Micromanagement in clinical supervision: a scoping review.

Micromanagement in clinical supervision in health professions education generally refers to supervision characterized by unproductive excessive control and attention to detail. It can affect autonomy, competence, well-being of learners, teamwork, and ultimately patient care. Despite its potential negative impact on learners and patients, no comprehensive review of this phenomenon has been conducted. This scoping review aims to explore the breadth of extant literature concerning micromanagement in clinical supervision in health professions education and map the body of research on the topic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review (PRISMA-ScR). We searched eight databases, and the final review and analysis comprised 12 articles that examined micromanagement in clinical supervision across health professions education. Micromanagement was conceptualized as ineffective supervisory practices such as undue scrutiny, excessive control, domination, and ineffectual leadership. Conversely, alternatives to micromanagement included entrusting or granting autonomy, coaching for independent practice, and providing effective supervision and leadership. Overall, micromanagement was attributed to individual behavioral and personality factors, such as distrust, perfectionism, self-conviction, and low self-esteem. The consequences of micromanagement included inadequacies in professional development and well-being of trainees and patient care, and organizational dysfunction. Suggested solutions included entrusting or empowering trainees with encouragement and clear communication, open communication efforts by trainees, organizational management for quality supervision, and faculty's valuing both clinical and educational goals. Current literature on micromanagement-in the context of clinical supervision in health professions education-was found to be sparse, implying a need for more rigorous research and discourse on this understudied area. The findings can be used to recognize, solve, and prevent the prevalent, and often unrecognized, phenomena of micromanagement, which may improve clinical supervision, the professional development of trainees and faculty, organizational management, and ultimately patient care.

Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years.

Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled "LifeStages" to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.

Enhancing medical student diversity through a premedical program: A Caribbean school case study.

Background: Physicians with backgrounds underrepresented in medicine (URiM) are more likely to practice in underserved communities. Recruitment into and assistance during medical education has the potential to increase the number of URiM physicians. This study analyzes URiM students' academic performance at a well-established Caribbean school with and without prior successful completion of the Medical Education Readiness Program (MERP). Methods: A retrospective analysis of premedical school requirements and achievements in medical school were performed for URiM students enrolled in Ross University School of Medicine between 2006 and 2012, through either MERP or direct admission. For MERP and non-MERP students, an independent sample two-tailed Student t-test was used to compare prerequisite Grade Point Average (p GPA), Medical College Admission Test (MCAT), and The United States Medical Licensing Examination (USMLE) Step 1 scores. Chi-square analysis was performed to compare the attrition rates for MERP and non-MERP URiM students in the first years of medical schools well as USMLE Step 1 pass rates. Results: A total of 1299 students entering medical school directly (n = 981) or through MERP (n = 318) were evaluated. The mean MCAT (19.6 for MERP vs. 21.6 for non-MERP, P < 0.001) and prerequisite GPA (2.8 for MERP vs. 3.1 for non-MERP, P < 0.001) were significantly lower for the MERP students. A similar percentage of MERP and non-MERP students reached the 2nd year (83.0% and 80.9% respectively, P = 0.407) and 3rd year (80.5% and 79.0% respectively, P = 0.565) of medical school. USMLE Step 1 pass rates for MERP (90.6%) and non-MERP (92.3%) as well as USMLE Step 1 mean scores (208.9 and 210.0 for MERP and non-MERP, respectively) were also comparable. Discussion: MERP-like programs can help URiM students with lower undergraduate scores succeed in medical school.

Students' responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand.

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the 'four principles' determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in 'real' settings and this information may help educators prepare students for these clinical ethical dilemmas.

Role Modeling Kindness at the Bedside.

Compassion and kindness are interchangeable attitudes and behaviors in society. As evidence shows the importance of compassion and kindness in healthcare, there has been a push to nurture and teach compassion through experiential learning in medical schools. However, there is not much evidence of educating learners on the importance of kindness as the complement or foundation of compassion and empathy. Kindness is the ability to act positively and appropriately and can be provided without emotion, judgment, or expecting anything in return. Kindness does not require the receiver to be in severe distress or suffering. Acts of kindness can be random acts done to anyone, anytime, with or without illness or suffering. Research shows that kindness elevates the healthcare profession for both clinicians and patients. Compassion and kindness must be taught through the integrated approach of role modeling, observation, practice, experience, and reflection in the classroom and in the clinical environment. It is vital that medical schools and healthcare institutions' faculty and staff make kindness to patients, families, and staff a key behavior, along with compassion and empathy. There is more that can be done to encourage acts of kindness through everyday actions; educators can display kindness toward colleagues and medical students in their learning. Kindness can improve conversations with patients and improve the emotional and social well-being of learners. Displaying kindness during bedside or classroom teaching would engrain its importance in the professional identity formation of future generations of physicians.

