PURPOSE:Consensus recommendations and guidelines for reporting quantitative research in health professions education (HPE) research are lacking. This study synthesizes available quantitative reporting recommendations and guidelines to present a harmonized framework and derive quantitative standards for reporting HPE research. METHOD:The authors identified existing standards, recommendations, and guidelines from peer-reviewed scientific journals in medicine, education, and social sciences by searching PubMed, Web of Science, and Google from August 2006 through April 2025. The authors also requested input from experts in HPE (scholars and journal editors) via electronic communication over 6 months (November 2024 to April 2025). The articles identified were then used to synthesize and generate an initial list of standards for reporting quantitative research in HPE. Two authors reviewed each article to rate its alignment with HPE research. All authors independently evaluated the full list of standards and discussed them as a group for their relevance and alignment for reporting in HPE; all authors also made recommendations for each standard (to report as is, report but modify, or drop). The group subsequently reviewed and collectively reached consensus on the final set of quantitative reporting standards. RESULTS:The authors reviewed a total of 34 articles, with 19 identified as having alignment with HPE quantitative research standards. Mean interrater agreement among author pairs was 98% (kappa = .96). Authors initially generated 40 reporting standards, of which 18 (45%) were modified and 1 (3%) was identified to be dropped. The final set of quantitative guidelines consisted of 39 standards, with each standard nested in one of 28 topic areas. CONCLUSIONS:The quantitative reporting standards identified in this study provide guidance to ensure rigor in reporting expectations for HPE research. These standards may also facilitate critical appraisal of articles and enhance the quality and impact of quantitative HPE research.

Undergraduate medical educators seek to optimize student learning, improve grading transparency and fairness, and provide useful information to residency programs. Recently, the United States Medical Licensing Examination's shift to pass/fail scoring for step 1 disrupted curricular and assessment operations, and schools' tiered grading practices have been scrutinized. In noting that significant institutional time and energy were being expended in addressing the current levels of student grade appeals, 6 public and private medical schools in the Northeastern United States engaged in an examination of grade appeals via a root cause analysis (RCA). From November 2021 to April 2022, the authors reviewed specific instances of grading challenges that the team of educators encountered previously. From May to June 2022, the authors met for a facilitated discussion of the question, "Why are students challenging grading processes and systems or outcomes?" From July to October 2022, the authors identified root causes by analyzing results from the fishbone diagram (process, equipment, materials, people, and environment) and using the "five whys" technique. Several potential explanations for grade appeals and challenging grading systems across institutions were identified, including variability in the quality or experience of evaluators, lack of clarity about the goals and expectations of clerkships and a lack of transparency about the grading process, having a tiered grading system, technical issues with equipment, and clinical productivity demands of faculty. In proposing solutions to root causes identified in the RCA, factors were mapped to Liaison Committee on Medical Education (LCME) standards to facilitate quality and process improvements in grading. Aiming to support the learning environment and a fair and equivalent assessment process, the authors present a novel RCA and LCME method that can contribute to improving grading systems and has the potential to enhance learning and success.

ProblemDue to generational exposure to the Black Lives Matter movement, other antibias social movements, and diverse peer advocacy groups, health professions students are often more knowledgeable than their teachers about ways in which systemic racism and bias have led to scientific inaccuracies that contribute to health inequities. However, traditional hierarchies and concerns about retaliation may limit educational communities from benefiting maximally from students' contributions. ApproachIn spring 2021, faculty and students at the Vagelos College of Physicians and Surgeons, Columbia University, designed a structural innovation to engage faculty and students in partnership toward decreasing bias in medical education. This article discusses development and implementation of a Statement of Partnership and Humility (SPH) disclosure slide on which faculty members acknowledge consideration of potential teaching biases and invite student feedback. OutcomesThe initial primary goal of the SPH slide was to increase faculty awareness and engagement in antibias topics; however, the unexpected dividends of decreasing faculty anxiety about receiving student feedback and promoting student engagement have proven equally powerful in promoting a healthy, inclusive learning environment. Next StepsNext steps include gathering qualitative and quantitative data to elicit both faculty and student perspectives on the use of the SPH slide, particularly with regard to psychological safety and openness to feedback.

