merldr merl

delivers reviews of current medical education research on posters and flyers
monthly on all RWJMS campuses

DR MERL is produced by …
MERIG* (Medical Education Research Interest Group) & the RWJMS Library of the Health Sciences

*MERIG Fact Sheet:

Who: clinicians, medical educators, researchers, master educators’ guild members, librarians

What: develop and maintain an information delivery system illustrating current trends in medical education research

Materials: wall posters and flyers

Journals:  Academic Medicine, Medical Education, Teaching & Learning in Medicine


DR MERL Reviewers:
Sarang Kim, MD
Laura Willett, MD

Medical Education

Articles Worth Reading
- 2012

Click here for newer reviews


Attendings compare learners to each other, not to a fixed standard.

In this elegant and provocative study, investigators asked attending physicians to score videos of residents with “borderline” clinical performance on a mini-CEX under two different circumstances, after seeing several good trainee videos, or after seeing several bad trainee videos.  The prior exposure had a large effect on the grades given the “borderline” performances.  For example, attendings gave failing grades to 55% borderline trainees after viewing good performances but to only 24% after viewing poor performances.  This difference is concerning if these evaluations were to be used for high-stakes decisions.  Evaluators in this study were not trained in grading the mini-CEX, but this might improve the results.—Laura Willett

Yeates P et al. Effect of Exposure to Good vs Poor Medical Trainee Performance on Attending Physician Ratings of Subsequent Performances.
JAMA. 2012;308(21):2226-2232


Does Analytical Reasoning increase Diagnostic Accuracy?

Yes, according to a randomized control study performed with 145 medical students during their 4th year OSCEs. After encountering a patient, students in the test group made a diagnosis with the aid of a differential diagnoses and symptoms table.  The control group omitted table and only submitted diagnosis.  The diagnostic accuracy scores on OSCEs were higher in the group using analytical reasoning (table).  Although this method seemed to reduce cognitive bias in 4th medical students, the approach works best on medical students and residents as opposed to more experienced doctors and may not work on very complex cases where students’ medical knowledge is the rate limiting factor. –Lee Ann Schein, Ph. D.

Myung SJ et al. Effect of enhanced analytic reasoning on diagnostic accuracy: A randomized controlled study.
Medical Teacher 2013, 1–3, Early Online(Posted online on January 18, 2013)


Are Artificial Students Better Than The Real Thing?

This small pilot study suggests that preclinical medical students conducting respiratory and/or cardiovascular system examinations on a life-size patient manikin (SimMan) showed greater improvement in their ability and confidence to perform physical exams above those using peer examinations.   In particular, students reported better ability to differentiate between normal and abnormal signs.  The manikin, which can be programmed with a range of clinical findings, is seen by the study authors as a self and effective means of teaching without any harm to patients.  –Lee Ann Schein, Ph. D.

Swamy M et al. Role of SimMan in teaching clinical skills to preclinical medical students
BMC Medical Education 2013, 13:20

small groups

The Faculties’ Side of the Story.

This qualitative study identified several key aspects of small group sessions which improved students’ learning.   The study focused on interactive small group learning seminars consisting of approximately 25 students and one content expert facilitator. After a semester 24 facilitators attended focus groups aimed at investigating which features of the small group seminar format were considered by the teachers to be important for optimal seminar learning.  The result was concrete tips for the construction of high-quality small group sessions and improved curriculum development, such as quality and quantity of reading material, non-threatening learning environments, stability of groups throughout the semester, and alignment of topics throughout all course learning elements. –Lee Ann Schein, Ph. D.

Spruijt A et al. Teachers' perceptions of aspects affecting seminar learning: a qualitative study
BMC Medical Education 2013, 13:22


Can we let attending physicians do 2-week vs. 4-week ward rotations?

