INTRODUCTION:Advising is essential for student success in graduate health professions education (HPE). Advising does not happen in a vacuum, yet most research focuses narrowly on advisor-advisee relationships. To address this gap, this study examines how institutional structures, policies, and programmatic dynamics influence the effectiveness of advising in graduate HPE. METHODS:We conducted semi-structured interviews with 15 HPE program leaders across six WHO regions. Using framework analysis guided by Activity Theory and the concept of knotworking, we analyzed how institutional systems shape advising practices. RESULTS:Five institutional factors were identified: (1) strategic advisor recruitment, (2) supportive advising cultures, (3) bureaucratic and resource constraints, (4) advisor training and evaluation, and (5) recognition and support for advisors. Leaders described advising as an adaptive, cross-system process shaped by institutional complexity and evolving student needs. DISCUSSION:Advising in graduate HPE operates beyond dyadic relationships. It is embedded within institutional activity systems and requires ongoing negotiation across structural boundaries. Programs must adopt systemic strategies, such as faculty development, workload alignment, and policy reform, to support effective advising networks.

The United States faces a critical shortage of physicians, and the demands on surgical educators are intensifying. The rise of educational initiatives like Graduate Health Professions Education (HPE) and the American College of Surgeons Accredited Education Institutes and the Education and Simulation (ACS-AEI ES) fellowship programs are examples of academia helping to meet this need. At Walter Reed National Military Medical Center, these 2 initiatives intersect. Fellows in the ACS-AEI ES program simultaneously pursue graduate education in HPE at the Uniformed Services University. The synergistic benefits, which we categorize as impacting the individual, the 2 programs, and the healthcare system as a whole, outweigh the sum of their parts. We suggest that overlapping educational programs can offer an efficient way to prepare surgeon-educators for excellence in complex, challenging healthcare systems. Partnerships like this can offer a blueprint to other institutions to maximize responsiveness and effectiveness in the face of growing challenges.

INTRODUCTION:Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. MATERIALS AND METHODS:Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs. RESULTS:The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains. CONCLUSIONS:Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.

PROBLEM:There is a need within graduate health professions education (HPE) programs to align advising practices to support an increasing number of working adult learners, especially those studying part-time and from remote locations. Despite the recognized importance of the advisor-advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities. Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently. APPROACH:The Department of Health Professions Education, Uniformed Services University, established a small cadre of faculty to serve as academic advisors (n = 7) in August 2018. This cadre uses an advising model based on 5 advising practices, called TOTAL Advising-train the advisors, onboard the learners, touch base frequently, annually review learners, and learner review. These advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program while managing the demands of their personal and professional lives. TOTAL Advising provides the framework needed to achieve 3 guiding beliefs: each learner is capable of completing the program, fostering community, and providing clear communication. OUTCOMES:Between May 2020-May 2024, learners who completed a degree (n = 21) were interviewed about their advising experiences by a program evaluator after they graduated. The themes observed from these reflect the program's 3 guiding beliefs. Additionally, from May 2018-May 2024, of the 574 learners who enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled. NEXT STEPS:The next steps for TOTAL Advising involve a comprehensive evaluation of the effectiveness of the training program for advisors and collaborating with other graduate HPE programs to share best practices in advising, discuss emerging challenges, and shape advising practices in the broader HPE community.

PURPOSE:High-ranking educational leaders in academic medicine oversee multiple clinical programs. This requires them to prioritize dozens of emergent tasks and responsibilities daily, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Identifying their key responsibilities and frequently used skills and competencies may clarify the educational needs of senior educational leaders and facilitate targeted professional development to promote effective and efficient performance. METHOD:In August 2022, researchers interviewed 12 designated education officers (DEOs) from U.S. Department of Veterans Affairs (VA) Veterans Health Administration medical centers about their daily work and most challenging responsibilities. Content analysis of interview transcripts identified key responsibilities and activities identified by participants and prioritization of the perceived skills needed to complete them. RESULTS:Participants emphasized 4 key areas of responsibility: fiscal, administrative, affiliate partnership, and educational duties. They identified 12 skills as baseline requirements for effective performance for which additional professional development would be useful and suggested that both new and more established educational leaders receive targeted professional development and mentoring to foster these capacities. CONCLUSIONS:The key skills participants identified by area of perceived responsibility are relevant to VA DEOs, designated institutional officers, and senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. Structured orientation programs and ongoing professional development for senior educational leaders could emphasize these areas of responsibility, potentially enriching DEOs' performance and reducing burnout.

