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, Andrew Klein, 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

Clinical sensemaking: Advancing a conceptual learning model of clinical reasoning
Medical Education: C. Koufidis, K. Manninen, J. Nieminen, M. Wohlin, and C. Silén
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.

Do resident unions improve graduate medical education training? Benefits and potential pitfalls
Academic Medicine: K. A. Julian and R. B. Baron
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.

Beyond thinking fast and slow: Implications of a transtheoretical model of clinical reasoning and error on teaching, assessment, and research
Medical Teacher: A. S. Parsons, T. P. Wijesekera, A. P. J. Olson, D. Torre, S. J. Durning, and M. Daniel
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.

Featured

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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.

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Perspectives on Medical Education: E. A. Valestrand, B. Whelan, K. E. R. Eliassen, and E. Schei
Alienation in the teaching hospital: How physician non-greeting behaviour impacts medical students’ learning and professional identity formation
The Gist
• Analysis of medical student focus group discussions to describe the influence of not being greeted by physician supervisors.
• Failing to greet students led to a sense of rejection, worsened confidence, and impaired learning.
WHY THIS IS A MUST READ

Simple gestures can go a long way but may be neglected in hurried clinical situations. This article draws attention to the impact of “phatic” signals - seemingly trivial acts that can have significant influence on trust and belonging - to help educators create positive learning environments.

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Medical Education: L. M. Allen, D. Balmer, and L. Varpio
Physicians’ lifelong learning journeys: A narrative analysis of continuing professional development struggles
The Gist
• Interviews of 12 physicians asking for stories from their learning journeys since completing postgraduate training.
• Physicians learned primarily through clinical situations with limited individualized feedback; formal learning activities and requirements were less helpful.
WHY THIS IS A MUST READ

Continuous professional development (CPD) is the longest phase in physicians’ lifelong learning; it is also the least organized. This article points to the need for greater structure in CPD and credit for learning that occurs during patient care.

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Medical Teacher: J. Montreuil, M. Lacasse, M.C. Audétat, É Boileau, M. C. Laferrière, A. Lafleur, S. Lee, M. Nendaz, and Y. Steinert
Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review update: BEME Guide No. 85
The Gist
• Review that added 18 articles from the last 5 years to 68 in a previous review.
• Identified 12 interventions with new thematic content, including the first for identity formation, and summarized findings across 86 studies and 121 interventions.
WHY THIS IS A MUST READ

Many learners struggle at some point and need extra support from educators. This article provides a well-organized synthesis of the state of the evidence and provides options targeted at specific challenges.