Medical EducationVolume 58, Issue 5 p. 648-649 REALLY GOOD STUFF Teaching transgender cultural competency with standardised patients Adi X. Mukund, Adi X. Mukund Contribution: ​Investigation, Conceptualization, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Project administration, Data curation, ResourcesSearch for more papers by this authorJustin L. Jia, Justin L. Jia Contribution: ​Investigation, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Project administration, Resources, Data curationSearch for more papers by this authorMichael Nedelman, Michael Nedelman Contribution: ​Investigation, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Project administration, Software, Resources, Data curationSearch for more papers by this authorTracy A. Rydel, Tracy A. Rydel Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Resources, SupervisionSearch for more papers by this authorRika Bajra, Rika Bajra Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Resources, SupervisionSearch for more papers by this authorMalathi Srinivasan, Malathi Srinivasan Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Resources, SupervisionSearch for more papers by this authorErika Schillinger, Erika Schillinger Contribution: ​Investigation, Writing - review & editing, Formal analysis, Resources, Methodology, ValidationSearch for more papers by this authorBenjamin H. Laniakea, Corresponding Author Benjamin H. Laniakea [email protected] Correspondence Benjamin H. Laniakea, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, 211 Quarry Rd Ste 405, MC 5985, Palo Alto, CA 94304, USA. Email: [email protected] Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Project administration, Formal analysis, Data curation, Supervision, Resources, Writing - original draftSearch for more papers by this author Adi X. Mukund, Adi X. Mukund Contribution: ​Investigation, Conceptualization, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Project administration, Data curation, ResourcesSearch for more papers by this authorJustin L. Jia, Justin L. Jia Contribution: ​Investigation, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Project administration, Resources, Data curationSearch for more papers by this authorMichael Nedelman, Michael Nedelman Contribution: ​Investigation, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Project administration, Software, Resources, Data curationSearch for more papers by this authorTracy A. Rydel, Tracy A. Rydel Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Resources, SupervisionSearch for more papers by this authorRika Bajra, Rika Bajra Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Resources, SupervisionSearch for more papers by this authorMalathi Srinivasan, Malathi Srinivasan Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Resources, SupervisionSearch for more papers by this authorErika Schillinger, Erika Schillinger Contribution: ​Investigation, Writing - review & editing, Formal analysis, Resources, Methodology, ValidationSearch for more papers by this authorBenjamin H. Laniakea, Corresponding Author Benjamin H. Laniakea [email protected] Correspondence Benjamin H. Laniakea, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, 211 Quarry Rd Ste 405, MC 5985, Palo Alto, CA 94304, USA. Email: [email protected] Contribution: ​Investigation, Conceptualization, Methodology, Validation, Writing - review & editing, Project administration, Formal analysis, Data curation, Supervision, Resources, Writing - original draftSearch for more papers by this author First published: 13 February 2024 https://doi.org/10.1111/medu.15325 Funding information: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. REFERENCE 1Davidge-Pitts C, Nippoldt TB, Danoff A, Radziejewski L, Natt N. Transgender health in endocrinology: current status of endocrinology fellowship programs and practicing clinicians. J Clin Endocrinol Metab. 2017; 102(4): 1286-1290. doi:10.1210/jc.2016-3007 10.1210/jc.2016?3007 PubMedWeb of Science®Google Scholar Volume58, Issue5May 2024Pages 648-649 ReferencesRelatedInformation

Background :This study describes the program and learning outcomes of a telehealth skills curriculum based on the Association of American Medical Colleges (AAMC) telehealth competencies for clerkship-level medical students.Methods :A total of 133 third- and fourth-year medical students in a required family medicine clerkship at Stanford University School of Medicine participated in a telehealth curriculum, including a telehealth workshop, site-specific telehealth clinical encounters, and telemedicine objective structured clinical examinations (teleOSCEs) between July 2020 and August 2021. Their workshop communication and physical examination competencies were assessed in two teleOSCEs utilizing a novel telehealth assessment tool. Students' attitudes, skills, and self-efficacy were assessed through voluntary pre-clerkship, post-workshop, and post-OSCE surveys.Discussion :Most learners reported low confidence in their telehealth physical examinations [n = 79, mean = 1.6 (scale 0-5, 5 = very confident, SD = 1.0)], which improved post-workshop [n = 69, 3.3 (0.9), p < 0.001]; almost all (97%, 70/72) felt the workshop prepared them to see patients in the clinic. In formative OSCEs, learners demonstrated appropriate "webside manner" (communication scores 94-99%, four items) but did not confirm confidentiality (21%) or review limitations of the visit (35%). In a low back pain OSCE, most learners assessed pain location (90%) and range of motion (87%); nearly half (48%) omitted strength testing.Conclusion: Our telehealth curriculum demonstrated that telehealth competencies can be taught and assessed in medical student education. Improvement in self-efficacy scores suggests that an 80-min workshop can prepare students to see patients in the clinical setting. Assessment of OSCE data informs opportunities for growth for further development in the curriculum, including addressing visit limitations and confidentiality in telehealth visits.

