Featured – AM Rounds http://academicmedicineblog.org Beyond the pages of Academic Medicine, journal of the AAMC Mon, 24 Jul 2017 16:00:14 +0000 en-US hourly 1 https://wordpress.org/?v=4.4.10 New Conversations: Justice, Disparities, and Meeting the Needs of Our Most Vulnerable Populations http://academicmedicineblog.org/new-conversations-justice-disparities-and-meeting-the-needs-of-our-most-vulnerable-populations/ http://academicmedicineblog.org/new-conversations-justice-disparities-and-meeting-the-needs-of-our-most-vulnerable-populations/#respond Mon, 24 Jul 2017 16:00:14 +0000 http://academicmedicineblog.org/?p=3467 AM Rounds Slider Master-07

This is a difficult time in health care. In Washington, health care legislation has advanced that would result in tens of millions of Americans becoming uninsured.1 Proposals to reduce Medicaid funding could affect access to health care among our most vulnerable populations, and the effects of these proposals upon insurance premiums and coverage options for those who purchase insurance through the exchanges are uncertain. All of this has occurred without the support of major health care organizations or consumer groups. How could such momentous changes affecting those most in need of health care access occur without including the opinions and expertise of the health care community or the patients that would be most affected by the changes? Can we find ways to have our voices heard?

On a global level, vulnerable populations are facing other challenges related to health care. The problems of the health care of refugees, victims of natural disasters, and those exposed to emerging infections have garnered well deserved attention. The poorest and most vulnerable populations of underdeveloped nations are particularly affected. But there are also ongoing problems of aging populations, chronic disease, health care workforce supply, and funding of health care that are creating problems for the health care of vulnerable populations in even the most developed nations. What can we learn from the experiences around the world to inform our conversations about ensuring that vulnerable populations have access to health care?

Mechanic and Tanner2 have described vulnerability as an interaction between the capacities of individuals, the stresses that they are exposed to, and their various support networks, which can facilitate or hinder the ability of the individual to cope with various health challenges. They identify as sources of vulnerability poverty, race, social isolation, physical and cognitive impairments, and limitations related to physical location. They suggest that moral values and politics interact in the way in which social policy priorities are developed, which may be an apt assessment of the drivers of current national health policy discussions. They end by noting, “attention to vulnerable groups not only assists their life chances but contributes more generally to the safety and quality of life of the entire community.”2

We have decided that the current context of health policy in the United States and around the world demands a New Conversations series about our responsibility to our most vulnerable populations and what we can do at our academic health centers (AHCs) and through our education programs to address their needs. While we recognize that there are journals that have focused on health disparities, immigrant health, and racial and ethnic minority health issues, our hope is to augment those efforts with the voices of our health professions leadership in education, research, administration, and clinical care in this journal.

We recognize that a focus on vulnerable and underserved populations will inevitably lead to discussions of social justice and health equity, and we acknowledge that many institutions have a long history of commitment to the needs of the poor and vulnerable that evolved from moral or religious perspectives. We would like to hear how these principles have been sustained, how they have evolved over time, and what the institutions intend to do to address current and future challenges. Others have recognized the need to understand and manage the health care needs of those whose vulnerabilities have led to high health care costs that affect the financial viability of institutions and health systems. We would like to hear how AHCs are improving population health management, especially through programs aimed at vulnerable populations.

The truth of the matter is that no one is invulnerable. All people have vulnerabilities as a result of genetic, environmental, age, race, education, psychological, or other factors. The difference is that some people have resources they can use to address situations in which the vulnerabilities have manifested themselves in illness. Others rely upon the support of public programs like Medicare or Medicaid, or the local support of emergency departments and hospitals that provide unreimbursed care. Development of systems that identify vulnerable patients and provide organized programs of disease prevention and management would also be of interest in this New Conversations series.

I ask that you submit contributions on this third New Conversations topic—guided by the questions, examples, and goals stated here—to be considered for publication in the journal. Please submit contributions through the journal’s online submission system, Editorial Manager (www.editorialmanager.com/acadmed), using the article type “New Conversations.” Submissions should be scholarly contributions that follow the journal’s regular submission criteria for Commentaries, Perspectives, Research Reports, Articles, or Innovation Reports. (For more information about those criteria, please see the journal’s Complete Instructions for Authors at http://journals.lww.com/academicmedicine/Pages/InstructionsforAuthors.aspx.) Submissions will be peer reviewed.