The quick answer is yes.  Attendings were much less likely to experience sever burnout (16% vs. 35%).  Patient outcomes were not changed.  Learner evaluations showed that both residents and students felt that the attendings were less able to fairly evaluate them with the shorter exposure, but other evaluations were fairly similar.Laura Willett

Lucas BP et al. Effects of 2- vs 4-Week Attending Physician Inpatient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout: A Randomized Trial
JAMA. 2012;308(21):2199-2207


M&Ms go systems-based

In a comparison of department of medicine mortality and morbidity conferences at one institution from the 1999-2000 academic year to 2010-11, discussion of systems-based practice issues increased remarkably.  For example, the chief resident made systems-based practice comments in 12% of the earlier sessions vs. 69% of the more recent sessions.  Explicit discussion of adverse events also became more common.-- LW

Gonzalo JD, et al. Systems-Based Content in Medical Morbidity and Mortality Conferences: A Decade of Change. JGME 2012, 4:438


Faculty can make their lectures more interactive

A 1-hour faculty development workshop for presenters at a pediatric residency conference series led to a large increase in active learning behaviors in subsequent conferences.  The results might have been exaggerated given the lack of blinding in observers. -- LW

Desselle BC, et al. Evaluation of a Faculty Development Program Aimed at Increasing Residents' Active Learning in Lectures. JGME 2012, 4:516-520.

standadized patients

How good are our standardized patients (SPs)?

Now we can find out.  Investigators from the Netherlands developed an internally validated scale to evaluate both the SPs role-play and feedback skills.  Under conservative assumptions, 20 evaluations were needed to obtain a reliable assessment, but those numbers are easily obtained in typical medical school clinical examination settings. -- LW

Bouter S, et al. Construction and Validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients’ Ability to Role Play and Provide Feedback to Students. 2012, Dec 23. [Epub ahead of print].


Gender does not affect medical students’ decisions about the severity of unprofessional behavior.

In this reassuring survey study of vignettes of potentially unprofessional behavior, neither the gender of the medical student evaluating the vignette, nor the gender of the “actor” in the vignettes, had a substantial effect on the students’ evaluations of the severity of the behavior described. -- LW

Stratton TD, et al. Does gender moderate medical students’ assessments of unprofessional behavior? JGIM 2012, 27:1643-1648


Simulations to Ease Student-to-Resident Transition (4 articles)

Lots of new information on simulations, mostly for early residents.  Both procedural (Cohen, Augustine) and non-procedural (Cohen, Miloslavsky) simulations increase learner confidence and/or competence for trained tasks.  Even better, for faculty-poor settings, senior residents are perceived as excellent preceptors for these sessions (Cooper, Miloslavsky). -- LW

Cohen ER, et al. Making July Safer: Simulation-Based Mastery Learning During Intern Boot Camp. Acad Med. 201,2 Dec 23. [Epub ahead of print]

Augustine EM, et al. Effect of Procedure Simulation Workshops on Resident Procedural Confidence and Competence. JGME 2012, 4:479-485.

Cooper DD, et al. Medical Students' Perception of Residents as Teachers: Comparing Effectiveness of Residents and Faculty During Simulation Debriefings. JGME 2012, 4:486-489.

Miloslavsky EM, et al. Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns. JGME 2012, 4:490-495


Surprise, Surprise.  Primary Care Doesn’t Pay Very Well

No news here, except for the crushing debt burden our medical students face.  86% have some debt at graduation, averaging $161,000.  A group from Boston and the AAMC did a number of calculations using financial planning software.  They found that a medical student with the average debt and standard repayment plan could (barely) achieve a middle-class lifestyle if they elect to go into primary care.  Those with a debt burden of $250,000 or more (15% of graduates) would have a negative cash flow in their 30’s if they elect a primary care specialty and use the standard repayment plan.  Graduates who elect a highly-paid subspecialty, under most assumptions, have about $3,000 a month more disposable income than those who elect to go into primary care.  Politicians, please stop wondering why we have a shortage of primary care physicians! -- LW

Youngclaus JA, et al. Can medical students afford to choose primary care? An economic analysis of physician education debt repayment. Acad Med. 2013 Jan;88(1):16-25.