Background and Objectives: The growing demand for primary care clinicians in the United States continues to outstrip their dwindling supply. Many allopathic medical schools, including Stanford University School of Medicine, are not adequately meeting this shortage. We sought to develop a preclerkship elective to increase the visibility and desirability of primary care at our institution. Methods: A novel 9-week preclerkship elective titled “Primary Care Defined: Perspectives and Procedures,” was designed as a series of procedural workshops followed by interactive sessions with local primary care clinicians. A total of 36 medical and physician assistant students were enrolled. We administered a questionnaire pre- and postcourse to evaluate the impact of the elective on learner interest and attitudes toward primary care. Results: Twenty-four enrolled and 10 nonenrolled learners completed the questionnaire both pre- and postcourse. A one-way analysis of covariance controlling for gender, program (medical doctor versus physician assistant), and precourse responses demonstrated that enrollees had a significantly increased interest in primary care compared to nonenrollees after the course (F1,32=9.22, P=.005). Enrollees also more positively rated their attitudes toward compensation, scope of practice, and job fulfillment than nonenrollees. Both groups had high levels of agreement on statements concerning patient-physician interactions and the importance of primary care to the health care system. Conclusion: The design and content of this elective offers a framework for other institutions looking to promote the value of primary care specialties, particularly family medicine. Creating opportunities for experiential learning and early student-faculty engagement may encourage preclerkship learners to consider a career in primary care.

BACKGROUND AND OBJECTIVES Professionalism is essential in medical education, yet how it is embodied through medical students' lived experiences remains elusive. Little research exists on how students perceive professionalism and the barriers they encounter. This study examines attitudes toward professionalism through students' written reflections. METHODS Family medicine clerkship students at Stanford University School of Medicine answered the following prompt: "Log a patient encounter in which you experienced a professionalism challenge or improvement opportunity." We collected and analyzed free-text responses for content and themes using a grounded theory approach. RESULTS One hundred responses from 106 students generated a total of 168 codes; 13 themes emerged across four domains: challenging patients, interpersonal interactions, self-awareness, and health care team dynamics. The three most frequently occurring themes were interacting with emotional patients, managing expectations in the encounter, and navigating the trainee role. CONCLUSIONS Medical students view professionalism as a balance of forces. While many students conceived of professionalism in relation to patient encounters, they also described how professionalism manifests in inner qualities as well as in health systems. Interpersonal challenges related to communication and agenda-setting are predominant. Systems challenges include not being seen as the "real doctor" and being shaped by team behaviors through the hidden curriculum. Our findings highlight salient professionalism challenges and identity conflicts for medical students and suggest potential educational strategies such as intentional coaching and role-modeling by faculty. Overall, students' reflections broaden our understanding of professional identity formation in medical training.

