The Access in Medicine (AIM) Summit, held in April 2024, convened 60 delegates from across the United States to generate practicable solutions for dismantling accessibility barriers in medical education. These proceedings outline the Summit's objectives and present the resulting insights and actionable recommendations. The Summit featured an innovative design that engaged diverse delegates in collaborative, idea-generating activities that elevated the lived experiences of learners with disabilities. Inspired by guiding principles of social justice and accessibility, delegates recommended a bundle of action-oriented strategies for addressing social and structural barriers to disability equity and inclusion. The proposed action steps identified critical intervention points that span the continuum of undergraduate medical education, from improving support of disabled learners in recruitment and admissions processes through to their residency application and postgraduation transition stages. Though medical education was the AIM Summit focus, delegates emphasized the generalizability of themes to broad training contexts (e.g., residency and other health professions education training), both in the sociostructural challenges they confronted and in the solutions they proposed. These proceedings highlight the vital steps necessary to build more equitable and inclusive learning environments for learners with disabilities.

Background Team leadership during medical emergencies like cardiac arrest resuscitation is cognitively demanding, especially for trainees. These cognitive processes remain poorly characterized due to measurement challenges. Using virtual reality simulation, this study aimed to elucidate and compare communication and cognitive processes-such as decision-making, cognitive load, perceived pitfalls, and strategies-between expert and novice code team leaders to inform strategies for accelerating proficiency development.Methods A simulation-based mixed methods approach was utilized within a single large academic medical center, involving twelve standardized virtual reality cardiac arrest simulations. These 10- to 15-minutes simulation sessions were performed by seven experts and five novices. Following the simulations, a cognitive task analysis was conducted using a cued-recall protocol to identify the challenges, decision-making processes, and cognitive load experienced across the seven stages of each simulation.Results The analysis revealed 250 unique cognitive processes. In terms of reasoning patterns, experts used inductive reasoning, while novices tended to use deductive reasoning, considering treatments before assessments. Experts also demonstrated earlier consideration of potential reversible causes of cardiac arrest. Regarding team communication, experts reported more critical communications, with no shared subthemes between groups. Experts identified more teamwork pitfalls, and suggested more strategies compared to novices. For cognitive load, experts reported lower median cognitive load (53) compared to novices (80) across all stages, with the exception of the initial presentation phase.Conclusions The identified patterns of expert performance — superior teamwork skills, inductive clinical reasoning, and distributed cognitive strategiesn — can inform training programs aimed at accelerating expertise development.

Introduction Suture skills are important for family physicians, and they are best learned during residency. To increase the residents’ readiness for clinical procedures, we developed a self-directed online suturing training program that targets knowledge and suturing techniques with video submission, evaluation, and feedback. The program was built to address residents’ difficulties in performing obstetric laceration repairs, although the content is also pertinent to office-based skin procedures. Methods First-year residents were assigned an online suturing training program during their surgical rotation. Assessments included a pre- and posttraining knowledge test and survey evaluating participants’ comfort level with suturing and their perception of the training program's value. Residents submitted videos of their suturing, which were graded by one expert preceptor, who provided coaching and feedback. Changes in test scores and comfort ratings pre- to posttraining were analyzed using paired Student t tests. Results Between 2018 and 2023, 64 residents were enrolled. Forty-seven (73%) submitted all expected videos, and 39 (61%) completed all components, including tests and surveys. Knowledge test and comfort level scores improved after the training (p < .001). The majority (>91%) of residents reported improved knowledge, suturing skill, and comfort level, and would recommend the program to their peers. Discussion This novel self-directed suturing training utilizing simulation, video capture, and asynchronous faculty coaching and feedback was an effective tool to support learning of suturing skills. This training allowed for the assessment of each resident's suture skills with minimal time burden on the preceptor to prepare each resident for clinical procedures.

AbstractObjectiveIntranasal medications have been proposed as adjuncts to out‐of‐hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows.MethodsWe conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands‐only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group.ResultsAmong LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment (p = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2 cpm, mean diff. −9.1 cpm, 95% CI −16.6, −1.6) and CCF (INMA 62.4% vs control 69.8%, mean diff. −7.5%, 95% CI −12.0, −2.9). Among FRs, we found no significant CPR2 delays (mean diff. −2.1 s, 95% CI −15.9, 11.7), which persisted after adjustment (p = 0.704), or difference in quality (CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. −5.3 cpm, 95% CI −12.6, 2.0; CCF INMA 79.6% vs control 81.2% mean diff. −1.6%, 95% CI −7.4, 4.3%)ConclusionsINMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.