Resident Remediation Is Successful…Usually

This large observational study of all University of Toronto residency programs may be of interest to residency directors.  Overall, about 3% of residents were referred to a university-wide board for remediation; similar percentages of residents were referred from all programs, except none were referred by pediatrics.  Medicine and family medicine tended to refer residents in their first year, whereas surgical programs tended to refer residents in later years.  Residents referred for remediation tended to have deficiencies identified in multiple competencies, most commonly medical expertise, professionalism, communication skills, and managerial skills.  Eighty percent of referred residents successfully completed their programs, after remediation which averaged about 6 months in length.  The remediation is otherwise not well described in this article. -- LW

Zbieranowski I., et al.
Remediation of Residents in Difficulty: A Retrospective 10-Year Review of the Experience of a Postgraduate Board of Examiners. Acad Med. 2013 Jan;88(1):111-116.

duty hours

“Don’t Know Much About”…The Effects Of Duty Hours Restrictions

This insightful opinion piece, written by trainees, points out we have undertaken duty hours restrictions with a marked impact on programs with no conclusive data that they benefit anyone.  “There are data to support every opinion.” – LW

Rosenbaum L. et al. Residents' duty hours--toward an empirical narrative.
N Engl J Med. 2012 Nov 22;367(21):2044-9. doi: 10.1056/NEJMsr1210160.


You Too Can Be A Successful Ward Attending

In a study of attendings and learners, researchers identified major domains of importance in determining the quality of the ward attending rounds:  learning atmosphere (being non-intimidating and respectful); clinical teaching style (modeling bedside manner and thought process); communicating expectations for residents and students; and team management (especially being “organized, efficient, and timely”). –LW

Roy B et al. Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds. J Gen Intern Med 2012 Nov;27(11):1492-8. doi: 10.1007/s11606-012-2121-6. Epub 2012 Jun 22.

Rounded Rectangle: Duty Hours

Do Fewer Work Hours = Less Learning? Kinda.

In this retrospective study, investigators at a Canadian teaching hospitals examined medical-surgical ICU patient and procedure volumes from 2001 to 2010 and matched them to resident on-call schedules to identify maximum experiential learning opportunities. Over the 9 year period, they found a decrease in the number of calls per resident, a 32% reduction in resident opportunity to admit patients and 34% reduction in resident opportunity to perform procedures. The study did not measure residents' clinical competence or directly track actual number of patients residents admitted, but less work hours seems to have led to less opportunities for learning.

Peets, AD. Changes in residents’ opportunities for experiential learning over time. Medical Education 2012; 46:1189-1193



Patients and colleagues tend to like doctors

Wright C. et al.
Multisource Feedback in Evaluating the Performance of Doctors: The Example of the UK General Medical Council Patient and Colleague Questionnaires.
Academic Medicine Volume 87(12), December 2012, p 1668–1678

Multi-source feedback is felt to be useful in the evaluation of practicing physicians.  In this UK study, patients and colleagues tended to give evaluations that were very skewed toward positive.  Also, very large numbers of surveys are required to generate stable estimates.  This suggests major weaknesses in the use of such surveys for the analysis of physician excellence.
Academic Medicine (December 2012)--LW


Great doctor traits

What makes a great doctor?
Mahant, S et al.
The Nature of Excellent Clinicians at an Academic Health Science Center: A Qualitative Study
Academic Medicine Volume 87(12), December 2012, p 1715–1721

Peer-nominated (see above) excellent physicians were interviewed and several common themes emerged:  high intrinsic motivation; humility; scholarship; reflection upon practice; and “everyday practice skills”.  These included cognitive skills, dealing with uncertainty, being pragmatic, good people skills, enthusiasm, adaptability, and recognition of one’s own limits.
Academic Medicine (December 2012)--LW