We will carry on the conversation outside the pages of the journal as well. Our blog AM Rounds (academicmedicineblog.org) will feature a series of discussions related to the New Conversations contributions that are published in the journal. I also encourage you to discuss New Conversations on Twitter using the hashtag #AcMedConversations by offering your opinions, posing questions, and responding to the opinions and questions posed by your colleagues. We will be using the journal’s Twitter handle, @AcadMedJournal, to do the same.

I will consider New Conversations submissions at any time, starting immediately—there is no deadline for submitting a contribution. Although we may not publish New Conversations contributions in every issue of the journal, we hope to have many of them to share in the pages of the journal and beyond as this third New Conversations series unfolds over the course of 2018.

In the end our approach to ensuring that vulnerable populations have access to health care will still come down to the commitment of our health professionals to provide compassionate high-quality care to every person they encounter regardless of their various vulnerabilities. How we educate our students and residents and faculty about their responsibilities, and how we recognize and support their activities to meet the needs of vulnerable populations will be more important than ever. We would like to hear about programs and ideas that provide the guidance and experience that help imbue in our students, residents, and faculty a lifetime commitment to the needs of vulnerable populations.


  1. Congressional Budget Office. HR 1628, American Health Care Act of 2017, Cost Estimate. May 24, 2017. https://www.cbo.gov/publication/52752. Accessed July 12, 2017.
  1. Mechanic D, Tanner J. Vulnerable people, groups, and populations: Societal view. Health Aff (Millwood). 2007;26;1220-1230.
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Tips for Reporting P Values, Confidence Intervals, and Power Analyses in Health Professions Education Research: Just Do It! http://academicmedicineblog.org/tips-for-reporting-p-values-confidence-intervals-and-power-analyses-in-health-professions-education-research-just-do-it/ http://academicmedicineblog.org/tips-for-reporting-p-values-confidence-intervals-and-power-analyses-in-health-professions-education-research-just-do-it/#respond Tue, 18 Jul 2017 11:00:40 +0000 http://academicmedicineblog.org/?p=3454 stethescope and medical chart 2

By: Colin P. West, MD, PhD, Eduardo F. Abbott, MD, and David A. Cook, MD, MHPE

Basic statistical results, including P values, confidence intervals, and power analyses, are variably reported in scientific publications and frequently misunderstood or misapplied. In our current article, Abbott et al, we examined the current prevalence and evolution over time in reporting of P values, confidence intervals, and power analyses in health professions education research (HPER) publications.

We found reporting of P values and confidence intervals in HPER publications increased from the 1970s to 2015, and in 2015, P values were reported in most HPER abstracts and main texts of published research papers. However, reporting of confidence intervals and power analyses remained uncommon and lagged behind reporting in general biomedical research. In addition, most reported P values were statistically significant according to the standard threshold of P ≤ .05, which seems likely to reflect selective (biased) reporting.

Several general recommendations stem from these results. First, more detailed quantitative reporting of key statistical results is needed in both abstracts and main texts of HPER publications. Basic descriptive results (which, depending on the situation, might include group means, proportions, and/or effect size measures, such as differences between means, relative risks, odds ratios, regression parameter estimates, and correlation coefficients) should be reported to allow readers to evaluate educational or clinical significance, which is not automatically conferred by statistical significance. Notably, it remains common for P values to be reported without these basic results, especially in abstracts. In addition, confidence intervals offer far more information to readers than P values alone, and the fact that only a minority of HPER publications report confidence intervals represents a methodological limitation the field must improve. Confidence intervals around effect size measures are particularly important (i.e., more important than confidence intervals around the group means or proportions). As the abstract may be the only part of a publication many readers will review, it is important that these core quantitative results be included there.

