Academic medicine : journal of the Association of American Medical Colleges
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparing diagnostic performance and the utility of clinical vignette-based assessment under testing conditions designed to encourage either automatic or analytic thought.
Although decades of research have yielded considerable insight into physicians' clinical reasoning processes, assessing these processes remains challenging; thus, the authors sought to compare diagnostic performance and the utility of clinical vignette-based assessment under testing conditions designed to encourage either automatic or analytic thought. ⋯ Instructions to trust one's first impres-sions result in similar performance when compared with instructions to consider clinical information in a systematic fashion, but have greater utility when used for the purposes of assessment.
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Multicenter Study
Caring for patients with limited English proficiency: are residents prepared to use medical interpreters?
To evaluate whether educational sessions on interpreter use and experience with interpreters are associated with resident self-efficacy in the use of professional interpreters. ⋯ Many residents who care for patients with LEP have never received educational sessions on interpreter use. Such training is associated with high self-efficacy and may enhance patient-provider communication. Incorporating this training into residency programs is necessary to equip providers with skills to communicate with patients and families with LEP.
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Medical educators have expressed concern that students' professional identities do not always align with their expectations or with professional standards. The authors propose that, in constructing appropriate professional identities, medical students today are affected by the competing discourses of diversity and standardization. ⋯ To influence medical students' professional identity construction, the authors advocate that educators seek change across the profession-faculty must acknowledge and take advantage of the tension between the discourses of standardization and diversity.
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National recommendations specify how medical schools should manage clinical conflicts of interest (CCOIs), including gifts and payments to physicians from pharmaceutical companies. A 2008 study showed that few schools had policies in keeping with the recommendations. The authors conducted a follow-up study in 2011 to assess possible improvements. ⋯ Schools have made great progress toward national standards, yet room for improvement remains: The data reveal not a race to the top but a shift from the bottom to the middle. Follow-up research should explore whether stronger policies emerge in the future.
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As third-year medical students rotate between clerkships, they experience multiple transitions across workplace cultures and shifting learning expectations. The authors explored clerkship transitions from the students' perspective by examining the advice they passed on to their peers in preparation for new clerkships. ⋯ These findings characterize the transitions that third-year students undergo as they rotate into new clinical training environments. Students emphasized different aspects of each clerkship in the advice they passed to their peers, and their comments often describe informal norms or opportunities that official clerkship orientations may not address. Peer-to-peer handoffs may help ease transitions between clerkships with dissimilar cultures and expectations.