Rounded Rectangle: Financing

Worrisome changes in medical school financing
Miller, JC, et al.
Perspective: Follow the Money: The Implications of Medical Schools’ Funds Flow Models
Academic Medicine Volume 87(12), December 2012, p 1746–1751

This interesting report on medical school financing compares sources of income in 1960 vs. 2008.  During this time, the number of US medical students doubled, full-time faculty increased by more than 10 fold, and revenues increased by nearly 20 fold.  Overall government funding as a percentage of revenue went from 58% to 30% (federal research funding from 31% to 19%), while clinical service provision increased dramatically as a percentage of medical school revenues, from 6% to 52%.  Tuition remains a minor contribution, declining from 6% to 3% of revenues.  In the current economic climate, it is unlikely that any of the traditional sources of medical school revenues – research funding, state appropriations, clinical revenues, tuition, or philanthropic donations – will be increasing.


Can residents be taught to be empathetic?  Yes!
Reiss H et al. 
Empathy training for resident physicians:  a randomized controlled trial of a neuroscience-informed curriculum.  JGIM Oct 2012; 27:1280.

In a randomized trial of three 1-hour sessions for residents in multiple specialties, patients of residents randomized to training graded their doctors better at “showing care and compassion” than patients of those who were not.  Training focused on the neurobiology of emotion and physician responses to “difficult” patients and situations—LW

gme cler

Not so CLER!
Development, Testing, and Implementation of the ACGME Clinical Learning Environment Review (CLER) Program 
Journal Of Graduate Medical Education (Sep 2012).

CLER visits are the new process by which a sponsoring institution will have visits from the ACGME every 18 months. All levels, from executive leadership to staff to resident, will be involved. Site visitors will examine how GME programs are integrated into institutional activities with regard to patient safety, quality improvement, transitions in care, supervision, duty hours and professionalism. How the institution and sites evaluate these areas and use that information to improve care is a focus of CLER. The project is currently starting beta testing, which will take 18 months and then the process will be finalized.—MK


Looking to improve your EBM teaching skills?
BMC MEd Educ 2009;9:59

This article describes the EU-EBM Trainer the Trainer project, which offers free on-line modules to help clinicians be effective EBM teachers in a variety of clinical setting including the inpatient wards and outpatient clinics.   The modules can be accessed at


Are you teaching your trainees to provide VALUE-based care?
J Gen Intern Med. 2012 Sep;27(9):1210-4. (Patel)

There is a national move to provide training in value-based, cost conscious care. This article describes a simple framework for assessing whether an intervention may provide value for patients. VALUE is an acronym for Validation/variability, Affordability/Access, Long-term benefit/Less side effects, Utility/Usability, and Effectiveness/Errors. The authors also describe specific and practical examples of how this framework can be used in residency training, including in daily rounds.--SK

Rounded Rectangle: Cost

Free curriculum on high-value, cost-conscious care
Annals of Internal Medicine. 2012 Aug;157(4):284-286. (Smith)

ABIM (AM Board of Internal Medicine), AAIM (Alliance for Academic Internal Medicine) and ACP (American College of Physicians) have created a free  curriculum to train internal medicine residents on providing high-value, cost conscious care. The curriculum consists of ten 1-hour interactive sessions that include discussions about benefits, harms and costs of interventions. Curricular materials, including faculty development material, are available online (

Residents reflect on their errors
Academic Medicine.  87(10):1361-1367, October 2012. (Ogdie, etal)

Forty-one medical residents analyzed diagnostic errors made on their patients.  Common contributors were: holding onto a diagnosis made early in the course, coming easily to mind, or presented by other providers; over-reliance on authority figures or consultants; personal reactions to patients; time pressures; poor transitions of care; and complex or incomplete information.--LW

Rounded Rectangle: Attendings

Longer (vs. shorter) interactions with attendings are preferable

Academic Medicine.  87(10):1389-1396, October 2012. (Hauer, et al)