Second, selective reporting of (typically) positive results provides a biased view of scientific investigations and their results. We recommend all analyses planned according to the research protocol be reported, ideally in the main text but at least in supplementary files. Of course, this requires that a research protocol exists to guide the study and analyses in the first place. To further reduce this bias, authors, reviewers, and editors should avoid automatically dismissing “negative” studies, and base their appraisal on a study’s scientific relevance and methodological rigor, including reporting of confidence intervals.

Third, sample size and power considerations remain quite uncommon in HPER publications. These should be integral elements of research protocols and reports. The fact that most reported P values are statistically significant, despite low power, for the majority of published HPER further highlights the degree of publication bias likely affecting the field.

Although there is progress to be made in HPER reporting it is notable that the reporting of these basic statistical results has generally improved over the last several decades. With continued attention to these issues, we are optimistic that HPER publications can match or even exceed the reporting quality of other biomedical research. We summarize our key recommendations below.


  1. Report basic descriptive results summarizing study data (e.g., group means, proportions, measures of variability).
  2. Report effect sizes (e.g., differences between means, relative risks, odds ratios, regression parameter estimates, correlation coefficients).
  3. Report confidence intervals, especially around effect sizes.
  4. Thoughtfully plan hypothesis tests, and account for all planned analyses in the final report.
  5. Distinguish statistical from educational significance.


  1. Rely on P values alone to report study results.
  2. “Cherry-pick” statistically significant P values for reporting.
  3. Dismiss statistically nonsignificant P values from methodologically sound and adequately powered studies.
  4. Conduct and report power analyses after data have been collected.
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Author Reading: From Reflex to Reflection: A Resident’s Perspective on Learning in a Clinical Setting http://academicmedicineblog.org/author-reading-from-reflex-to-reflection-a-residents-perspective-on-learning-in-a-clinical-setting/ http://academicmedicineblog.org/author-reading-from-reflex-to-reflection-a-residents-perspective-on-learning-in-a-clinical-setting/#respond Tue, 11 Jul 2017 19:00:27 +0000 http://academicmedicineblog.org/?p=3463 A new episode of our podcast is now available through iTunes. Listen today.

In this episode, Veena Patel reads her essay, “From Reflex to Reflection: A Resident’s Perspective on Learning in a Clinical Setting,” in which she reflects on a patient encounter that motivated her to be a proponent of change and improvement at her hospital. Her essay was published in the Teaching and Learning Moments column in the July issue of Academic Medicine.

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What’s New and In the Queue for Academic Medicine http://academicmedicineblog.org/whats-new-and-in-the-queue-for-academic-medicine-25/ http://academicmedicineblog.org/whats-new-and-in-the-queue-for-academic-medicine-25/#respond Mon, 03 Jul 2017 19:20:27 +0000 http://academicmedicineblog.org/?p=3457 acmedipadjournaljuly2014

What’s New: A Preview of the July Issue

The July issue of Academic Medicine is now available! Read the entire issue online at academicmedicine.org or on your iPad using the Academic Medicine for iPad app. Highlights from the issue include:

Well-Being in Graduate Medical Education: A Call for Action
Ripp and colleagues find that physician wellness programs, though costly, may promote greater patient satisfaction, long-term physician satisfaction, and increased physician productivity. Recommendations are made at national, hospital, program, and non-work levels.

The Net Present Value and Other Economic Implications of a Medical Career
Commenting on Marcu et al, Reinhardt explains how the NPV is calculated then discusses other issues concerning the economics of a medical career, including medical school tuition, residents’ salaries, and investments in human capital as tax deductible.

The Use of Social Media in Graduate Medical Education: A Systematic Review
Sterling and colleagues describe the effect of social media platforms on residency education, recruitment, and professionalism as mixed, and the quality of existing studies as modest at best.

Considerations for Medical Students and Advisors after an Unsuccessful Match
Bumsted and colleagues discuss medical schools’ responsibilities to unmatched students and to society, outline various pathways for unmatched students to secure a GME or other non-clinical position in the future, and share guidelines for advising unmatched students following an unsuccessful Match.

Enhancing Student Empathetic Engagement, History-Taking, and Communication Skills During Electronic Medical Record Use in Patient Care
LoSasso and colleagues suggest a simple intervention providing specialized training in electronic medical record–specific communication can improve medical students’ empathic engagement, history-taking skills, and communication skills.