Comparing and Contrasting Professional Identity Formation Among Health Professional Students.

This project aims to review and compare the professional identity formation (PIF) of medical, dental, nursing, and pharmacy students while analyzing the role of interprofessional education (IPE) in this journey. Our medical research librarian conducted a literature review. Papers were selected based on the inclusion criteria developed by authors for PIF and IPE topics, which were then stratified for each health program of interest: medicine, dentistry, nursing, and pharmacy. The IPE core competencies were analyzed to understand the effect of IPE on each respective group of health professional students. Among all four major health professions, trust, collaboration, responsibility, accountability, communication, and empathy are key values within PIF. Trust, collaboration, and empathy were also regarded as core values in developing professionalism. Medical and dental students placed greater emphasis on responsibility and accountability regarding PIF. IPE played a crucial role in PIF for all students as values, teamwork, roles, and responsibilities were emphasized among each healthcare discipline of interest. This review provides significant information regarding which characteristics are emphasized for professional development across healthcare training programs. Future research to explore how certain characteristics and values influence healthcare as a whole is crucial. Investigating various influences on PIF outcomes is warranted for enhancing professional training programs and promoting interprofessional collaboration for better healthcare delivery.

Meckel's diverticulum: A rare and missed cause of adult gastrointestinal bleed.

Our report details a rare case of gastrointestinal bleeding in an adult male from Meckel's diverticulum. Diagnostic tests were negative except for technetium-99m pertechnetate scintigraphy with SPECT/CT, highlighting importance of diverse modalities.

Disney Rash in Las Vegas: Benign Lower Extremity Purpura Following Prolonged Walking.

This case follows an adult middle-aged female patient who developed a purpuric rash, soreness, and swelling on her legs after walking for several days in Las Vegas. With no prior petechial rash history or presence of systemic symptoms, exercise-induced purpura (EIP) was suspected due to her protracted walking in warm weather. She recovered fully with supportive treatment. EIP, also known as exercise-induced vasculitis (EIV), is often poorly recognized, misdiagnosed, and inappropriately treated. There is a need for increased awareness and clinical diagnosis of EIV based on thorough history and physical examination.

Exploring Generative Artificial Intelligence-Assisted Medical Education: Assessing Case-Based Learning for Medical Students.

The recent public release of generative artificial intelligence (GenAI) has brought fresh excitement by making access to GenAI for medical education easier than ever before. It is now incumbent upon both students and faculty to determine the optimal role of GenAI within the medical school curriculum. Given the promise and limitations of GenAI, this study aims to assess the current capabilities of a GenAI (Chat Generative Pre-trained Transformer, ChatGPT), specifically within the framework of a pre-clerkship case-based active learning curriculum. The role of GenAI is explored by evaluating its performance in generating educational materials, creating medical assessment questions, answering medical queries, and engaging in clinical reasoning by prompting it to respond to a problem-based learning scenario. Our results demonstrated that GenAI addressed epidemiology, diagnosis, and treatment questions well. However, there were still instances where it failed to provide comprehensive answers. Responses from GenAI might offer essential information, hint at the need for further inquiry, or sometimes omit critical details. GenAI struggled with generating information on complex topics, raising a significant concern when using it as a 'search engine' for medical student queries. This creates uncertainty for students regarding potentially missed critical information. With the increasing integration of GenAI into medical education, it is imperative for faculty to become well-versed in both its advantages and limitations. This awareness will enable them to educate students on using GenAI effectively in medical education.

Racial and Ethnic Disparities Within Social Determinants of Health Amongst Patients With Systemic Lupus Erythematosus.

Introduction This study aims to identify the influence of social determinants of health (SDoH) on patients with systemic lupus erythematosus (SLE), emphasizing racial and ethnic disparities in healthcare. Methods A cross-sectional study used the National Institute of Health's (NIH) All of Us Research Program (AoU). From 727,000 patients, SLE patients were categorized by race, ethnicity, and responses to the Social Determinants of Health survey from May 2018 until March 2023. Survey questions addressed transportation access, neighborhood safety, provider biases, and food insecurity. JMP Pro 16.0 and R 4.2.2 were used for statistical analysis. Results Significant racial disparities were evident amongst SLE patients for transportation access, neighborhood safety, food security, and respect from healthcare providers (p-value < 0.001). African Americans, Asians, and White participants showed different perceptions regarding neighborhood crime, healthcare provider courtesy, and feeling unheard by providers, with respective p-values of 0.001, 0.010, and 0.023. Hispanic participants perceived higher neighborhood crime rates, felt unsafe during nighttime walks, felt unheard by healthcare providers, and reported worrying about food security compared to non-Hispanic participants, with respective p-values of 0.003, 0.003, 0.009, and <0.001.  Discussion SLE is affected by access to care, treatments, stress, and lifestyle habits. Therefore, identifying SDoH for SLE patients is critical as it impacts disease progression, leading to delays in diagnosis, improper management, and worsening morbidity.  Conclusion Targeted social and community-based interventions may improve access to care, identify implicit biases among providers, and alleviate food insecurity.

