What’s New and In the Queue for Academic Medicine

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What’s New: A Preview of the May Issue
The May 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:

Academic Medicine’s Critical Role in the “Third Curve” of Health Care
With the traditional, fee-for-service model of care as “Curve I” and the era of population-based medicine as “Curve II,” Paz identifies the emergence of “Curve III,” characterized by patient-centered, consumer-directed models of care, in this New Conversations piece.

All Health Is Global Health, All Medicine Is Social Medicine: Integrating the Social Sciences Into the Preclinical Curriculum
Kasper and colleagues argue for the importance of including social medicine and global health in the preclinical curriculum and describe Harvard Medical School’s innovative, integrated approach to teaching these disciplines. Two blog posts on this article written by an MD/MBA student and a fourth-year resident are available.

Does Time Pressure Have a Negative Effect on Diagnostic Accuracy?
ALQahtani and colleagues find time pressure has a negative impact on diagnostic performance. They propose the effect is moderated by both the case difficulty level and the physician’s level of experience.

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review
Carney and colleagues found 33 articles that yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. However, more rigorous validation of assessment tools and more robust evaluation designs are needed in educational research and curriculum assessment.

What’s In the Queue: A Sneak Peek
Here’s a preview of an upcoming research report by Martinez and colleagues.

Measuring Moral Courage Among Interns and Residents: Scale Development and Initial Psychometrics
William Martinez, MD, MS, Sigall K. Bell, MD, Jason M. Etchegaray, PhD, and Lisa Soleymani Lehmann, MD, PhD, MSc

Abstract

Purpose
This study aims to develop a practical and psychometrically sound set of survey items that measures moral courage among physicians in the context of patient care.

Method
Between March and June 2013, medical and surgical interns and residents from two large, academic medical centers in the Northeastern United States were invited to anonymously complete an electronic survey containing items about moral courage, empathy, and speaking up about safety breaches.

Results
Principal components analysis of the moral courage items demonstrated a single, meaningful, nine-item factor labeled the Moral Courage Scale for Physicians (MCSP). All item-total score correlations were significant (P < .01) and ranged from 0.57 to 0.76. The Cronbach’s alpha for the MCSP was 0.90. Consistent with our expectations based on theory, MCSP scores were negatively associated with being an intern versus a resident (B = –4.17, P < .001), suggesting discriminant validity. MCSP scores were positively associated with respondents’ Jefferson Scale of Physician Empathy “perspective taking” score (B = 0.53, P < .001), a construct conceptually relevant to moral courage, suggesting convergent validity. Finally, MCSP scores were positively correlated with self-reported speaking up about patient safety breaches (r = 0.19, P = .008), an action that involves moral courage, suggesting concurrent validity.

Conclusions
The authors provided initial evidence for the reliability and validity of a measure of moral courage for physicians. The MCSP may help researchers and educators to tangibly measure physician moral courage as a concept, and track progress on a set of desired behaviors in response to curricular interventions.

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