BACKGROUND:Errors in reasoning are a common cause of diagnostic error. However, it is difficult to improve performance partly because providers receive little feedback on diagnostic performance. Examining means of providing consistent feedback and enabling continuous improvement may provide novel insights for diagnostic performance.METHODS:We developed a model for improving diagnostic performance through feedback using a six-step qualitative research process, including a review of existing models from within and outside of medicine, a survey, semistructured interviews with individuals working in and outside of medicine, the development of the new model, an interdisciplinary consensus meeting, and a refinement of the model.RESULTS:We applied theory and knowledge from other fields to help us conceptualise learning and comparison and translate that knowledge into an applied diagnostic context. This helped us develop a model, the Diagnosis Learning Cycle, which illustrates the need for clinicians to be given feedback about both their confidence and reasoning in a diagnosis and to be able to seamlessly compare diagnostic hypotheses and outcomes. This information would be stored in a repository to allow accessibility. Such a process would standardise diagnostic feedback and help providers learn from their practice and improve diagnostic performance. This model adds to existing models in diagnosis by including a detailed picture of diagnostic reasoning and the elements required to improve outcomes and calibration.CONCLUSION:A consistent, standard programme of feedback that includes representations of clinicians' confidence and reasoning is a common element in non-medical fields that could be applied to medicine. Adapting this approach to diagnosis in healthcare is a promising next step. This information must be stored reliably and accessed consistently. The next steps include testing the Diagnosis Learning Cycle in clinical settings.

AbstractObjectives:Virtual reality has emerged as a unique educational modality for medical trainees. However, incorporation of virtual reality curricula into formal training programmes has been limited. We describe a multi-centre effort to develop, implement, and evaluate the efficacy of a virtual reality curriculum for residents participating in paediatric cardiology rotations.Methods:A virtual reality software program (“The Stanford Virtual Heart”) was utilised. Users are placed “inside the heart” and explore non-traditional views of cardiac anatomy. Modules for six common congenital heart lesions were developed, including narrative scripts. A prospective case–control study was performed involving three large paediatric residency programmes. From July 2018 to June 2019, trainees participating in an outpatient cardiology rotation completed a 27-question, validated assessment tool. From July 2019 to February 2020, trainees completed the virtual reality curriculum and assessment tool during their cardiology rotation. Qualitative feedback on the virtual reality experience was also gathered. Intervention and control group performances were compared using univariate analyses.Results:There were 80 trainees in the control group and 52 in the intervention group. Trainees in the intervention group achieved higher scores on the assessment (20.4 ± 2.9 versus 18.8 ± 3.8 out of 27 questions answered correctly, p = 0.01). Further analysis showed significant improvement in the intervention group for questions specifically testing visuospatial concepts. In total, 100% of users recommended integration of the programme into the residency curriculum.Conclusions:Virtual reality is an effective and well-received adjunct to clinical curricula for residents participating in paediatric cardiology rotations. Our results support continued virtual reality use and expansion to include other trainees.

STUDY OBJECTIVE:Bystander cardiopulmonary resuscitation increases the likelihood of out-of-hospital cardiac arrest survival by more than two-fold. A common barrier to the prompt initiation of compressions is moving victims to the floor, but compression quality on a "floor" versus a "mattress" has not been tested among lay bystanders. METHODS:We conducted a prospective, randomized, cross-over trial comparing lay bystander compression quality using a manikin on a bed versus the floor. Participants included adults without professional health care training. We randomized participants to the order of manikin placement, either on a mattress or on the floor. For both, participants were instructed to perform 2 minutes of chest compressions on a cardiopulmonary resuscitation Simon manikin Gaumard (Gaumard Scientific, Miami, FL). The primary outcome was mean compression depth (cm) over 2 minutes. We fit a linear regression model adjusted for scenario order, age, sex, and body mass index with robust standard errors to account for repeated measures and reported mean differences with 95% confidence intervals (CIs). RESULTS:Our sample of 80 adults was 66% female with a mean age of 50.5 years (SD 18.2). The mean compression depth on the mattress was 2.9 cm (SD 2.3) and 3.5 cm (SD 2.2) on the floor, a mean difference of 0.58 cm (95% CI 0.18, 0.98). Compression depth fell below the 5 to 6 cm depth recommended by the American Heart Association on both surfaces. In the adjusted model, the mean depth was greater when the manikin was on the floor than the mattress (adjusted mean difference 0.62 cm; 95% CI 0.23 to 1.01), and mean depth was less for females than males (adjusted mean difference -1.42 cm, 95% CI -2.59, -0.25). In addition, the difference in compression depth was larger for female participants (mean difference 0.94 cm; 95% CI 0.54, 1.34) than for male participants (mean difference -0.01 cm; 95% CI -0.80, 0.78), and the interaction was statistically significant (P = .04). CONCLUSION:The mean compression depth was significantly smaller on the mattress and with female bystanders. Further research is needed to understand the benefit of moving out-of-hospital cardiac arrest victims to the floor relative to the detrimental effect of delaying chest compressions.