Third year medical students in traditional block and year-long longitudinal clerkships were interviewed about successful and unsuccessful relationships with their teachers.  In both groups, longer interactions (days to weeks for block students, year-long for longitudinal students) were viewed as more conducive to learning.  Block students tried to match their behaviors to their attendings' expectations, while longitudinal students described less-hierarchical relationships with their preceptors.  A major caveat is that longitudinal students and preceptors were self-selected.--LW


Do residents like evaluating their attendings?
Academic Medicine.  87(10):1397-1400, October 2012. (Myers, et al)

The quick answer is no - they find it time-consuming and wonder whether it is worth it.  Residents felt it was most important that they provide feedback on attendings perceived as either much better or much worse than average. Some residents expressed worries that their evaluations would not be strictly confidential and could be damaging to them.--LW



Student Uncertainties Drive Teaching During Case Presentations: More So With SNAPPS
Academic Medicine Volume 87(9), September 2012, p1210-1217 (Wolpaw)

In a study of a small number of audiotaped presentations by medical students to family medicine preceptors, researchers found that preceptors directly aligned their teaching towards 80% of questions posed during the presentation.  Students posed about 2 questions per presentation.  A small number of students had been trained in the presentation technique known as SNAPPS (Summarize, Narrow, Analyze, Probe, Plan, Select).  These students asked slightly more questions, and more of their questions had to do with diagnostic reasoning.—LW

Rounded Rectangle: Doctor Shadowing

Preparing Students for Clerkship: A Resident Shadowing Program
Academic Medicine Volume 87(9), September 2012, p1288-1291 (Turner)

A low-cost voluntary program is described in which first-year students were assigned to shadow randomly selected first-year residents during their clinical duties for several hours a month, for a mean total of 44.5 hours.  Nearly all participants enjoyed the experience, and about three fourths felt that the students would be better prepared for their clerkships.--LW

Rounded Rectangle: Mistreatment

Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts
Academic Medicine Volume 87(9), September 2012, p1191-1198 (Fried)

Regarding an issue which has been pointed out at our institution, the David Geffen (UCLA) Medical School started a committee to reduce medical student mistreatment in 1995.  Reports of mistreatment have declined somewhat but remained at fairly high levels, particularly verbal abuse (reported by about 35% of students) and power abuse (reported about 25% of students).  An example of the latter is being influenced to deliver take-out food to scattered residents.  Residents and clinical faculty were the most commonly cited sources of mistreatment.—LW

Rounded Rectangle: Writing

Good advice from the deputy editors of Medical Education.
 Medical Education Volume 46(9), September 2012, p828-829 (Boulet, et al)

Here is some practical advice from the deputy editors of Medical Education that include issues you should consider even before you begin your research, to advice on writing specific sections of the manuscript, to strategies for responding to request for revisions.—SK

Rounded Rectangle: Doctor-Patient

Do too many cooks spoil the broth? The effect of observers on doctor-patient interaction.
Medical Education Volume 46(8), August 2012, p785-794 (Bristowe, et al)

Is your doctor listening? Maybe not so well, if there are other health professionals or medical students observing, according to this study of 5 plastic surgeons in 63 outpatient consultations. When other health professionals were present, visits were longer, with fewer patient questions answered. Although this is an observational study of just a few plastic surgeons which limits causal inferences or generalizability, it does raise an interesting question about the role of the observer in the patient-doctor interaction.—SK

Rounded Rectangle: Teaching

Should we teach using schemas? Evidence from a randomised trial.
Medical Education Volume 46(8): August 2012, p815-822 (Blissett, et al).