Competency-based medical education (CBME) focuses on preparing physicians to improve the health of patients and populations. In the context of ongoing health disparities worldwide, medical educators must implement CBME in ways that advance social justice and anti-oppression. In this article, authors describe how CBME can be implemented to promote equity pedagogy, an approach to education in which curricular design, teaching, assessment strategies, and learning environments support learners from diverse groups to be successful. The five core components of CBME programs – outcomes competency framework, progressive sequencing of competencies, learning experiences tailored to learners’ needs, teaching focused on competencies, and programmatic assessment – enable individualization of learning experiences and teaching and encourage learners to partner with their teachers in driving their learning. These educational approaches appreciate each learner’s background, experiences, and strengths. Using an exemplar case study, the authors illustrate how CBME can afford opportunities to enhance anti-oppression and social justice in medical education and promote each learner’s success in meeting the expected outcomes of training. The authors provide recommendations for individuals and institutions implementing CBME to enact equity pedagogy.

Competency-based education of health professionals has been gaining momentum across the globe for the past two decades. The central tenet is to start with the outcomes that are required of a trainee to meet the health care needs of the public. These outcomes lead to the elaboration of requisite competencies, which in turn drive the curriculum and assessment programs. Educators have encountered many challenges in the development and implementation of curricula and assessment systems that effectively teach and measure performance of the requisite competencies. Entrustable professional activities (EPAs) offer an excellent framework for addressing many of those challenges. In this chapter, we offer the unique potential of an EPA framework in promoting a competency-based curriculum. We review some of the curricular structural implications of using EPAs, including the role of sequencing of EPAs in the curriculum, describe how an EPA-based curriculum adds agency to the trainee’s journey, and explore the notion of time-variability in competency-based education and training based on success stories using an EPA framework. We conclude that a well-designed curriculum and assessment system using EPAs provides an excellent foundation for ensuring health professionals’ readiness to provide safe and effective care within the scope of their discipline and at the appropriate level of supervision.

BACKGROUND:In 2024 in the United States there is an attack on diversity, equity, and inclusion initiatives within education. Politics notwithstanding, medical school curricula that are current and structured to train the next generation of physicians to adhere to our profession's highest values of fairness, humanity, and scientific excellence are of utmost importance to health care quality and innovation worldwide. Whereas the number of anti-racism, diversity, equity, and inclusion (ARDEI) curricular innovations have increased, there is a dearth of published longitudinal health equity curriculum models. In this article, we describe our school's curricular mapping process toward the longitudinal integration of ARDEI learning objectives across 4 years and ultimately creation of an ARDEI medical education program objective (MEPO) domain. METHODS:Medical students and curricular faculty leaders developed 10 anti-racism learning objectives to create an ARDEI MEPO domain encompassing three ARDEI learning objectives. RESULTS:A pilot survey indicates that medical students who have experienced this curriculum are aware of the longitudinal nature of the ARDEI curriculum and endorse its effectiveness. CONCLUSIONS:A longitudinal health equity and justice curriculum with well-defined anti-racist objectives that is (a) based within a supportive learning environment, (b) bolstered by trusted, structured avenues for student feedback and (c) amended with iterative revisions is a promising model to ensure that medical students are equipped to effectively address health inequities and deliver the highest quality of care for all patients.