Peer coaching is a form of faculty development in which faculty improve their teaching skills through collaborative work or peer observation of teaching. As a tool grounded in experiential learning, peer coaching promotes targeted feedback, reflection on action, and collegial exchange to improve teacher self-efficacy and trainee learning outcomes. Nevertheless, faculty developers face challenges in creating sustainable, effective peer coaching programs as faculty fear scrutiny of their teaching practices. Additionally, to promote collegial exchange, faculty (the person observed and peer coach) must trust one another and accept vulnerability. Without attending to trust, faculty developers may find themselves on black ice, designing and implementing ineffective peer coaching programs. In this Black Ice article, we underscore the role of trust in peer coaching and present five ways to help faculty developers get a grip by incorporating trust into the design and implementation of peer coaching programs, optimizing its efficacy.

Introduction:Effective advising is crucial for student success in graduate Health Professions Education (HPE) programs. However, the implementation and impact of advising remain underexplored, particularly from the perspective of program leaders. This study explores how HPE program leaders conceptualize advising practices that support student success. Methods:We conducted a qualitative narrative inquiry study to explore worldwide leaders' perspectives on advising in graduate HPE programs. Fifteen program leaders across six World Health Organization regions were purposively sampled and interviewed using a semi-structured approach. Thematic analysis, informed by developmental advising theory, was employed to identify key advising strategies and challenges. Results:Findings revealed that leaders conceptualize advising in terms of learners' academic advancement, personal development, and community building. Leaders largely prioritized clear communication, goal setting, and holistic student support within their programs' advising systems. The advisor-advisee relationship mattered to leaders. They highlighted challenges that might influence this relationship: faculty workload, role conflicts, and the need for structured advising models. Discussion:This study underscores the critical role of advisors in HPE programs, revealing that effective advising involves both academic guidance and social support. It highlights a gap in the existing literature on how program leaders in graduate HPE programs conceptualize and support advising, and advocates for the expansion of developmental advising that addresses not only administrative tasks but also the broader developmental needs of students, such as career advancement and personal growth. The findings suggest that HPE programs support student success by fostering holistic advising practices and professional development for advisors.

BackgroundGraduate medical education is a critical period for fostering self-directed learning (SDL). This study introduced an academic coaching program to support SDL among internal medicine (IM) residents, leveraging Gallimore and Tharp's four-stage model as a scaffolding framework.ObjectiveTo assess the impact of academic coaching on residents' performance, including Internal Medicine In-Training Examination (IM-ITE) scores, individualized learning plans (ILPs), and attitudinal changes. The study also explored how coaching influenced SDL within the residency program.Design and ParticipantsA mixed-methods case study was conducted in a mid-sized university's IM residency program. Quantitative measures included pre- and post-coaching surveys, ILP analysis, and IM-ITE score evaluation. Semi-structured interviews provided qualitative insights into participant experiences. Of 77 eligible residents, 40 enrolled in the coaching program, and 27 (18 post-graduate year (PGY) 1 and PGY2) completed at least one session. Baseline IM-ITE scores guided enrollment for mandatory participants.Key ResultsOf the 77 residents, 51 had complete IM-ITE data and individualized learning plans (ILPs) from 2022 and 2023. Residents attending one coaching session demonstrated significant improvement in IM-ITE percentile scores (p = .022), while those with two or more sessions showed significant gains in both percent correct (p = .015) and percentile scores (p = .003). No significant differences were observed in ILPs or attitudinal surveys. Qualitative analyses of resident participant interviews highlight coaching's positive influence on SDL, organized into input, process, and output domains.ConclusionsSustained coaching, defined as two or more coaching meetings, is associated with improved IM-ITE performance. Qualitative findings underscore the program's role in enhancing residents' SDL.

Introduction The American Academy of Periodontology (AAP) In-Service Examination (ISE) is offered annually to residents in postdoctoral periodontal programs across the United States and Canada. The language in AAP published guidance supports both formative and summative uses of the exam, presenting discordance in how to use and interpret the AAPISE. It is important to clarify how programs use data, as formative assessments are low-stakes and aim to provide feedback to learners for improving their learning. On the other hand, summative assessments are used to make high-stakes decisions, such as program admission, graduation, and licensure. These two types of assessments serve different purposes and have distinct outcomes. This study aimed to explore and characterize how stakeholders utilize the AAPISE and its associated score reports. Methods Semi-structured interviews of periodontology program directors, department chairs, and residents were conducted in 2022. Data from these interviews were explored, coded, and thematically analyzed. Results A total of 16 interviews were conducted and analyzed: four chairs, eight program directors, and four residents representing the experience at 20 postdoctoral periodontal programs. Five major themes were identified regarding the use of the AAPISE: formative assessment, board preparation, program development, promoting a culture of achievement, and summative assessment. Conclusion This study's findings suggest varied uses of the AAPISE amongst postdoctoral periodontal program stakeholders, reflecting the variance within the AAP guidance. The discordant uses and guidance jeopardize the AAPISE’s potential to align with the 2018 Consensus Framework for Good Assessment elements. The authors propose recommendations to the AAP and stakeholders for future use.