Integrating the Teaching and Assessment of Moral Reasoning into Undergraduate Medical Education to Advance Health Equity.

Moral reasoning skills among medical students have regressed despite the implementation of ethics teachings in medical education curricula. This inability to retain moral reasoning capability is attributed to difficulty transitioning to the principled thinking stage of moral reasoning as well as worsening of ethical decision-making skills during clerkship education due to the "hidden curriculum." Prior studies have examined the efficacy of individual strategies for moral education, but there is insufficient analysis comparing multiple educational interventions and moral reasoning assessment tools. The role and impact of these instruments in medical curricula for the advancement of health equity is reviewed.

Decoding medical educators' perceptions on generative artificial intelligence in medical education.

Generative AI (GenAI) is a disruptive technology likely to generate a major impact on faculty and learners in medical education. This work aims to measure the perception of GenAI among medical educators and to gain insights into its major advantages and concerns in medical education. A survey invitation was distributed to medical education faculty of colleges of allopathic and osteopathic medicine within a single university during the fall of 2023. The survey comprised 12 items, among those assessing the role of GenAI for students and educators, the need to modify teaching approaches, GenAI's perceived advantages, applications of GenAI in the educational context, and the concerns, challenges, and trustworthiness associated with GenAI. Responses were obtained from 48 faculty. They showed a positive attitude toward GenAI and disagreed on GenAI having a very negative effect on either the students' or faculty's educational experience. Eighty-five percent of our medical schools' faculty responded to had heard about GenAI, while 42% had not used it at all. Generating text (33%), automating repetitive tasks (19%), and creating multimedia content (17%) were some of the common utilizations of GenAI by school faculty. The majority agreed that GenAI is likely to change its role as an educator. A perceived advantage of GenAI in conducting more effective background research was reported by 54% of faculty. The greatest perceived strengths of GenAI were the ability to conduct more efficient research, task automation, and increased content accessibility. The faculty's major concerns were cheating in home assignments in assessment (97%), tendency for blunder and false information (95%), lack of context (86%), and removal of human interaction in important feedback processes (83%). The majority of the faculty agrees on the lack of guidelines for safe use of GenAI from both a governmental and an institutional policy. The main perceived challenges were cheating, the tendency of GenAI to make errors, and privacy concerns.The faculty recognized the potential impact of GenAI in medical education. Careful deliberation of the pros and cons of GenAI is needed for its effective integration into medical education. There is general agreement that plagiarism and lack of regulations are two major areas of concern. Consensus-based guidelines at the institutional and/or national level need to start to be implemented to govern the appropriate use of GenAI while maintaining ethics and transparency. Faculty responses reflect an optimistic and favorable outlook on GenAI's impact on student learning.

Nurturing Empathy through Arts, Literature, and Role Play for Postgraduate Trainees of Ophthalmology.

Background and Purpose: Empathy is essential in patient-centered compassionate health care. Lack of formal training, workload, patient factors, and digitalization have been attributed to its regression. Empathy can be nurtured by educational interventions. A structured empathy education module for postgraduate trainees is not available in India. The aim for this research was to develop, deliver, and evaluate one for ophthalmology postgraduate trainees. Methodology: This interventional study was conducted in the tertiary ophthalmology department of Western India during 2022-2023. Four workshops comprising of interactive lectures, literature, creative arts, and role plays were delivered with trained facilitators. Data from surveys for trainee self-assessment, patient perception of trainee empathy, pre-post knowledge test, and trainee and facilitator feedback were collected and analyzed. Results: Seventy-nine ophthalmology postgraduate trainees participated in this intervention. Excessive workload and lack of training were shared as the barriers to empathetic care. Trainees showed improved knowledge, skills, and attitude in empathy after the workshops. The facilitators and trainees were satisfied with the learning goals, execution, utility, feasibility, and relevance of the workshops. Ninety-three percent trainees want this module to be a part of postgraduate curriculum. Conclusion: This study substantiates the use of structured interactive training for cultivating empathy in postgraduate trainees. Barriers against empathy were identified and can be mitigated by restorative measures. Literature, arts, and role plays are the effective education tools for empathy.

