US News And World Report Rankings Remain Deeply Flawed And Far Too Influential

Rankings: In this thoughtful commentary, the author describes the US News and World Report formula used to rank medical schools and quotes dean Robert Alpen of Yale that “there’s nothing really in (the) formula that is really evaluating the quality of medical education.  That would be so much more valuable to the applicants, to the students.  And it would incentivize us to do a better job in education.”  The author also posits that the student descriptor inputs to the formula may reinforce “a flawed system that values test-taking abilities above all other attributes even before medical school begins.”  The author suggests other, much more meaningful metrics:  preparation for residency; career trajectory; quality of clinical care 10-20 years after graduation; career satisfaction; research impact of the school; community benefit from school, faculty, and graduates. Obviously, these are much more difficult to measure than the metrics currently in the formula. The author ends with an acknowledgement that the pernicious effect of these rankings are not confined to medical schools but extend to many types of educational institutions.  He quotes law professor Jeffrey Evans Stake:

“US News has set up a game.  The players are the schools being ranked and the faculty members at those schools.  Most faculty members and administrators seek to increase their school’s rank by various strategic moves.  These moves are costly, in terms of money and other resources, but do little or nothing to improve legal education for students.  Indeed, it is worse than that.  Many of the strategies run contrary to the interests of students and society.”

It is important to note that the US News and World Report ranking for “primary care” is not discussed in this commentary, but shares similar fatal flaws:  a plurality of the ranking is based on a dean-level reputational survey with an extremely low response rate; the student descriptors are similarly flawed; and there is no measure of long-term entry into primary care by a school’s graduates. — Laura Willet, MD

McGaghie WC, America’s Best Medical Schools: A Renewed Critique of the U.S. News & World Report Rankings. Acad Med. 2019 Apr

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Don’t Know Much About Entrustable Professional Activities Or Learner Handovers For Medical Students

Enstrustable Professional Activities & Learner Handovers: Two scoping reviews reinforce our overall lack of knowledge about how to employ EPAs and learner handovers, the feeding forward of prior learner performance.  The reviewers of articles on EPAs found only 26 empirical studies of EPAs in medical student education which evaluated the EPAs in light of the Ottawa Criteria for evaluations.  They conclude that “reproducibility, equivalence, educational effect, and catalytic effect (ed. note: curricular effect) all require further study.”  The reviewers of learner handovers found 24 applicable studies, almost all coming from outside the healthcare education literature.  The main consistent finding, in 22 of 24 studies, was that the provision of prior performance information tended to influence raters in the direction of the prior rating.  Other important questions about learner handovers were addressed by fewer studies or had less consistent data. — Laura Willett, MD

Meyer EG, Chen HC, Uijtdehaage S, Durning SJ, Maggio LA. Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education, Acad Med. 2019 Apr

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Humphrey-Murto S, LeBlanc A, Touchie C, Pugh D, Wood TJ, Cowley L, Shaw T. The Influence of Prior Performance Information on Ratings of Current Performance and Implications for Learner Handover: A Scoping Review. Acad Med. 2019 Apr

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How Residents And Fellows Navigate The Telephone

Communication: In this qualitative study, researchers interviewed 17 residents and fellows in multiple specialties regarding workplace telephone conversations.  Generally, these trainees felt that they had learned a lot over the years about how to make their telephone interactions more efficient and productive.  Three major “tensions” were identified:  power differentials; pushback ; and trustworthiness/uncertainty.  All of the tensions could have a negative or positive effect on patient care and learning.  For example, trainees learned how to give more succinct and useful presentations, and tried to view the situation from their conversation partner’s point of view in response to these tensions.  The authors discuss whether trainees should be taught these skills in a more formal way and other implications of their findings. — Laura Willett, MD

Eppich WJ, Dornan T, Rethans JJ, Teunissen PW “Learning the Lingo”: A Grounded Theory Study of Telephone Talk in Clinical Education. Acad Med. 2019 Mar

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Multi-Institution Curriculum Collaboration

Collaboration: In the United States undergraduate medical education has been focusing on defining the competencies and goals of the curriculum, almost to the exclusion of deciding what content should be taught. Each institution, therefore, must reinvent the wheel in determining what topics should be covered in their curriculum. An original collaborative effort by five medical schools took the first step in designing necessary core content and curricular resources for an undergraduate microbiology and immunology course curriculum. They designed self-contained modules for each topic area containing an introductory video, a set of factual videos, an in-class interactive learning session with resources, and summative and formative assessments. The key to these modules is their flexibility. They are designed to be used either as a total educational curriculum or added into an existing curriculum; integrated as a resource, a flipped class room or as the basis of a curriculum. These modules were then implemented to varying degrees in the five schools, with positive student satisfaction and assessment data. This is an innovative curricular design that can standardize the undergraduate microbiology and immunology content taught at US medical schools, while being flexible enough to be integrated into any curriculum. Collaborating on curricular content between schools will enable faculty to more attentively focus their efforts on the quality of teaching. – Lee Ann Schein, PhD.