Practicing professionals are usually high-achieving adult learners who prefer to take courses online, given their professional and personal commitments. Typically, high achievers are self-directed and intrinsically motivated learners. This does not mean that they do not need or will not benefit from robust academic advising. A qualitative study was undertaken to explore what academic advising strategies are effective for high-achieving professional learners. Findings showed that the academic advising needs of these learners were influenced by their busy lifestyles and need for social interaction as adult and online learners. These learners wanted proactive advising from knowledgeable advisors who were committed to their success. This study showed that high-achieving graduate learners need academic advising, and effective academic advising can enhance student retention.

Higher education accreditation has spread internationally as a vehicle for quality assurance and improvement but is strongly influenced by accreditation practices in the United States. The organisational structure and processes of seven United States health professions accreditors were analysed to identify common characteristics that reflect general fitness for purpose and infrequent features that show potential to enhance the effectiveness of accreditation processes, increase engagement of and support by accredited institutions and programmes and provide greater transparency.

Introduction: Professional identity formation is central to physicians' identity over their full careers. There is little guidance within military service on how to leave careers as clinician educator faculty in graduate medical education programs. The objective of our study was to explore how leaving this community of practice (COP) affects a clinician educator's professional identity. Methods: We used reflexive thematic analysis with Communities of Practice as a sensitizing construct. Fifteen semi-structured interviews were conducted among active-duty clinician educators at the point of their retirement from the military. Interview questions focused participants' lived experiences as clinician educators and professional identity changes leading to and resulting from the decision to retire. Results: We found the clinician educators' journey through a time of professional transition led to three connected themes: Loss Precedes Growth, Fallow Season—Liminal Space, and New Growth. Discussion: The experiences of military clinician educators retiring from active duty demonstrate how leaving one COP emanates across a range of professional identities. In addition, the decision to leave a professional COP can lead to a sense of disloyalty to that community. Normalizing this transition in a way that honors the community's values offers the opportunity to enable the decision to retire. Understanding retirement as a process that first involves identity loss, followed by the discomfort of a liminal space before achieving new growth creates the opportunity to engage in rituals that celebrate the service of departing community members, releasing them to grow into new identities.

ABSTRACT Introduction Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation. Material and Methods This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation. Results The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair. Conclusions The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training.

Introduction: Advising is happening across the medical education continuum, within non-medical graduate education programs, and is central to the advancement of said learners. This suggests that advising should play a role in graduate health progressions education (HPE) programs. Materials and Methods: To explore advising curricula among HPE programs, we conducted a website review of all published HPE programs on the Foundation for Advancement of International Medical Education and Research's website. Results: We recognized the lack of information published on advisory roles in graduate HPE programs. This prompted a literature review, which revealed a similar gap. Conclusions: Advising serves to benefit a student, advisor, and program thus carrying importance and need for discussion. This article is intended to kick-start a scholarly discussion about advising within graduate HPE programs.

Phenomenon: Ownership of patient care is a key element of professional growth and professional identity formation, but its development among medical students is incompletely understood. Specifically, how attitudes surrounding ownership of patient care develop, what experiences are most influential in shaping them, and how educators can best support this growth are not well known. Therefore, we studied the longitudinal progression of ownership definitions and experiences in medical students across their core clerkship curriculum. Approach: We conducted a series of four longitudinal focus groups with the same cohort of medical students across their core clerkship curriculum. Using workplace learning theory as a sensitizing concept, we conducted semi-structured interviews to explore how definitions, experiences, and influencers of ownership developed and evolved. Results were analyzed inductively using thematic analysis. Findings: Fifteen students participated in four focus groups spanning their core clerkship curriculum. We constructed four themes from responses: (1) students' definitions of ownership of patient care evolved to include more central roles for themselves and more defined limitations; (2) student conceptions of patient care ownership became more relational and reciprocal over time as they ascribed a more active role to patients; (3) student assessment fostered ownership as an external motivator when it explicitly addressed ownership, but detracted from ownership if it removed students from patient care; and (4) structural and logistical factors impacted students' ability to display patient care ownership. Insights: Student conceptions of ownership evolved over their core clerkship curriculum to include more patient care responsibility and more meaningful relational connections with patients, including recognizing patients' agency in this relationship. This progression was contingent on interactions with real patients and students being afforded opportunities to play a meaningful role in their care. Rotation structures and assessment processes are key influencers of care ownership that merit further study, as well as the voice of patients themselves in these relationships.