Artificial intelligence (AI) methods, especially machine learning and natural language processing, are increasingly affecting health professions education (HPE), including the medical school application and selection processes, assessment, and scholarship production. The rise of large language models over the past 18 months, such as ChatGPT, has raised questions about how best to incorporate these methods into HPE. The lack of training in AI among most HPE faculty and scholars poses an important challenge in facilitating such discussions. In this commentary, the authors provide a primer on the AI methods most often used in the practice and scholarship of HPE, discuss the most pressing challenges and opportunities these tools afford, and underscore that these methods should be understood as part of the larger set of statistical tools available. Despite their ability to process huge amounts of data and their high performance completing some tasks, AI methods are only as good as the data on which they are trained. Of particular importance is that these models can perpetuate the biases that are present in those training datasets, and they can be applied in a biased manner by human users. A minimum set of expectations for the application of AI methods in HPE practice and scholarship is discussed in this commentary, including the interpretability of the models developed and the transparency needed into the use and characteristics of such methods. The rise of AI methods is affecting multiple aspects of HPE including raising questions about how best to incorporate these models into HPE practice and scholarship. In this commentary, we provide a primer on the AI methods most often used in HPE and discuss the most pressing challenges and opportunities these tools afford.

ABSTRACT:In this issue of Academic Medicine , Thelen and colleagues present a thoughtful perspective on the emerging opportunity to use longitudinal educational data to improve graduate medical education and optimize the education of individual residents, and call for the accelerated development of large interinstitutional data sets for this purpose. Such applications of big data to medical education hold great promise in terms of informing the teaching of individuals, enhancing transitions between phases of training and between institutions, and permitting better longitudinal education research. At the same time, there is a tension between whose data they are and consequently how they ought to be used. This commentary proposes some practical, privacy and ethical, and philosophical considerations that need to be explored as early efforts to aggregate data across the medical education continuum mature and new efforts are undertaken.

Purpose: As educators in undergraduate medical education, we seek to maximize student learning, grading transparency and fairness, and provide useful information to residency programs that support continued professional development. In recent years medical schools have encountered disruptions to curricular and assessment operations, in part due to the impacts of COVID-191 and the change to a pass/fail-scored United States Medical Licensing Examination (USMLE) Step 1. Medical schools have also developed an increased awareness of long-standing systemic inequities in the grading of nonmajority racial groups.2 Contemporaneously, clerkship grade appeals were becoming noticeable enough to clerkship directors in medicine (CDIM) and psychiatry that national surveys were conducted to begin to quantify the prevalence of these appeals and try to understand reasons for them.3,4 In noting that significant institutional resources were being expended in addressing the present levels of student grade appeals, our group sought to extend the literature by engaging in a systematic analysis of grade appeals across 6 medical schools. Method: Six medical schools (Albert Einstein College of Medicine, Columbia University Vagelos College of Physicians and Surgeons, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Frank H. Netter School of Medicine—Quinnipiac University, The State University of New York Downstate College of Medicine, The City University of New York School of Medicine), including public, private, research-intensive, and primary care-oriented institutions, sought to learn more about grade appeals and systems challenges at our schools. All schools contributed descriptive data regarding processes and criteria for clerkship grade assignments, which were tiered (variations of honors/high pass/pass/fail) at all institutions, and clerkship grade appeal processes. The group examined the central question, “Why are students challenging grading processes/systems or outcomes?” through a modified root cause analysis (RCA).5 Using this modified RCA approach, the authors identified multiple contributing factors including system challenges that potentially lead students to appeal clerkship grades. These factors were mapped to standards/elements from the Liaison Committee on Medical Education (LCME) Data Collection Instrument as a means to structure quality and process improvements in clerkship grade assignments to address the issue of student clerkship grade appeals and system challenges more holistically. Results: Grade appeal reasons fell most commonly into Standard 9 (teaching, supervision, assessment), with reported issues including perceived variability in raters’ use of assessment forms, inconsistencies between mid-clerkship feedback and final grades, and perceptions of the lack of transparency in grade determination. Standard 4 (faculty preparation, productivity, participation, and policies) was another common area for reasons to appeal, related to potential issues with faculty development on how to use assessment or rating forms, or differential faculty assessment training across clinical sites. Standards 3, 5, 6, 8, 10, and 11 also were identified as containing potential reasons for student grade appeals. Additionally, reasons were identified that did not fit into LCME standards but potentially impact grade appeals. These “student factors” included students who are more comfortable self-advocating and negotiating for grades and/or culture of privilege in seeking further justification of grades, as well as national use of grades in residency candidacy decisions. Discussion: We found many similarities in potential reasons for submitting grade appeals and challenging grading systems across institutions. Classifying reasons for grade appeal and system challenges into LCME standards is useful because schools often assign standards and specific elements within standards to individual departments or stakeholders for continuous quality improvement interventions. For example, faculty development-related challenges were identified and, thus, could be targeted for evaluation and improvement. As another example, assessment or grading committees could address challenges related to perceptions of the lack of grading transparency and potentially decide to share some group grading data back with students. Significance: We found that conducting a modified RCA to understand the issues giving rise to grade appeals and using an LCME framework to classify reasons for the grade appeals is a useful approach to identifying specific areas for improvement as well as stakeholders who can help to address them. The LCME framework was an effective way to classify the majority of the reasons for appeals, with “student factors” capturing the rest. With the ultimate goal of creating an optimal learning environment and a fair and equitable assessment process in mind, we believe this methodology can contribute to making improvements to our grading systems that enhance student learning and success.

