient care in the ED. However, faculty and students must be wary of the distinction between activities that add value and "scutwork," tasks that involve little learning and do not require medical expertise. In this perspective, the student, resident, and faculty authors discuss learner and educator perspectives for how medical students can be productive contributors to patient care in the ED without being subjected to scutwork. They also recommend ideas for productive student activities that promote learning, contrasted with examples of scutwork to avoid. Definitions of value-added activities and scutwork depend on the learner's experience level and interests and are subject to debate. However, if medical students can be engaged in learning while also providing meaningful contributions to patient care, students, educators, and patients stand to benefit.

Exploring Action Items to Address Resident Mistreatment through an Educational Workshop.

Mistreatment of trainees is common in the clinical learning environment. Resident mistreatment is less frequently tracked than medical student mistreatment, but data suggest mistreatment remains prevalent at the resident level. To address resident mistreatment, the authors developed an Educational Advance to engage emergency medicine residents and faculty in understanding and improving their learning environment. The authors designed a small-group session with the following goals: 1) Develop a shared understanding of mistreatment and its magnitude; 2) Recognize the prevalence of resident mistreatment data and identify the most common types of mistreatment; 3) Relate study findings to personal or institutional experiences; and 4) Generate strategies for combating mistreatment and strengthening the clinical learning environment at their home institutions. Design was a combination of presentation, small group discussion, and facilitated discussion. Results were presented to participants from a previously administered survey of resident mistreatment. Public humiliation and sexist remarks were the most commonly reported forms. Faculty were the most frequent perpetrators, followed by residents and nurses. A majority of respondents who experienced mistreatment did not report the incident. Session participants were then asked to brainstorm strategies to combat mistreatment. Participants rated the session as effective in raising awareness about resident mistreatment and helping departments develop methods to improve the learning environment. Action items proposed by the group included coaching residents about how to respond to mistreatment, displaying signage in support of a positive learning environment, zero tolerance for mistreatment, clear instructions for reporting, and intentionality training to improve behavior.

Medical Student- and Resident-Authored Publications in Academic Medicine From 2002 to 2016: A Growing Trend and Its Implications.

PURPOSE: The extent of medical trainees' engagement in scholarly medical education publication is not well described. This study sought to quantify the prevalence of medical student- and resident-authored medical education publications over 15 years, a benchmark essential for understanding current and future trends in trainee scholarship. METHOD: Of 91 identified journals, 16 met inclusion criteria as indexed general medical education journals. Only Academic Medicine provided complete author role information, allowing identification of medical student and resident authors. The authors retrospectively compiled and analyzed citation records from Academic Medicine from 2002 to 2016, tracking trainee authorship, author position, and publication type. RESULTS: A total of 6,280 publications were identified, of which 4,635 publications, by 16,068 authors, met inclusion criteria. Trainees were 6.0% (966/16,068) of all authors and authored 14.5% (673/4,635) of all publications. Trainee authorship rates varied by publication type: Trainees authored 33.3% (160/480) of medical humanities publications versus 6.9% (27/392) of commentaries. From 2002-2004 to 2014-2016, the proportion of authors who were trainees increased from 3.9% (73/1,853) to 7.1% (330/4,632) (P < .001 for trend). Over the same period, the percentage of trainee-authored publications increased: 9.4% (58/620) to 18.8% (225/1,199) (P < .001 for trend), driven primarily by increased trainee first authorship. CONCLUSIONS: Trainees constitute a small but growing proportion of authors and authored publications in Academic Medicine. Further work is needed to understand what trainee-, institutional-, and journal-level factors contribute to this trend, and whether similar increases in trainee authorship are occurring in other journals and fields.

Time to Reevaluate the Away Rotation: Improving Return on Investment for Students and Schools.

