Hafferty, Frederic W.

This Perspective discusses the flaws in the process and methods of institutional external validation in medical education.

Perceived self‐efficacy influences how one approaches goals, tasks, and challenges, and has been shown to affect motivation and academic behaviors. The ability to accurately assess one's competency and limitations is also a critical skill for physicians. Research has shown that medical students can underestimate their perceived clinical skills compared to observer assessment, but limited research has addressed perceived knowledge specific to anatomy. This study compares student perception and faculty evaluation of academic competency in a gross anatomy course. Additionally, this study revisits whether daily audience response system (ARS) questions is a predictor of academic success, and the impact of near‐peer tutoring on student performance. Data from 51 first year medical students in a 7‐week gross anatomy course were evaluated. At the end of week 3 of the course, students with a cumulate ARS grade below the 70% pass requirement were contacted by faculty with individualized formative feedback on academic performance and presented with opportunities for improvement and formal tutoring. All students irrespective of performance were made aware of opportunities for tutoring. Six near‐peer teaching assistants tutored students who requested help. Mean ARS scores and laboratory practice practical grades were evaluated before and after the students received formative feedback. Students were placed into one of four groups based on two factors: (1) their perceived ability to succeed in the course, and (2) faculty perception of their potential for success. Students in groups 1 and 3 were identified by faculty members as potentially at risk, whereas groups 2 and 4 were viewed as low risk. From the students' perspective, those in groups 1 and 2 self‐identified as needing assistance, whereas groups 3 and 4 felt that they were not at risk of failing the course. Of the 12 students contacted by faculty, 6 (12% of the class) requested a tutor (group 1). Additionally, 11 (21%) students who were not contacted by faculty requested a tutor (group 2). Six (12%) students that were contacted by faculty did not request a tutor (group 3), while 28 (55%) were not contacted by faculty and did not request a tutor (group 4). The averages of daily ARS scores between groups after feedback was significantly greater in group 4 compared to groups 1 and 2 (68% vs 61% and 63%, p=0.04 and 0.04, respectively). In addition, the post faculty feedback practical average scores were significantly higher in group 4 compared to group 1 (67% vs 56%, p=0.04). These data show that in an environment that fosters acceptance of academic support, students are more receptive to receiving and reaching out for help from near‐peer tutors. Formative feedback from ARS scores continue to be a reliable indicator for tracking student performance. Improvement of student performance in final course evaluation may be a positive indicator of success from near‐peer tutoring. Support or Funding Information None

While small group learning and team‐based learning (TBL) have become widely accepted modalities in medical education, surprisingly little is known about how medical students interact between and within their learning teams and how dissection teams themselves interact with faculty or teaching assistants (TAs). This study sought to examine: (1) interactions between faculty/TAs and student teams; and (2) student table‐to‐table interactions taking place in the anatomy didactic block at Mayo Medical School. In addition, interactions between students in the same student team and overall team dynamics were examined by faculty. The purpose of this study is to understand dissection group dynamics and how these sets of interactions relate to student academic performance . The amount of time faculty/TAs spent with a group during each teaching session was recorded by students at the end of each session. The number of team‐to‐team interactions were also recorded. These values were then compared to student examination performance. Results from this study indicated that the individual time faculty/TAs spend with teams and the number of table‐to‐table interactions appeared to have no correlation with overall team academic performance. However, faculty assessment of interactions within student teams and overall team dynamics appears to be an accurate predictor of the team's overall academic performance, where groups with well‐defined leadership roles and strong cooperation between team members performed higher than those where this was not present . Support or Funding Information Mayo Clinic College of Medicine Department of Anatomy

Abstract Introduction To enter a profession is to take on a new identity. Professional identity formation can be difficult, with medical learners struggling to adopt professional norms. The role of ideology in medical socialisation may offer insight into these tensions experienced by medical learners. Ideology is the system of ideas and representations that dominates the minds of individuals or social groups and calls individuals into certain ways of being and acting in the world. In this study, we use the concept of ideology to explore residents' experiences with identity struggle during residency. Methods We conducted a qualitative exploration of residents in three specialties at three academic institutions in the United States. Participants engaged in a 1.5‐hour session involving a rich picture drawing and one‐on‐one interview. Interview transcripts were coded and analysed iteratively, with developing themes compared concurrently to newly collected data. We met regularly to develop a theoretical framework to explain findings. Results We identified three ways that ideology contributed to residents' identity struggle. First was the intensity of work and perceived expectations of perfectionism. Second were tensions between the developing professional identity and pre‐existing personal identities. Many residents perceived messages regarding the subjugation of personal identities, including the feeling that being more than physicians was impossible. Third were instances where the imagined professional identity clashed with the reality of medical practice. Many residents described how their ideals misaligned with normative professional ideals, constraining their ability to align their practice and ideals. Conclusion This study uncovers an ideology that shapes residents' developing professional identity—an ideology that creates struggle as it calls them in impossible, competing or even contradictory ways. As we uncover the hidden ideology of medicine, learners, educators and institutions can play a meaningful role in supporting identity development in medical learners through dismantling and rebuilding its damaging elements.

Abstract Purpose Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition. Method The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data. Results Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF. Conclusions Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.

AbstractThe Covid‐19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web‐performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web‐designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.