What’s In the Queue: A Sneak Peek

Here’s a preview of an upcoming research report by Baker and colleages.

Exploring Faculty Developers’ Experiences to Inform Our Understanding of Competence in Faculty Development
Lindsay Baker, MEd, Karen Leslie, MEd, MD, Danny Panisko, MD, Allyn Walsh, MD, Anne Wong, MD, PhD, Barbara Stubbs, MD, and Maria Mylopoulos, PhD



Now a mainstay in medical education, faculty development has created the role of the faculty developer. However, faculty development research tends to overlook faculty developers’ roles and experiences. This study aimed to develop an empirical understanding of faculty developer competence by digging deeper into the actions, experiences, and perceptions of faculty developers as they perform their facilitator role.


A constructivist grounded theory approach guided observations of faculty development activities, field interviews, and formal interviews with 31 faculty developers across two academic institutions from 2013 to 2014. Analysis occurred alongside and informed data collection. Themes were identified using a constant comparison process.


Consistent with the literature, findings highlighted the knowledge and skills of the faculty developer and the importance of context in the design and delivery of faculty development activities. Three novel processes (negotiating, constructing, and attuning) were identified that integrate the individual faculty developer, her context, and the evolution of her competence.


These findings suggest that faculty developer competence is best understood as a situated construct. A faculty developer’s ability to attune to, construct, and negotiate her environment can both enhance and minimize the impact of contextual variables as needed. Thus, faculty developers do not passively experience context; rather, they actively interact with their environment in ways that maximize their performance. Faculty developers should be trained for the adaptive, situated use of knowledge.

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Academic Medicine Earns Impact Factor of 5.255, Highest Ever! http://academicmedicineblog.org/academic-medicine-earns-impact-factor-of-5-255-highest-ever/ http://academicmedicineblog.org/academic-medicine-earns-impact-factor-of-5-255-highest-ever/#respond Tue, 27 Jun 2017 13:59:29 +0000 http://academicmedicineblog.org/?p=3448

Thomson Reuters released its 2016 Journal Impact Factors (JIFs), and Academic Medicine has earned a JIF of 5.255. It is our highest JIF ever and places us at the top of the Education, Scientific Disciplines category and third in the Health Care Sciences & Services category, our highest ranking yet in this category.

In addition to having the top JIF in our category, Academic Medicine maintained its status as the most highly-cited journal in the field with more than 13,000 citations in 2016.

The JIF for a given year is calculated by dividing the number of citations during the previous two-year period by the total number of articles published in those two years. Our 2016 JIF reflects the number of citations we received in 2014 and 2015 divided by the number of articles we published in those two years.

The JIF is just one way to measure a journal’s success and influence. Former Academic Medicine editor-in-chief Steven L. Kanter, MD, wrote an editorial in our September 2009 issue examining different ways to understand a journal’s impact. Academic Medicine continues to strive for excellence in every measure, and we appreciate your support along the way!

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The Unstoppables: Undocumented Students in Medical Education http://academicmedicineblog.org/the-unstoppables-undocumented-students-in-medical-education/ http://academicmedicineblog.org/the-unstoppables-undocumented-students-in-medical-education/#comments Tue, 27 Jun 2017 11:00:09 +0000 http://academicmedicineblog.org/?p=3437 hands in go team formation

By: Raquel Rodriguez

R. Rodriguez is a first-year family medicine resident, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.

At eight years old, my first glimpse of the United States was the arid land that separates the U.S.-Mexico border. As I sat in the car waiting to be assessed by the uniformed border patrol guards—marveling at the barren land of opportunity—I could not have imagined how crossing this border would transform my life. My new, secretive existence would make the simplest tasks into unusual challenges. As an undocumented student, turning sixteen came without a driver’s license, turning eighteen came with no reassurance that I would be able to attend college, and my first trip home as an undergraduate was plagued with anxiety as I handed my student ID to airport security. Fearing deportation, I guarded my secret and focused on my education.