Objective: To assess the feasibility and utility of simulation-based training in teaching concepts surrounding management of traumatic brain injury (TBI). Background: Neurology trainees respond to neurological emergencies but often do not have the opportunity to practice implementing their clinical knowledge and communication skills in managing such emergencies outside the clinical setting. Design/Methods: We developed a simulation-based training program for neurology residents to practice managing a patient presenting with acute TBI under the direct supervision of an expert in neurocritical care with opportunities for debriefing and feedback. The educational aims of the simulation were to familiarize learners with Brain Trauma Foundation guidelines on the management of TBI and to allow learners to practice closed loop communication in a multidisciplinary team. The simulation involved two learners, one confederate playing the role of emergency room nurse and ICU fellow, and a hired actor who played the role of the patient. Prior to the simulation, learners were given a 10-slide presentation to review relevant topics. A total of 40 minutes was allotted per session; 5 minutes to introduce the scenario, 20 minutes to complete the scenario, and 10 minutes for a debriefing. The effect of the simulation on learner aptitude in managing TBI was assessed via anonymous post-test. Results: A total of 8 learners participated in the simulation-based training. We were able to complete all simulation sessions in the allotted 40-minute time frame. On post-test reporting, 7/8 learners felt confident in managing TBI, 8/8 felt their confidence improved with the simulation, and 8/8 endorsed comfort in accessing resources regarding TBI guidelines. Conclusions: Teaching TBI management via simulation-based training is feasible and allows trainees to gain experience and comfort managing TBI. Disclosure: Dr. Franzova has nothing to disclose. Dr. Waldrop has nothing to disclose. Dr. Nwankwo has nothing to disclose. Dr. Ader has nothing to disclose. Dr. Bell has nothing to disclose. Dr. Velazquez has nothing to disclose. Dr. Agarwal has nothing to disclose. Dr. Roh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals. Dr. Park has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical Care. The institution of Dr. Park has received research support from National Institutes of Health. Sander Connolly has received intellectual property interests from a discovery or technology relating to health care. Dr. Claassen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Claassen has stock in iCE Neurosystems. The institution of Dr. Claassen has received research support from NINDS. The institution of Dr. Claassen has received research support from McDonnel Foundation. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Amiel has nothing to disclose. Dr. Ghoshal has nothing to disclose.