Introduction Since 2005, the American College of Surgeons Accredited Educational Institutes has provided accreditation of surgically focused simulation centers with the added benefit of identifying best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education. This study aimed to examine the evolution of the best practices observed by accreditors during site visits over the 8-year period. Methods Accreditation included the completion of an application form followed by a site visit by a simulation expert and review of all materials by an accreditation committee to identify areas out of compliance along with areas far exceeding accreditation standards. These are termed “best practices.” To evaluate the evolution of accreditation feedback and embedded associations, the compiled list of 337 best practices identified from all 247 site visits over an 8-year period was analyzed and visualized using epistemic network analysis, a quantitative ethnographic technique for modeling the structure of connections in qualitative data. Results The overall association network of the data indicates that the strongest associations were between assessment, curriculum development, faculty development, research, and teaching methods, demonstrating a highly interconnected model of accreditation feedback. Best practices evolved from an early focus on teaching methods, faculty, and curriculum development to more advanced educational topics including assessment, research, resources, and overall center governance. Distribution of associations also increased over the 8-year period with more nuanced and interconnected statements demonstrating higher-level feedback including explanations, contributing factors, impact on other areas, and, in some cases, recommendations to share best practices outside the organization. Conclusions The epistemic network analysis of this 8-year database of simulation center feedback provides a novel perspective on an organization and the evolving field of simulation from an optional to essential modality in healthcare professions education.

Abstract Background: Understanding how cardiovascular structure and physiology guide management is critically important in paediatric cardiology. However, few validated educational tools are available to assess trainee knowledge. To address this deficit, paediatric cardiologists and fellows from four institutions collaborated to develop a multimedia assessment tool for use with medical students and paediatric residents. This tool was developed in support of a novel 3-dimensional virtual reality curriculum created by our group. Methods: Educational domains were identified, and questions were iteratively developed by a group of clinicians from multiple centres to assess understanding of key concepts. To evaluate content validity, content experts completed the assessment and reviewed items, rating item relevance to educational domains using a 4-point Likert scale. An item-level content validity index was calculated for each question, and a scale-level content validity index was calculated for the assessment tool, with scores of ≥0.78 and ≥0.90, respectively, representing excellent content validity. Results: The mean content expert assessment score was 92% (range 88–97%). Two questions yielded ≤50% correct content expert answers. The item-level content validity index for 29 out of 32 questions was ≥0.78, and the scale-level content validity index was 0.92. Qualitative feedback included suggestions for future improvement. Questions with ≤50% content expert agreement and item-level content validity index scores <0.78 were removed, yielding a 27-question assessment tool. Conclusions: We describe a multi-centre effort to create and validate a multimedia assessment tool which may be implemented within paediatric trainee cardiology curricula. Future efforts may focus on content refinement and expansion to include additional educational domains.

IntroductionSince 2005, the American College of Surgeons Accredited Educational Institutes has provided accreditation of surgically focused simulation centers with the added benefit of identifying best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education. This study aimed to examine the evolution of the best practices observed by accreditors during site visits over the 8-year period.MethodsAccreditation included the completion of an application form followed by a site visit by a simulation expert and review of all materials by an accreditation committee to identify areas out of compliance along with areas far exceeding accreditation standards. These are termed "best practices." To evaluate the evolution of accreditation feedback and embedded associations, the compiled list of 337 best practices identified from all 247 site visits over an 8-year period was analyzed and visualized using epistemic network analysis, a quantitative ethnographic technique for modeling the structure of connections in qualitative data.ResultsThe overall association network of the data indicates that the strongest associations were between assessment, curriculum development, faculty development, research, and teaching methods, demonstrating a highly interconnected model of accreditation feedback. Best practices evolved from an early focus on teaching methods, faculty, and curriculum development to more advanced educational topics including assessment, research, resources, and overall center governance. Distribution of associations also increased over the 8-year period with more nuanced and interconnected statements demonstrating higher-level feedback including explanations, contributing factors, impact on other areas, and, in some cases, recommendations to share best practices outside the organization.ConclusionsThe epistemic network analysis of this 8-year database of simulation center feedback provides a novel perspective on an organization and the evolving field of simulation from an optional to essential modality in healthcare professions education.