In recent years, not unlike me, many undocumented students throughout the country have found themselves without clear hope for the future. Their ineligibility for employment having hindered their efforts to pursue a medical career. Despite their unrelenting persistence, their achievements in the classroom, and the support of entire communities, the dream of attending medical school seemed out of reach. I met many of these hopeful students as I searched for one who had successfully matriculated into a medical training program. I found none. Nonetheless, their stories of resilience amazed me and provided me with the motivation to investigate further.

Counter to the advice of premedical advisers, I applied to medical school. At the time, their concerns were valid and quite serious: How will you pay for medical school when your immigration status makes you ineligible for federal loans? What will you do after graduation without employment eligibility?

A medical program took a chance on my application, and I began my studies in the fall of 2011. As expected, financial challenges persisted, but a significant reprieve arrived shortly before my third-year clerkships. The Deferred Action for Childhood Arrivals (DACA) program was implemented. Via this federal memorandum, I was finally allowed to obtain employment authorization, a driver’s license, and an identity of belonging in the United States—benefits that had eluded me since my arrival in this country almost twenty years ago.

Since the DACA program was established, many medical schools have officially opened their doors to DACA recipients. While these talented students currently make up a small percentage of medical students, their stories have impressed me with their resilience, creativity, and humility—traits that everyone would value in their own physician. As described in the article, “Considerations for Residency Programs Regarding Accepting Undocumented Students Who Are DACA Recipients,” the next step is to facilitate their continued medical training.

On the days when my commute to the hospital provides me with time for reflection, I think about the undocumented students I have met and how my achievements are inspired by their stories. These students have given me hope. Now, I can only dream that the communities they call home will give them the precious opportunity to see an America that is not arid, but one that has tall buildings, resplendent streets, and where their dreams will know no boundaries.

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Author Reading: Humbled http://academicmedicineblog.org/author-reading-humbled/ Thu, 22 Jun 2017 09:40:49 +0000 http://academicmedicineblog.org/?p=3446 A new episode of our podcast is now available through iTunes. Listen today.

In this episode, J.S. Desai reads his essay, “Humbled,” in which he reflects on what his first patient, his big brother, has taught him about knowing and judging others in his care. His essay was published in the Teaching and Learning Moments column in the June issue of Academic Medicine.

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Editorial Board Q&A: Grace Huang, MD http://academicmedicineblog.org/editorial-board-qa-grace-huang-md/ Mon, 19 Jun 2017 19:45:44 +0000 http://academicmedicineblog.org/?p=3440 Grace Huang Lori Newman 20160411 001

Grace Huang, MD, Editor-in-Chief of MedEdPORTAL, associate professor of medicine at Harvard Medical School, hospitalist at Beth Israel Deaconess, Director of the Rabkin Fellowship in Medical Education, Co-Director of the BIDMC Academy, and Associate Program Director in Internal Medicine

Describe your current activities. 

I have a marvelously multifaceted career, and its common threads are mentorship and scholarship. My faculty development roles allow me to cultivate the careers of faculty members seeking to excel as educators and leaders. For our residency program, I am responsible for resident evaluation and remediation, which is hard, meaningful work. I am the new Editor-in-Chief of MedEdPORTAL, which gives me the privilege of witnessing and shaping the innovative teaching efforts of faculty around the world. As an investigator, I am studying critical thinking, cognitive bias, high value care, and most recently, physician wellness.  Lastly, but not least, my clinical function as a hospitalist reminds me constantly of our ultimate mission as healers.

What gaps do you see in the current academic medicine scholarship?

I’ve always cherished the function of peer review. But my editorial role has given me an intimate window on its beauty…and where it falls short. I entered the position at MedEdPORTAL hoping to better explore the concept of “scholarship on scholarship” and to understand how we can build on a time-honored establishment and take it to the next level.

Name two to three seminal Academic Medicine articles that everyone in your field should read.

What issues will we be reading about in Academic Medicine in five years? 

As the interface between teacher and learner continues to blur, we will be reading more about peer learning and student-as-teacher programs.

We will fully recognize the power of simulation and will use it routinely for high stakes assessment.

Lastly, I pray in 5 years we will be reading about what we learned in conquering physician burnout.

What book(s) are you reading right now? 