In 2014, the Association of American Medical Colleges (AAMC) published 13 Core Entrustable Professional Activities (EPAs) that graduating students should be able to perform with indirect supervision when entering residency. A ten-school multi-year pilot was commissioned to test feasibility of implementing training and assessment of the AAMC's 13 Core EPAs. In 2020-21, a case study was employed to describe pilot schools' implementation experiences. Teams from nine of ten schools were interviewed to identify means and contexts of implementing EPAs and lessons learned. Audiotapes were transcribed then coded by investigators using conventional content analysis and a constant comparative method. Coded passages were organized in a database and analyzed for themes. Consensus among school teams regarding facilitators of EPA implementation included team commitment to piloting EPAs; agreement that: proximal EPA adoption with curriculum reform facilitates EPA implementation; EPAs 'naturally fit' in clerkships and provided opportunity for schools to reflect on and adjust curricula and assessments; and inter-school collaboration bolstered individual school progress. Schools did not make high-stakes decisions about student progress (e.g., promotion, graduation), yet EPA assessment results complemented other forms of assessment in providing students with robust formative feedback about their progress. Teams had varied perceptions of school capability to implement an EPA framework, influenced by various levels of dean involvement, willingness, and capability of schools to invest in data systems and provide other resources, strategic deployment of EPAs and assessments, and faculty buy-in. These factors affected varied pace of implementation. Teams agreed on the worthiness of piloting the Core EPAs, but substantial work is still needed to fully employ an EPA framework at the scale of entire classes of students with enough assessments per EPA and with required data validity/reliability. Recommendations stemming from findings may help inform further implementation efforts across other schools adopting or considering an EPA framework.

IMPORTANCE Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency. OBJECTIVE To assess progress in developing an entrustment process in the Core EPAs framework. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database. INTERVENTIONS Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations. MAIN OUTCOMES AND MEASURES On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded. RESULTS Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of "ready for indirect supervision" increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P <.001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P <.001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P <.001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs. CONCLUSIONS AND RELEVANCE These findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.

BACKGROUND: The Association of American Medical Colleges described 13 Core Entrustable Professional Activities (EPAs) that graduating students should be prepared to perform under indirect supervision on day one of residency. Surgery program directors recently recommended entrustability in these Core EPAs for incoming surgery interns. We sought to determine if graduating students intending to enter surgery agreed they had the skills to perform these Core EPAs. STUDY DESIGN: Using de-identified, individual-level data collected from and about 2019 Association of American Medical Colleges Graduation Questionnaire respondents, latent profile analysis was used to group respondents based on their self-assessed Core EPAs skills’ response patterns. Associations between intended specialty, among other variables, and latent profile analysis group were assessed using independent sample t-tests and chi-square tests and multivariable logistic regression methods. RESULTS: Among 12,308 Graduation Questionnaire respondents, latent profile analysis identified 2 respondent groups: 7,863 (63.9%) in a high skill acquisition agreement (SAA) group and 4,445 (36.1%) in a moderate SAA group. Specialty was associated with SAA group membership (p < 0.001), with general surgery, orthopaedic surgery, and emergency medicine respondents (among others) overrepresented in the high SAA group. In the multivariable logistic regression models, each of anesthesiology, ophthalmology, pediatrics, psychiatry, and radiology (vs general surgery) specialty intention was associated with a lower odds of high SAA group membership. CONCLUSION: Graduating students’ self-assessed Core EPAs skills were higher for those intending general surgery than for those intending some other specialties. Our findings can inform collaborative efforts to ensure graduates’ acquisition of the skills expected of them at the start of residency.

The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates’ performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools’ capacity to collect multimodal evidence about their students’ performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners’ readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.

Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government. Knowledge Syntheses in Medical Education: Examining Authors’ Gender, Geographic Location, and Institutional Affiliation

Programmatic assessment supports the evolution from assessment of learning to fostering assessment for learning and as learning practices. A well-designed programmatic assessment system aligns educational objectives, learning opportunities, and assessments with the goals of supporting student learning, making decisions about student competence and promotion decisions, and supporting curriculum evaluation. We present evidence-based guidance for implementing assessment for and as learning practices in the pre-clinical knowledge assessment system to help students learn, synthesize, master and retain content for the long-term so that they can apply knowledge to patient care. Practical tips are in the domains of culture and motivation of assessment, including how an honour code and competency-based grading system can support an assessment system to develop student self-regulated learning and professional identity, curricular assessment structure, such as how and when to utilize low-stakes and cumulative assessment to drive learning, exam and question structure, including what authentic question and exam types can best facilitate learning, and assessment follow-up and review considerations, such exam retake processes to support learning, and academic success structures. A culture change is likely necessary for administrators, faculty members, and students to embrace assessment as most importantly a learning tool for students and programs.