The American College of Surgeons launched the Accredited Education Institutes (ACS-AEIs) in 2005 to create a network of simulation centers to offer the highest-quality surgical education and training and to pursue cutting-edge scholarship. Specific standards and criteria were developed to accredit simulation centers, and decisions made based on the application, site surveyor visit, and ACS-AEI Accreditation Committee review. In addition to granting accreditation and providing recommendations for improvement, site surveyors and the Accreditation Committee identified best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education. Best practices were compiled into a list starting in 2011 for dissemination to all members of the ACS-AEI Consortium through on-line videos, newsletters, and workshops at the Annual ACS Surgical Simulation Summit. Using thematic analysis, the authors classified common themes from the 337 best practices identified during 247 accreditation reviews between June 2011 and June 2019. As best practices were extracted, the authors compiled them into a single database. Eight overarching themes were identified, including approaches to faculty development, scholarly activity, development of curricula, use of resources, delivery of educational content, assessment of learners, and collaboration between centers. The authors discuss themes in the context of their practical relevance and highlight strategies used at different centers, with an emphasis on the importance of each theme in developing a successful simulation program.

We sought to assess whether HHFNC results in greater production of aerosolized particles than 6 liters per minute nasal cannula, using state-of-the-art techniques of aerosol measurement, in spontaneously breathing human volunteers in a simulated hospital room.For each volunteer, we first measured background aerosol levels in the room immediately prior to testing. We then measured aerosol levels while the healthy volunteer laid in bed - - with the head of bed at 30 degrees - - wearing the following oxygen delivery devices: (a) 6L/min nasal canula (NC) with humidification; (b) non-re-breather mask (NRB) with 15L/min gas flow, non-humidified; (c) HHFNC with 30L/min gas flow; (d) HHFNC with 60L/min gas flow. Two scanning mobility particle sizing (SMPS) systems (TSI 3080/3030, TSI 3080/3750) were used to measure aerosols 10 to 500 nanometer (nm) in size for each of the oxygen delivery devices.There was no variation in aerosol level within patients between room air, 6 L/min NC, 15 L/min NRB, 30 L/min HHFNC, and 60 L/min HHFNC, regardless of coughing.

Purpose: Pediatric cardiology requires a clear understanding of how cardiovascular structure and physiology guide therapeutic decisions. Pediatric residents have limited exposure to pediatric cardiology during training, and outside of standard clinical oversight, there is a paucity of methods available for assessing trainee knowledge despite the need for trainees to recognize and properly refer these patients in a general pediatric setting after graduation. Here we describe a multicenter collaborative effort to develop and validate a multimedia assessment tool for assessing pediatric residents’ knowledge of key concepts of …

BACKGROUND:Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. METHODS:In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. RESULTS:Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. CONCLUSION:Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long-term value of simulation solutions. Limitations and application of the tool are discussed.

BACKGROUND:Since the inception of American College of Surgeons' Accredited Educational Institute (ACS-AEI) Consortium, accreditation reviews have identified best practices in simulation-based education and center operations. A review of best practices would support the communication of these best practices, offer recognition of exemplar institutes, and facilitate discussion and sharing of resources amongst AEIs. METHODS:We examined 5 years of ACS AEI accreditation best practices identified across all standards and criteria. The goal was to identify resources that could be shared among AEIs and recognize AEI champions that have promoted best practices in surgical simulation. RESULTS:From 149 site reviews (July 2011-June 2016), reviewers identified 197 best practices across 83 AEIs (52.9% of all sites reviewed received a best practice). A total of 52.5% of best practices were associated with curriculum development, delivery of effective education and assessment, and 25 available resources were identified that could be shared among AEIs. The majority of best practices (n = 117, 59.3%) were identified at 24 AEIs, with the highest number of best practices identified at Banner Simulation Center and New Orleans Learning Center (10 each over 2 reviews). Twenty-two other institutes presented 97 best practices, with between 3 to 8 per institute (mean = 4.4, standard deviation = 1.6). Specific best practices, criteria, and AEI champions are highlighted. CONCLUSION:Review of AEI accreditation best practices identified common themes for surgical simulation programs and identified tools that could be shared to advance all programs and champion AEIs that have promoted best practices in surgical simulation.