I really ought to read more of the kind of books that would inform my work but I tend toward escapist literature instead. I just finished Seveneves by Neal Stephenson. This book spans millennia, beginning with the premise that the fragmentation of the moon into 7 parts will lead eventually to a meteoric shower that destroys the earth. How the world grapples with this inevitability is only the first half of the book…

How Prepared Are You to Lead? http://academicmedicineblog.org/how-prepared-are-you-to-lead/ http://academicmedicineblog.org/how-prepared-are-you-to-lead/#comments Tue, 13 Jun 2017 13:21:17 +0000 http://academicmedicineblog.org/?p=3402 EKG rhythm with light bulb

By: Peter Pronovost, MD, PhD, and Christopher Myers, PhD, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine

Physicians increasingly are being asked to lead health systems and improvement efforts, so it is important that they have the necessary skills to do so. To see why and how these leadership skills matter, we propose a quick test. Below, we present three scenarios that a health leader might need to navigate. As you read these scenarios, we encourage you to reflect on whether you have a framework you could use to address the issues described, whether you have all of the necessary skills to address these issues, and whether you have a commitment and mechanism to grow and develop these skills.

Case 1: You were just hired as a new attending in a surgical division. A nurse comes to you confidentially to raise concerns about the quality of care provided in the division. The nurse does not want you to discuss the issue with others, because she fears she will suffer retaliation. She states that there is a strong culture of fear and distrust. What do you do?

Case 2: You are leading a project to introduce a new pathway for managing heart failure patients. You bring together the academic and community cardiologists and the primary care physicians. The main academic cardiologist says he wants to make the pathway as he is the world expert. He drafts a pathway and hands it out at the first meeting. The other physicians feel disrespected and do not want to participate. You are under pressure from your hospital leadership to implement the pathway and reduce practice variation. Yet the physicians do not want to join. What could you have done differently and how might you recover?

Case 3: You recently have been made the chief quality officer of a hospital. The boarding time for patients admitted through the emergency department is very high, and your Board and leadership want you to reduce it. You understand that it is a complex problem involving multiple departments. You also know that the interventional cardiologists and surgeons do not want emergency department patients to take their beds–they want to be able to accept transfers from outside hospitals. You call a meeting to work on the problem. How would you motivate the different departments and lead the change effort? The lead medicine physician and surgeon say you do not even need a meeting because the emergency medicine patients are a low priority. How do you approach the problem and get them on board?

All three of these cases illustrate issues of trust, teamwork, power, and change in organizations. These are issues that all leaders face every day, yet they are not the issues that physicians are trained to address. In all three cases, an understanding of leadership and organizational dynamics could provide the frameworks and tools to successfully navigate these challenges.

How did you do on the test? Did you feel prepared to handle the situations? If you need more training, where will you get it?

While we believe these topics need to be incorporated into the medical school curriculum, for physicians who are already in practice, we suggest looking for opportunities at business schools (particularly for those physicians at AMCs affiliated with large universities). Increasingly, business schools are offering specialized courses and opportunities for developing the leadership skills needed in health care. For instance, at Johns Hopkins, we offer a specialized five-day Executive Certificate in Health Care Leadership and Management, which is open to health professionals from any institution and offered for continuing education credit. This program brings together health leaders and management experts to develop the kinds of foundational skills and abilities described in our Academic Medicine article.

In addition to formal training, ongoing skills development through peer or formal coaching is also important. This training can be practical. For example, ask a trusted colleague to provide feedback on your performance in a high stakes meeting. Did you listen to others’ concerns? Did you align around a common interest? Did you reduce resistance? Whatever the source, though, it is never too late to develop these critical leadership competencies, and, by doing so, we can improve the quality of care we provide.

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Author Reading: Nutella http://academicmedicineblog.org/author-reading-nutella/ Thu, 08 Jun 2017 07:17:14 +0000 http://academicmedicineblog.org/?p=3431 A new episode of our podcast is now available through iTunes. Listen today.

In this episode, Dr. Sarah Bernstein reads her essay, “Nutella,” in which she reflects on a patient who taught her that being a doctor sometimes means sharing a spoonful of Nutella and bearing witness to a patient’s journey rather than ordering tests and medications. Her essay was published in the Teaching and Learning Moments column in the June issue of Academic Medicine.

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