Problem There is a paucity of guidance regarding implementation of telemedicine curricula at the clerkship level, particularly with students actively engaged in video and telephone encounters. The COVID-19 pandemic caused rapid shifts in the delivery of medical education to clerkship-level students. This article describes the successful pilot of a direct patient care, virtual health curriculum at the clerkship level and discusses lessons learned. Approach All 18 preceptors and 5 students at Stanford University School of Medicine, California, enrolled in the required 4-week family medicine clerkship in April 2020 were connected as virtual partners via a commercial video platform. The combined use of both this video program and Epic electronic health record (EHR) software as modes for teaching and patient care led to technical challenges and logistical hurdles. As part of an iterative process, clerkship leadership identified problems via preceptor and student interviews and integrated that feedback to create a model for delivering high-quality, clerkship-level clinical instruction during the COVID-19 shelter in place order. Outcomes Of those who completed an evaluation, the majority of preceptors (n = 16; 89%) and students (n = 4; 100%, 1 student did not respond) expressed satisfaction with the virtual, remote teaching model conducted over 37 clinic visits. A detailed 14-step process list resulted from identifying and addressing both audio and video technical challenges and is provided for use by other institutions that wish to implement this workflow. Next Steps Future directions include assessing patient perspectives on the involvement of students in virtual visits, soliciting patient input for a more robust patient-physician-student virtual experience, and integrating a multiparty platform, when available, via the EHR to afford greater student autonomy.

Providing a strong foundation in culinary medicine (CM)—including what constitutes a healthy diet and how to find, obtain, and prepare healthy and delicious food—is a cornerstone of educating health professionals to support patients in achieving better health outcomes. The Culinary Medicine Curriculum (CMC), published in collaboration with the American College of Lifestyle Medicine, is the first, comprehensive, open-source guide created to support the implementation of CM at health professional training programs (HPTPs) worldwide. The CMC is modeled after the successful CM elective course for Stanford University School of Medicine students. Key goals of the CMC include presenting healthy food as unapologetically delicious, quick, and inexpensive; translating lessons learned to healthy eating on-the-go; practicing motivational interviewing on healthy dietary behavior changes; and demonstrating how to launch a CM course. The CMC highlights a predominantly whole food, plant-based diet as seen through the lenses of different world flavors and culinary traditions. It was developed, published, and distributed with the aim of expanding CM by reducing barriers to creating CM courses within most types of HPTPs and practice settings. During the first 2 months the CMC was available, it was downloaded 2379 times in 83 countries by a wide variety of health care professionals interested in teaching CM. The global interest in this first, freely available, evidence-based CMC underscores the demand for CM resources. Such resources could prove foundational in expediting development of CM courses and expanding the reach of CM and counseling on dietary behavior changes into patient care.

Purpose: The immense clerical burden felt by physicians is one of the leading causes of burnout. Scribes are increasingly being used to help alleviate this burden, yet few published studies investigate how scribes affect physicians' daily work, attitudes and behaviors, and relationships with patients and the workplace. Methods: Using a longitudinal observational design, data were collected, over 1 year, from 4 physicians working with 2 scribes at a single academic family medicine practice. Physician experience was measured by open-ended written reflections requested after each 4-hour clinic session. A data-driven codebook was generated using a constant comparative method with grounded theory approach. Results: A total of 361 physician reflections were completed, yielding 150 distinct excerpts; 289 codes were assigned. The 11 themes that emerged were further categorized under 4 domains. The most frequently recurring domain was clinic operations, which comprised 51.6% of the codes. Joy of practice, quality of care, and patient experience comprised 22.1%, 16.3%, and 10.0% of the codes, respectively. Conclusions: Our study suggests that integrating scribes into a primary care clinic can produce positive outcomes that go beyond reducing clerical burden for physicians. Scribes may benefit patient experience, quality of care, clinic operations, and joy of practice.

PURPOSE:Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.METHODS:We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close.RESULTS:Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028).CONCLUSIONS:To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.

Background : The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE. Methods : Participants were medical students in their first or second year of clinical clerkships, enrolled in a required family medicine clerkship at Stanford University. Participants completed an OSCE that was directly observed by trained faculty staff, who used the Measure of Patient-Centered Communication (MPCC) instrument to measure empathic behaviours. Statistics were used to determine correlations between observed empathy and the students' year of clerkship, gender, and specialty preference. Results : A total of 129 medical students, evenly divided by gender and clerkship year, participated. There was a possible trend towards higher MPCC scores among students in their second clerkship year compared with students in their first year (p = 0.09), which became more significant when adjusted for outlier effects (p = 0.05). There was no difference in performance by gender. Students interested in a 'people-oriented' specialty scored higher in 'handling the patient's frustration' compared with those who are interested in a 'technology-oriented' specialty. Discussion : In our study, observed empathic behaviours were not lower in the second compared with the first year of clerkship training. More research is warranted to investigate the apparent discrepancy between self-administered empathy scores and observed empathic behaviours.