Chen SF, Deitz J, Batten JN, DeCoste-Lopez J, Adam M, Alspaugh JA, Amieva MR, Becker P, Boslett B, Carline J, Chin-Hong P, Engle DL, Hayward KN, Nevins A, Porwal A, Pottinger PS, Schwartz BS, Smith S, Sow M, Teherani A, Prober CG.A Multi-Institution Collaboration to Define Core Content and Design Flexible Curricular Components for a Foundational Medical School Course: Implications for National Curriculum Reform.Acad Med. 2019 Feb

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Beware The Predatory Medical Journal!

Publishing: Anyone wishing to publish in open access medical journals should read this article first. The authors offer a comprehensive “red flag” checklist of bad practices to help avoid falling prey to illegitimate journals.   Things to look out for: Is there an editorial board? How is peer review conducted? Are there article processing charges or article submission charges? Does the publisher communicate via spam? How will the research be archived and indexed?  By clearly outlining the process in both traditional subscription-based and open access publishing models, the authors present a balanced overview of the concerns and benefits of scholarly communication in today’s world and provide an excellent tool to assist when submitting research to a journal that no one’s ever heard of before. — Victoria Wagner, MLS

Baker EF, Iserson KV, Aswegan AL, Larkin GL, Derse AR, Kraus CK; American College of Emergency Physicians Ethics Committee, Open Access Medical Journals: Promise, Perils, and Pitfalls, Acad Med. 2018 Dec

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Maybe You Shouldn’t Be A Doctor

Perspective: This thoughtful perspective is required reading for all educators who deal with struggling learners.  They cite troubling evidence that a vast majority of educators think that many institutions “had graduated students who should not have graduated,” and they speculate on the causes for this “failure to fail”.  Students not suited cognitively or emotionally to medicine may feel trapped into a medical career by the time and money already invested, or by familial or self-expectations.  As educators, we worry about our learners’ ability to cope with debt they have accumulated, we lack expertise in feedback and remediation, and we don’t know enough about alternative career options to give good advice to our students who we think should not be physicians.  The authors end with several practical recommendations for schools and the profession. — Laura Willett, MD

Bellini LM, Kalet A, Englander R. Providing Compassionate Off-Ramps for Medical Students Is a Moral Imperative. Acad Med. 2018 Dec

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Communication During and After Residency Interviews Causes Applicant Distress

Match: The National Resident Matching Program (NRMP), The Institutional, Program, and Applicant Match Participation Agreement (MPA), and the code of conduct (COC) are clear in stressing the importance of avoiding inappropriate and coercive tactics during the interviews and in follow-up communication. But are the training programs complying?

This study, utilizing an anonymous, 31-question survey sent to candidates applying to 8 residency programs at Cleveland Clinic regarding their interview experiences, studied residency applicant perspectives about postinterview communications (31% of the 6693 candidates responded).

The following rates of inappropriate questions were reportedly asked during interviews:

about other interviews: 72% of applicants were asked, occurring at 25% of all interviews
marital status: 38% of applicants were asked, occurring at 14% of all interviews
children or plans to have children: 17% of applicants were asked, occurring at 5% of all interviews, with women asked about childbearing 50% more frequently than men
how highly they would rank a program: 15% of applicants were asked

Overall, 91% of respondents engaged in postinterview communication. A total of 70% of respondents informed their top program that they had ranked it highly; 70% of this subset reported associated distress, and 78% reported doing this to improve match success. A total of 71% would feel relief if postinterview communication was actively discouraged, and 51% would prefer applicants to be prohibited from notifying programs of their rank. — David Cohen, MD

Camille Berriochoa, Chandana A. Reddy, Steven Dorsey, Steven Campbell, Christine Poblete-Lopez, Richard Schlenk, Abby Spencer, John Lee, Matthew Eagleton, and Rahul D. Tendulkar (2018) The Residency Match: Interview Experiences, Postinterview Communication, and Associated Distress. Journal of Graduate Medical Education: August 2018, Vol. 10, No. 4, pp. 403-408.

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