Background: Recently, a significant increase occured in the use of medical simulation technology for teaching and assessment. Improved patient safety during medical education has driven simulation-based education (SBE), particularly in resident education. Although many countries have integrated SBE into their undergraduate programs, some developing countries, including Turkey, have been slow to apply SBE into their graduate programs. We propose a review of existing examples of SBE used which may promote the implementation of similar curricula in developing countries. Methods: To derive a representative sample of relevant curricula, we performed a web-based literature review using the search terms “simulation” and (“ graduate, resident”) and (“clinical decision-making” or ‘‘clinical reasoning”) and “training’’. Results: Of the 83 original articles, ten resulting articles were relevant to SBE used to support residents’ clinical decision-making in six clinical areas. We summarize the ten curricula and discuss them in the context of three primary considerations (course administration, content development, and assessment program evaluation) so they may be applied in similar graduate curricula in Turkey and others. Conclusions: It is obvious that simulation-based education offers benefits. In particular, graduate-level training programs used to support clinical decision-making are critical to the development of competent physicians around the world.

UNLABELLED:Phenomenon: Existing research provides little specific evidence regarding the association between public and private medical school curricular settings and the proportion of medical students matching into family medicine careers. Institutional differences have been inadequately investigated, as students who match into family medicine are often consolidated into the umbrella of primary care along with those matching in internal medicine and pediatrics. However, understanding medical school contexts in relation to career choice is critical toward designing targeted strategies to address the projected shortage of family physicians. This study examines factors associated with family medicine residency match rates and the extent to which such factors differ across medical school settings. APPROACH:We combined data from a survey of 123 departments of family medicine with graduate placement rates reported to the American Academy of Family Physicians over a 2-year period. Chi-square/Fisher's Exact texts, t tests, and linear regression analyses were used to identify factors significantly associated with average match rate percentages. FINDINGS:The resulting data set included 85% of the U.S. medical schools with Departments of Family Medicine that reported 2011 and 2012 residency match rates in family medicine. Match rates in family medicine were higher among graduates of public than private medical schools-11% versus 7%, respectively, t(92) = 4.00, p < .001. Using a linear regression model and controlling for institutional type, the results indicated 2% higher match rates among schools with smaller annual clerkship enrollments (p  = .03), 3% higher match rates among schools with clerkships lasting more than 3 to 4 weeks (p  = .003), 3% higher match rates at schools with at least 1 family medicine faculty member in a senior leadership role (p  = .04), and 8% lower match rates at private medical schools offering community medicine electives (p < .001, R(2) = .48), F(6, 64) = 9.95, p < .001. Three additional factors were less strongly related and varied by institutional type-informal mentoring, ambulatory primary care learning experiences, and institutional research focus. Insights: Educational opportunities associated with higher match rates in family medicine differ across private and public medical schools. Future research is needed to identify the qualitative aspects of educational programming that contribute to differences in match rates across institutional contexts. Results of this study should prove useful in mitigating physician shortages, particularly in primary care fields such as family medicine.

The principal goal of most simulation-based learning is enhanced clinical skill, with the desired outcome being skill retention and improved performance over time. While evide nce supports simulation based training at the clerkship, graduate, and post graduate level, the evidence supporting its long term benefit at the pre clerkship level is less well established. Using quantitative methods, this research assessed the effect of skill based clinical simulation training on all second year medical students’ enrolled in two simulation courses at the University of Michigan during the 2013 2014 academic year (n=39). Pre course, post course, and 6 month follow up questionnaires were adm inistered, and analysis of variance was used to assess change in students' knowledge, self reported confidence, and competency. Students in Course 1 (n=12) completed a post course and 6 month follow up skills test, and results were compared to faculty cont rols. Differences between groups were assessed using t tests. Odds ratios were calculated.Knowledge improved from pre course to post course; the gain was retained at follow up only for students in Course 1. Students perceived the courses as improving know ledge, confidence, and skill, though scores were significantly lower at follow up. For the subset of students participating in the skills test, the time to complete central line and thoracentesis at follow up did not significantly differ from post course; however, an increase was observed for lumbar puncture. Compared to faculty, students took significantly more time to complete the central line procedure. Outcomes for needle redirects and correct sequencing were mixed, with most procedures showing no signi ficant difference between measurement periods. Assessing students’ skill and the maintenance of that skill over time using objective and empirically derived measures can be challenging. The evaluation strategy described herein could be adapted to many proc edures commonly practiced within primary care and other medical specialties. Brief exposure to clinical simulation early in medical training and prior to clerkships can have a positive and lasting effecton medical students’ knowledge, confidence, and skil l for selected procedures.