Students may use different diagnostic reasoning strategies to solve clinical problems. Schema-based reasoning is a process where key clinical features are used to include or exclude sets of diagnoses. In this randomized controlled study of schema-based instruction vs traditional instruction in 2nd year medical students in a cardiac physical diagnosis course, schema-based instruction improved retention of structured knowledge and diagnostic performance.—SK

Residency Data VisualizationVisualizing Resident Competency Data with Radar Graphs

The Radar Graph: the development of an educational tool to demonstrate resident competency
Journal of Graduate Medical Education Volume 4(2), June, 2012, p220-226 (no online version yet, available in print at the RWJ Library, New Brunswick)

This small, but timely study in data visualization grapples with the challenge of showing large data sets of residency skill level information in a easily readable format.   Using New Innovations, Microsoft Access and Excel, researchers at Lehigh Valley Health Network’s Family Medicine program built several radar graphs, which show targets, trends and gaps in residency competency.   The authors provide practical tips on compiling data from multiple assessments vehicles into an easy-to-read visualization. 


Transitions of CareTransitions of care:  Faculty feedback improves intern sign-out of hospitalized patients

Faculty Member Review and Feedback Using a Sign-Out Checklist: Improving Intern Written Sign-Out
Academic Medicine Volume 87(8), August, 2012, p1125-1131

In this randomized controlled trial, faculty delivered twice-monthly feedback on interns’ written signout to an overnight coverage team.  Over two weeks, the intervention interns demonstrated moderate improvement as measured by the same checklist used to give feedback.  Other outcomes, such as patient safety or night float intern satisfaction, were not measured

osceObjective standardized clinical examinations (OSCEs) fail to identify students with below-average diagnostic reasoning

Examining the Diagnostic Justification Abilities of Fourth-Year Medical Students
Academic Medicine Volume 87(8), August, 2012, p1008-1014

In an interesting preliminary study, the authors find that many fourth-year students who pass the OSCE checklist, by performing adequate numbers of history and physical exam maneuvers and identifying the correct diagnosis, are unable to adequately describe their diagnostic reasoning.  Two main categories of diagnostic errors were identified:  premature closure of the diagnostic process, and failure to recognize common symptoms patterns.  Another study to confirm the validity and reproducibility of the diagnostic reasoning instrument would be useful.

Clerkship GradesWithout a grid, clerkship grades are uninterpretable

Variation and Imprecision of Clerkship Grading in U.S. Medical Schools
Academic Medicine Volume 87(8), August, 2012, p1070-1076

No news here.  This compendium of clerkship grades from 119 medical schools shows that grades are all over the map.  The percentage of students earning the top grade in a clerkship ranges from 2% to 93%. Schools have grading systems with anywhere from 2 (Pass/Fail) to 11 (A/A-/B+, etc.) tiers of grades.  Extra grading tiers seem to contribute to grade inflation:  97% of students end up with one of the three highest grades regardless of the number of tiers.  Fewer than 1% of students fail any clerkship.



Video-based cases may not be better than text-based cases in problem based learning. 

Medical Education
Issue: Volume 46(4), April 2012, p 426-435

In a randomized controlled study of 2nd year medical students in PBL tutorials, one group was given video-based cases and the other group text-based cases.  Critical thinking in student discussions was measured using a critical thinking model that classified student utterances into deep or superficial critical thinking. The authors found that while students preferred video cases to text cases, the odds of deep thinking were significantly lower using video-based cases (OR 0.66, 95% CI 0.58-0.75). The authors speculate that higher student satisfaction in video cases suggest students spent less effort on learning. This study did not examine whether the differences in deep critical thinking had any impact on student achievement or long term retention of new knowledge. 

Evaluating cognitive ability, knowledge tests and situational judgment for postgraduate selection

Medical Education
Issue: Volume 46(4), April 2012, p 399-408

General cognitive ability tests (such as IQ assessments) are commonly used in a broad range of occupations to select candidates. This study suggests that such tests are not well suited for use in selecting candidates for residency training, and tests that measure cognitive and non-cognitive professional attributes may be better.

Varying conceptions of competence: an analysis of how health sciences educators define competence.

Medical Education
Issue: Volume 46(4), April 2012, p 357-365

This review describes varying ways in which competence is defined, and finds that although there is general acceptance that knowledge and skills are not the only components of competence, there is little agreement on the nature of other essential ingredients of competence. 