Away rotations are common among senior medical students preparing to apply for residency. For competitive specialties, multiple away rotations may be viewed as a de facto requirement for a strong application. Although away rotations are often valuable learning experiences, a variety of noneducational factors motivate students to enroll, including the need for letters of recommendation, students' uncertainty regarding their strength as applicants, perceived competitiveness of residency applications, and conflicting guidance from advisors.Students who enroll in away rotations often benefit from a novel educational environment, opportunities for career exploration, and the chance to assess "fit" with a program. Yet away rotations also come at a significant cost. Students must deal with the time and expenses of rotating at multiple institutions. The application process for away rotations is expensive, disjointed, and inefficient. Students must work hard to make an impression on host institution faculty, and risk hurting their residency applications with a negative letter of recommendation.To reduce the burden of away rotations, future research should assess the impact of multiple away rotations on success in the Match. Allowing students limited access to letters of recommendation content would allow students and advisors to make informed decisions regarding additional rotations. Students would benefit from greater standardization of the application process for away rotations, with uniform dates, timely acceptances and rejections, and a cap for the number of applications per student. Students can maximize their returns by targeting away rotations that provide the most diverse educational experiences and valuable letters of recommendation.

Tracking Student Mistreatment Data to Improve the Emergency Medicine Clerkship Learning Environment.

INTRODUCTION: Medical student mistreatment is a prevalent and significant challenge for medical schools across the country, associated with negative emotional and professional consequences for students. The Association of American Medical Colleges and Liaison Committee on Medical Education have increasingly emphasized the issue of mistreatment in recent years, and medical schools are tasked with creating a positive learning climate. METHODS: The authors describe the efforts of an emergency department (ED) to improve its clerkship learning environment, using a multifaceted approach for collecting mistreatment data and relaying them to educators and clerkship leadership. Data are gathered through end-of-rotation evaluations, teaching evaluations, and an online reporting system available to medical students. Mistreatment data are then relayed to the ED during semi-annual meetings between clerkship leadership and medical school assistant deans, and through annual mistreatment reports provided to department chairs. RESULTS: Over a two-year period, students submitted a total of 56 narrative comments related to mistreatment or unprofessional behavior during their emergency medicine (EM) clerkship. Of these comments, 12 were submitted in 2015-16 and 44 were submitted in 2016-17. The most frequently observed themes were students feeling ignored or marginalized by faculty (14 comments); students being prevented from speaking or working with patients and/or attending faculty (11 comments); and students being treated in an unprofessional manner by staff (other than faculty, 8 comments). CONCLUSION: This article details an ED's efforts to improve its EM clerkship learning environment by tracking mistreatment data and intentionally communicating the results to educators and clerkship leadership. Continued mistreatment data collection and faculty development will be necessary for these efforts to have a measurable effect on the learning environment.

Medical Professionalism: A Series of Near-Peer Facilitated Workshops for First-Year Medical Students.

INTRODUCTION: Professionalism is a core competency of medical education. It impacts one's ability to generate rapport with patients, foster patient satisfaction, and enhance the overall well-being of the medical professional. Unprofessional attitudes among medical students have been associated with higher rates of career dissatisfaction and burnout. A group of faculty and medical students at our institution have developed a series of peer facilitated modules addressing a set of common themes relevant to medical professionalism: professionalism in the clinical setting, professional electronic communication, teamwork and community, and work-life integration. METHODS: Student discussions on professionalism were facilitated by senior medical students. Using a 5-point Likert scale, electronic pre- and postsurveys assessed the impact of the workshop on first-year medical students' understanding of various professionalism topics. RESULTS: Seventy-seven percent of first-year medical students (n = 131) felt the modules contributed to their learning. Pre- and postsurveys showed significant improvements in understanding of and comfort with the majority of topics discussed. Students felt that their knowledge improved as well. Narrative comments expressed approval of the modules and suggested they addressed unmet needs in the medical curriculum. DISCUSSION: These modules were successfully incorporated into the first-year medical school curriculum and led to improved student understanding and comfort around these topics. Senior medical student facilitators also found the experience useful in their own career development. Although these modules were designed for medical students, they may also be useful for other professional students (e.g., dental, nursing, etc.) or for interprofessional educational experiences.