Must Reads

What is a ‘Must Read’ for those interested in medical education?

Each month, we identify 3-4 noteworthy articles from the health professions education literature and label them as “must reads.” Selection is based on several criteria including originality and methodological rigor. Our process includes a formal search of the peer-reviewed literature, screening titles and abstracts, full text review, and an editorial meeting to achieve consensus.

Who are we and why are we doing this?

Our reviewers include individuals with expertise in teaching, educational oversight, and research as well as those who are beginning their careers as educational scholars.

The volume of health professions education articles has become overwhelming. In curating some of the best new published papers, we hope to make it easier for all of us to keep abreast of cutting edge educational scholarship and practices.

We’d welcome involvement in the selection process. Reviewers can earn CME credit and contribute to Must Reads research. If you are interested in supporting this work or have perspectives to share, please email Sean Tackett: stacket1@jhmi.edu.

You can also follow @MedEdMustReads on X (aka Twitter) to be notified when new must read articles are selected and sign up to receive an email each month.

(Current Reviewers: Kara Alcegueire, Paul Bain, Kavita Chapla, Scott Kinkade, Viviane Liao, Erica Lin, Liju Mathew, Pallavi Menon, Amin Nakhostin-Ansari, Bridget O’Brien, Ashley Paul, Julianne Perretta, Katherine Senko, Julia Shalen, Kiara Smith, Sean Tackett, Scott Wright)

Featured This Month

Associations of internal medicine residency milestone ratings and certification examination scores with patient outcomes
JAMA: B. M. Gray, J. L. Vandergrift, J. P. Stevens, R. S. Lipner, F. S. McDonald, and B. E. Landon
The GIst
• Analysis of 6,898 hospitalists across 455,120 admissions over 3 years in the U.S. to determine if board certification scores and ACGME milestone ratings related to inpatient outcomes.
• Board exam scores, not milestones ratings, were associated with improved patient outcomes.
WHY THIS IS A MUST READ

Attempts to tie medical education to patient outcomes on a national scale are rare. This study supports that a broad knowledge base – reflected in standardized exams - is important in clinical care and shows complexity in using milestone ratings as measures of overall clinical competency.

Feedback, learning, and becoming: Narratives of feedback in complex performance challenges
Medical Education: M. Bearman, M. Dracup, R. Ajjawi, C. Kirby, and J. Brown
The GIst
• Interviews of 16 recently graduated general practitioners to identify narratives during difficult learning scenarios.
• Describes 4 common plotlines: (1) Journeyperson, (2) Hero’s Quest, (3) Solo Journeyer, and (4) Endless Struggle.
WHY THIS IS A MUST READ

We tell ourselves stories all the time. This study provides frameworks for how educators can understand where they fit into learners’ stories and provide appropriate support and feedback.

Are pre-clerkship remediation, grading, and reporting practices equitable in the U.S.? A national survey
Teaching and Learning in Medicine: W. H. Eidtson, A. Konopasky, J. Fong, K. E. Schmitt, L. Foster-Johnson, and V. T. Lyons
The GIst
• Survey of U.S. pre-clerkship curriculum deans to describe grading and remediation policies.
• Grading and remediation practices varied and were inconsistently reported to residency programs.
WHY THIS IS A MUST READ

Fairness in assessment is important to protect the interests of medical learners and the public. This study found that some schools may not be reporting on student performance transparently, which may result in unfair judgments and suggests reform is needed.

Featured

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Medical Education: C. Koufidis, K. Manninen, J. Nieminen, M. Wohlin, and C. Silén
Clinical sensemaking: Advancing a conceptual learning model of clinical reasoning
The GIst
• Analysis of data from interviews and clinical observations to understand how medical students make sense out of patient encounters.
• Sensemaking was cyclical with 3 steps: (1) framing a clinical problem, (2) inquiring into it, and (3) taking action.
WHY THIS IS A MUST READ

Clinical situations are full of ambiguity. Clinical sensemaking’s focus on how learners assign meaning to clinical information and arrive at concrete next steps can be useful for education and additive to models for diagnostic and management reasoning.

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Academic Medicine: K. A. Julian and R. B. Baron
Do resident unions improve graduate medical education training? Benefits and potential pitfalls
The GIst
• Commentary on postgraduate trainee unions and their tradeoffs.
• Pluses included better worker rights and benefits and opportunities for advocacy and leadership; minuses included taking positions against the program and being in conflict with some accreditation requirements.
WHY THIS IS A MUST READ

Residents’ roles as both practicing healthcare workers and learners in educational programs create tensions in the U.S. While residents should be actively engaged by all programs and institutions, unionizing may add credibility when residents advocate for improvements in care.

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Medical Teacher: A. S. Parsons, T. P. Wijesekera, A. P. J. Olson, D. Torre, S. J. Durning, and M. Daniel
Beyond thinking fast and slow: Implications of a transtheoretical model of clinical reasoning and error on teaching, assessment, and research
The Gist
• Commentary proposing an integrated conceptual model of clinical reasoning.
• Summarized 5 theories and implications for clinical reasoning teaching, assessment, errors, and research.
WHY THIS IS A MUST READ

Clinical reasoning is complex and relates to many existing theories. This article’s brief description of each theory and final model may enable learners and educators to better apply theory to practice.

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Medical Education: D. Huang, C. Whitehead, and A. Kuper
Competing discourses, contested roles: Electronic health records in medical education
The Gist
• Critical discourse analysis of 159 articles on electronic health records (EHRs) in medical education.
• Identified 3 major discourses - EHRs represented: (1) skills to be learned, (2) systems that coordinated care, and/or (3) cognitive processes (e.g., clinical reasoning).
WHY THIS IS A MUST READ

EHRs are so common that it can be easy to overlook their impact. This article highlights how different ways of thinking about EHRs influence their integration into medical education and care.

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Academic Medicine: C. R. Runyon, M. A. Paniagua, F. A. Rosenthal, A. L. Veneziano, L. McNaughton, C. T. Murray, and P. Harik
SHARP (SHort Answer, Rationale Provision): A new item format to assess clinical reasoning
The Gist
• Innovation report from the National Board of Medical Examiners (NBME) describing a test item format with 2-steps: (1) input a clinical decision then (2) select evidence to justify it.
• Pilot tested 35 items with 177 medical students to demonstrate proof-of-concept.
WHY THIS IS A MUST READ

Standardized assessment of clinical reasoning has long been a challenge. This new format may have better constructive alignment with reasoning processes and represent the future of test-taking.

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Medical Teacher: T. Thesen, W. J. Marrero, A. J. Konopasky, M. S. Duncan, and K. E. Blackmon
Towards precision well-being in medical education
The Gist
• Cluster analysis of data from 3,632 medical students measuring levels of anxiety, depression, and flourishing.
• Characterized 3 clusters as “Healthy-flourishers,” “Getting-By,” and “At-Risk.”
WHY THIS IS A MUST READ

Student well-being continues to need more attention in medical schools. This study illustrates the value of large datasets to better understand how to target support to those most likely to need it.