Journal of general internal medicine
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Medical education continues to evolve with technologic advances, cultural changes, and progress in the application of learning theories. One example is Cutrer's concept of the Master Adaptive Learner (MAL), where the trainee self-directs learning and innovates to maintain a level of expertise in a domain. We suggest that this concept can be applied alongside ideas of adaptive and teacher expertise to represent the medical educator of the future-the Master Adaptive Clinician Educator (MACE). ⋯ The MACE reflects and continuously develops an educational toolbox, applies lessons from learning theories, and appropriately adapts to various learning environments. In this manuscript, we build upon recent publications outlining roles and competencies of clinician-educators by applying the MAL model; we propose a dynamic, adaptable, and well-trained expert educator who is best poised to lead future generations of medical trainees. We challenge institutional leaders and national societies to take the lead in creating structures to support the growth and promotion of MACEs with the goal of positively reshaping medical education and the clinician educator.
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Observation stays in Medicare have grown over the last 15 years, yet limited research exists on how observation may impact outcomes for older adults. ⋯ Among Medicare beneficiaries hospitalized for fewer than 5 days, observation stay was associated with higher rates of 30-day unplanned hospital returns compared to inpatient admission. However, we simultaneously observed lower out-of-pocket costs among those hospitalized under an observation stay. The mixed results suggest that additional research and engagement with relevant parties is needed to optimize observation stay policy.