Supplemental Digital Content is Available in the Text. Introduction:Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators?Methods:The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators.Results:Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct.Discussion:The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.

Introduction: Empathy improves patient outcomes and increases perception of physician competence. However, empathy may contribute to biased decision-making and provider burnout. To help providers harness the benefits of empathy without the pitfalls, comprehensive knowledge about the practice of empathy is needed – particularly in high-stress contexts, such as in critical care. This qualitative study explores how critical care physicians experience empathy in intensive care units and how this might inform the medical education of critical care physicians throughout their training. Methods: Working from a constructivist orientation, we engaged in thematic analysis of semi-structured interviews with critical care physicians. We asked participants to describe their personal experiences of empathy including how they handled events requiring empathy, managed empathic distress, and reframed their understanding of empathy over time. Data analysis followed the six steps of thematic analysis and used Hoffman’s Theory of Empathy to further inform our understanding of the data. Results: We identified limitations of empathy in the intensivist experience, which were consistent with Hoffman’s theory of empathy. This theory describes arousal, habituation, and bias which were prevalent in the data. Further, intensivists altered their behavior due to these limitations and to manage empathic distress. Additionally, burnout as a consequence of empathy was identified, though interviewees discussed prevention methods and the development of resilience. Discussion: Empathy and empathic distress among intensivists have been understudied in the literature thus far. Our study reveals that critical care physicians acutely experience limitations of empathy to include over-arousal, habituation, and bias—all of which impact interactions with patients, physician stress, and physician burnout. The knowledge that fully trained intensivists struggle with the limitations of empathy has implications to all stages of physician education from medical student through continuing medical education for attendings since all must learn and practice the empathic skills required to optimize patient care and maintain their own wellness.

Purpose Military surgeons have the unique responsibility of maintaining a broad set of surgical skills to care for combat-related injuries during times of peace. Lower and upper limb amputations are life-altering combat injuries sustained by our military personnel. Salvage of a limb saves someone from impaired mobility, abnormal physiology, and social effects of amputation and requires the knowledge and technical proficiency to diagnose and treat vascular traumatic injuries. Methods A needs assessment of deployable military surgeons was performed which demonstrated a need for additional training to diagnose and treat vascular emergencies. For simulation skills training, a novel low-cost arterial model was developed by our institution's mixed material layering 3D medical applications center. A focused simulation curriculum was developed which included both didactic and technical skills training for vascular trauma emergencies. Learners were assessed using a pre-, post-test design to evaluate efficacy. Results A realistic vascular model was developed using 3D printed technologies and was used for traumatic vascular emergency skills training. Implementation of the VESSELS course using both in-person and online asynchronous formats demonstrated significant increases in knowledge and confidence in diagnosing and managing limb-threatening injuries. Conclusions A novel, low-cost simulation model and curriculum was developed that increases the understanding of vascular surgical techniques and emergency procedures. This course is an option for deploying military surgeons and surgeons without vascular training who are responsible for managing vascular emergencies.

Introduction In an age of increasingly face-to-face, blended, and online Health Professions Education, students have more choices of institutions at which to study their degree. For an applicant, oftentimes, the first step is to learn more about a program through its website. Websites allow programs to convey their unique voice and to share their mission and values with others such as applicants, researchers, and academics. Additionally, as the number of master in health professions education (MHPE), or equivalent, programs rapidly grows, websites can share the priorities of these programs. Methods In this study, we conducted a website review of 158 MHPE websites to explore their geographical distributions, missions, educational concentrations, and various programmatic components. Results We compiled this information and synthesized pertinent aspects, such as program similarities and differences, or highlighted the omission of critical data. Conclusions Given that websites are often the first point of contact for prospective applicants, curious collaborators, and potential faculty, the digital image of MHPE programs matters. We believe our findings demonstrate opportunities for growth within institutions and assist the field in identifying the priorities of MHPE programs. As programs begin to shape their websites with more intentionality, they can reflect their relative divergence/convergence compared to other programs as they see fit and, therefore, attract individuals to best match this identity. Periodic reviews of the breadth of programs, such as those undergone here, are necessary to capture diversifying goals, and serves to help advance the field of MHPE as a whole.

Phenomenon: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. Approach: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. Findings: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only engagement with educator roles but disengagement with other roles; imagination of future roles with the support of mentors; and fluid alignment with multiple mutually reinforcing identities. Participants identified boundary objects like resumes and formal roles that helped them negotiate across Community of Practice boundaries. Insights: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.