The Emerging Role of Generative Artificial Intelligence in Medical Education, Research, and Practice.

Recent breakthroughs in generative artificial intelligence (GAI) and the emergence of transformer-based large language models such as Chat Generative Pre-trained Transformer (ChatGPT) have the potential to transform healthcare education, research, and clinical practice. This article examines the current trends in using GAI models in medicine, outlining their strengths and limitations. It is imperative to develop further consensus-based guidelines to govern the appropriate use of GAI, not only in medical education but also in research, scholarship, and clinical practice.

Role Modeling in Medical Education: A Twenty-First Century Learner's Perspective.

Traditional role modeling is a complex process of observation and emulation delivered by experienced senior physicians with an unknown outcome. Role modeling through organized modalities has been utilized as an educational tool in medical school for years. However, effects of parenting, near peers, gender, race, and social media on role modeling in medical education have not been well characterized yet play a significant role in the development of modern clinicians. The aim of this paper is to encourage students as future medical and clinical educators through an in-depth analysis of role modeling, with the goal of improving their "role modeling consciousness."

Segregation Predicts COVID-19 Fatalities in Less Densely Populated Counties.

Aim It is well known that social determinants of health (SDoH) have affected COVID-19 outcomes, but these determinants are broad and complex. Identifying essential determinants is a prerequisite to address widening health disparities during the evolving COVID-19 pandemic. Methods County-specific COVID-19 fatality data from California, Illinois, and New York, three US states with the highest county-cevel COVID-19 fatalities as of June 15, 2020, were analyzed. Twenty-three county-level SDoH, collected from County Health Rankings & Roadmaps (CHRR), were considered. A median split on the population-adjusted COVID-19 fatality rate created an indicator for high or low fatality. The decision tree method, which employs machine learning techniques, analyzed and visualized associations between SDoH and high COVID-19 fatality rate at the county level. Results Of the 23 county-level SDoH considered, population density, residential segregation (between white and non-white populations), and preventable hospitalization rates were key predictors of COVID-19 fatalities. Segregation was an important predictor of COVID-19 fatalities in counties of low population density. The model area under the curve (AUC) was 0.79, with a sensitivity of 74% and specificity of 76%. Conclusion Our findings, using a novel analytical lens, suggest that COVID-19 fatality is high in areas of high population density. While population density correlates to COVID-19 fatality, our study also finds that segregation predicts COVID-19 fatality in less densely populated counties. These findings have implications for COVID-19 resource planning and require appropriate attention.

Micromanagement During Clinical Supervision: Solutions to the Challenges.

Learner autonomy is an invaluable asset in graduate medical education, preparing the trainee to independently face challenges in the future professional settings. Educational institutions face the difficult task of providing a balance between learner autonomy and supervision. In graduate medical education, trainees often prefer less supervision than what is imparted by their attending physician. This increased supervision comes at the cost of learner autonomy and has not exhibited improvement in patient outcomes or safety. When attendings exhibit control over details, the trainees may label them as "micromanagers". Cardinal features of a micromanager include excessively requesting updates, insisting that the task be done their way, and scrutinizing every detail. This micromanaging behavior is non-conducive to the learning environment and may even contribute to supervisor burnout. The business literature reveals a debate about this very topic. Unfortunately, there is still a lack of literature on micromanagement in graduate medical education. Although a conglomerate of internal factors may lead to excessive supervision in an academic medical institution, we surmise that micromanagement exists because of a complex dynamic between three drivers: accountability, trust, and autonomy. When trainees are held accountable, they learn to take ownership for their actions which leads to establishment of trust which further enables motivation and gaining of autonomy. Supervising attendings should ideally be able to comfortably adjust their level of supervision based on their trust and the trainee's competence, accountability, and autonomy. The micromanaging physician is unable to do so, and this can have a detrimental effect on the learner. Micromanagement can be perceived by some as a beneficial component during the early immersion of the trainee with the rationalization for better patient outcomes and safety. However, in the long term, it threatens the learning environment and erodes the complex relationship between accountability, trust, and autonomy. We recommend an action plan to mitigate micromanagement at three levels-the micromanager, the micromanaged, and the organizational structure-and hope that these solutions enhance the learning environment for both the trainee and supervisor.

Racial Identity and Relevance in Teaching Clinical Skills and Diagnostic Medicine: A Small/Pilot Focus Session to Engage Medical Educators.