How can we produce more rural practitioners? (3 articles)

A major problem for the US (if not so much for New Jersey) is a dearth of rural physicians.  Several predictors of rural practice are identified:  growing up in a rural area, planning to pursue rural medicine and/or family medicine, attending medical school near or in a rural area, and participating in a rural program in medical school.  It is likely that similar attributes may predict physicians who care for the urban under-served.

Medical School Rural Programs: A Comparison with International Medical Graduates in Addressing State-Level Rural Family Physician and Primary Care Supply

Academic Medicine
Issue: Volume 87(4), April 2012, p 488-492

The Relationship Between Entering Medical Students’ Backgrounds and Career Plans and Their Rural Practice Outcomes Three Decades Later

Academic Medicine
Issue: Volume 87(4), April 2012, p 493-497

Which U.S. Medical Schools Are Providing the Most Physicians for the Appalachian Region of the United States?

Academic Medicine
Issue: Volume 87(4), April 2012, p 498-505

“DR MERL Recommends appeared at the 4/18/2012 UMDNJ Master Educators Symposium on Simulation (   A DR MERL poster that highlighted recent medical education literature on simulation was presented in the Robert Wood Johnson University Hospital atrium.  Flyers with follow up information including the DR MERL website and Twitter (rwjlibrary  #DR_MERL_Recommends) were handed out.   Interested visitors discussed the literature reviews and inquired about DR MERL’s presence on the web.    Kerry O’Rourke and James Galt introduced DR MERL and answered questions. “

Faculty development:  “How are my lectures?”

Academic Medicine
Issue: Volume 87(3), March 2012, p 356-363

A recently developed peer assessment form was evaluated and found to have excellent inter-rater reliability, at least among a group of raters who had intensively discussed the use of the instrument with actual lecture ratings, to establish a common frame of reference.  It may be hard to duplicate the training of these raters in other settings.

Faculty development for clinician educators:  a peer mentoring group

Academic Medicine
Issue: Volume 87(3), March 2012, p 378-383

Junior clinician educators found that a bimonthly peer mentoring group assisted with personal and professional growth.  This looks promising (and inexpensive), but is based on the feedback of only seven faculty.

Eliminating the “July effect”?

Academic Medicine
Issue: Volume 87(3), March 2012, p 308-319

Researchers at the University of Minnesota offered a new voluntary course in April of the fourth year of medical school to students who had matched into surgically-related specialties.  The course included sessions on technical skills as well as the general medical management of acutely ill hospitalized patients.  Once the students became interns, their supervising residents rated them as superior to comparator interns from other institutions (who had not taken the new course).  By the end of August, the ratings of interns who had taken the course and the comparator interns had equalized.

Students and residents report frequent exposure to defensive medicine

Academic Medicine
Issue: Volume 87(2), February 2012, p 142–148

More than 90% of learners report sometimes or often observing such practices, especially ordering more tests, more medications, or more consultations than medically indicated.  Large numbers (27-47%) also observed non-indicated invasive procedures, avoidance of indicated procedures, and failure to disclose medical errors.  The study is limited by learners perhaps inferring that certain things were done to avoid liability, but 41-60% report that their attendings sometimes or often explicitly refer to malpractice liability concerns playing a role in clinical decisions.

Resident diagnostic reasoning errors are common, and associated with patient harm

Academic Medicine
Issue: Volume 87(2), February 2012, p 149–156

Dutch investigators reviewed records of 247 patients admitted for dyspnea, and found at least one episode of suboptimal diagnostic reasoning in 66%.  Records of patients experiencing harm showed more episodes of suboptimal reasoning (4.9) vs. those without (2.0).  The study is limited by the determination of suboptimal reasoning by retrospective chart review, with only modest inter-rater reliability.

 How can we make diagnosis safer?

Academic Medicine
Issue: Volume 87(2), February 2012, p 135–138

A commentary on the study above suggests the creation of checklists for the top 20 or 30 symptoms, and suggests that the National Quality Forum take responsibility for this task.




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