Academic medicine : journal of the Association of American Medical Colleges
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Educational psychology indicates that learning processes can be mapped on three dimensions: cognitive (what to learn), affective or motivational (why learn), and metacognitive regulation (how to learn). In a truly student-centered medical curriculum, all three dimensions should guide curriculum developers in constructing learning environments. The authors explored whether student motivation has guided medical education curriculum developments. ⋯ Motivational processes may be a substantially undervalued factor in curriculum development. Building curricula to specifically stimulate motivation in students may powerfully influence the outcomes of curricula. The elements essential for stimulating intrinsic motivation in students, including autonomy support, adequate feedback, and emotional support, appear lacking as a primary aim in many curricular plans.
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Comparative Study
Contemporary performance of U.S. teaching and nonteaching hospitals.
To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics. ⋯ Teaching hospitals offer advanced clinical capabilities, educate the next generation of providers, care for disadvantaged urban populations, and are leaders in health care research and innovation. However, many stakeholders may be unaware of an additional value-relatively higher quality and safety in many areas, with similar adjusted costs.
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To characterize national physician organizations' efforts to reduce health disparities and identify organizational characteristics associated with such efforts. ⋯ Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts.
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Factors that support self-efficacy in family-centered care (FCC) must be understood in order to foster FCC in trainees. Using social cognitive theory, the authors examined (1) how three supportive experiences (observing role models, practicing for mastery, and receiving feedback) influence self-efficacy with FCC during rounds and (2) whether the influence of these supportive experiences was mediated by self-efficacy with three key FCC tasks (relationship building, information exchange, and decision making). ⋯ Both observing role models and practicing for mastery foster students' self-efficacy with FCC during rounds, operating through self-efficacy with key FCC tasks. Results suggest the importance both of helping students gain self-efficacy in key FCC tasks before rounds and of helping educators implement supportive experiences during rounds.
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Cultural competency efforts have received much attention in medical education. Most efforts focus on the acquisition of knowledge and skills about various groups based on race and ethnic identity, national origins, religion, and the like. The authors propose an approach, "Cultural Competency 2.0," that does not reject such efforts but, rather, adds a more critical and expanded focus on learners' attitudes and beliefs toward people unlike themselves. ⋯ Suggestions are offered for how and where Cultural Competency 2.0 can be used in the curriculum through narrative medicine, particularly through the development of reading practices that unmask illusions of "pure" objectivity often assumed in clinical settings, and that make visible how words and images constrain, manipulate, or empower individuals, groups, ideas, or practices. The authors argue that these educational approaches should be sustained throughout the students' clinical experiences, where they encounter patients of many kinds and see clinicians' varied approaches to these patients. Further, these educational approaches should include assisting students in developing strategies to exercise moral courage within the limitations of their hierarchical learning environments, to strengthen their voices, and, when possible, to develop a sense of fearlessness: to always be advocates for their patients and to do what is right, fair, and good in their care.