Background The relevance and importance of using racial and ethnic categories in medical education is an area requiring richer discussion and engagement among all health professions educators. Objectives There is a genuine need to identify opportunities for leveraging social and structural determinants of health to address health disparities within medical education. We designed a focus session led by a team of diverse clinical and basic science faculty to analyze how medical curricula can integrate racial/ethnic identity as a clinical indicator. We sought to develop strategies to empower medical students and teachers to integrate race as a social rather than a biological construct. Methods The 90-minute focus session included an interactive presentation reviewing the literature related to the use of racial identity in medical education, small group case-based discussions in breakout rooms, a large group debrief, and an optional activity for participants to apply the knowledge gained. The study was approved by the Nova Southeastern University Institutional Review Board (IRB #: 2021-185-NSU). Results Thirty-three participants attended the session at the 2021 International Association of Medical Science Educators (IAMSE) Conference. Eleven (33%) participated in both pre-session and post-session surveys. Survey data revealed significant pre-/post-changes in the knowledge of the advantages and disadvantages of using race in medical education. Qualitative data indicated that participants acquired new knowledge related to the integration of racial identity as a clinical indicator and they were willing to incorporate strategies learned into their teaching. Conclusion Our study data suggests that this focus session equipped faculty with new knowledge and resources to effectively incorporate racial/ethnic identity into medical school curricula to increase awareness of healthcare disparities.

Defining Advising, Coaching, and Mentoring for Student Development in Medical Education.

Medical school curricula integrate classroom academic teaching, hands-on clinical training, longitudinal professional development, and identity formation to prepare students to enter the healthcare workforce as residents. Mentorship, coaching, and advising are well-recognized approaches used by educators to help young learners accomplish their personal and professional goals and objectives. However, undergraduate medical education literature has not clearly articulated the distinctions between the roles and core responsibilities of each guidance approach. Attempts to describe each role and responsibility have generated ambiguity and steered institutions towards implementing their own role-specific functions. The purpose of this paper is to establish a functional framework that may be used to differentiate the principal duties of a mentor, coach, and advisor in the context of undergraduate medical education (UME). Four key components are necessary to achieve this goal: (1) adopting a singular definition for each form of guidance; (2) characterizing each role based on unique skills; (3) describing the interplay between learner needs and educator capabilities; (4) training educators on how to effectively distinguish each form of guidance. Creating clear distinctions between mentors, coaches, and advisors in medical education will bolster students' academic experience and improve the educator-learner relationship. These definitions may also benefit faculty members by providing a clear framework for their responsibilities, which can be used for evaluations or determining future promotions.

"I Agree to Disagree": Comparative Ethical and Legal Analysis of Big Data and Genomics for Privacy, Consent, and Ownership.

STATEMENT OF PURPOSE: Digital healthcare, as it relates to big data and genomics, presents a real threat to privacy and ownership rights for individuals and society. Research Question/Hypothesis: Our experience with genomics provides a lens to facilitate the way we navigate toward a future health data space. Contemporary and innovative legal and ethical models can be applied to concepts of privacy, ownership, and consent in relation to big data. SIGNIFICANCE: Technological innovation has transformed healthcare at a faster rate than legal reform, security measures, and consent policies can adapt. The Health Information Portability and Accountability Act (HIPAA) has been recognized as a work in progress, with respect to big data as it relates to healthcare and individual wellbeing. The shortcomings of HIPAA, and its application to big data, can be paralleled with its prior limitations surrounding genomics in the last two decades. The Genetic Information and Nondiscrimination Act (2008) and Genomic Data Sharing Policy (2015) were established to overcome HIPAA's inadequacies concerning genetic discrimination and security. These policies can serve as a basic model for our approach to legislative reform as it relates to privacy risks with big data generated in healthcare and from healthy individuals in society who are not patients. In addition to notions of privacy, concepts of ownership and consent have become increasingly vague and opaque. The technological advancements have facilitated access and transmission of information, such that big data can be sold for financial gain for commercial enterprise. This applies to genomics, with companies like 23andMe, in addition to big data, as it relates to big tech giants like Apple or Google who oversee wearable and search term data. Clarity of ownership within a digital healthcare arena needs to be defined through ethical and legal frameworks at a global level. APPROACH: A narrative review of the literature published between 2010 and 2021 was performed using PubMed and Google Scholar. Articles discussing privacy, security, ownership, big data, and genomics were included as relevant literature. IMPORTANCE: As a society, we are at a crossroads; we must determine the extent of privacy that we are willing to give for science and society. We cannot continue with the current status quo in hope that individual will be used for the greater good of society. We need to strive for a cohesive approach to combat privacy violations by encouraging legislative reform, ethical accountability, and individual responsibility.