What’s New and In the Queue for Academic Medicine

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

See More, Do More, Teach More: Surgical Resident Autonomy and the Transition to Independent Practice
In this Commentary, Hashimoto and colleagues highlight the problem of decreasing autonomy in surgical residency, outline specific threats to resident autonomy, and discuss potential solutions to mitigate their impact.

Professional Formation in the Gross Anatomy Lab and Narrative Medicine: An Exploration
Students experience professional development in evolving, narrative terms. Kissler and colleagues solicited written reflections from students at Baylor, to explore how their content and form illuminated relevant themes.

Perceptions of Peer-to-Peer Interprofessional Feedback Among Students in the Health Professions
van Schaik and colleagues asked students from seven professions to rate usefulness and positivity of feedback; analyses included interactions between profession of feedback recipients and providers. Findings suggest that students perceive interprofessional feedback positively.

How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers
Mamykina and colleagues observed residents during a single day shift and captured all their activities using a validated taxonomy of clinical activities, expanded to describe computer-based activities. They found residents spent considerably more time interacting with computers than in direct contact with patients.

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

Structural Vulnerability: A Clinical Tool to Address Health Disparities
James Quesada, PhD, Seth M. Holmes, MD, PhD, Kim Sue, MD, PhD, and Philippe Bourgois, PhD

Abstract
This Perspective defines the social science concept of “structural vulnerability” for health care providers to address the social determinants of health. Patients are structurally vulnerable when their location in society’s multiple overlapping and mutually reinforcing power hierarchies (e.g., socioeconomic, racial, cultural) and institutional- and policy-level statuses (e.g., immigration status, labor force participation) puts their health at risk. The concept of structural vulnerability can help providers link the clinical challenges of an individual patient to larger political, economic, demographic, and sociocultural hierarchies harmful to health. Two case studies of structurally vulnerable patients are presented and their distinct outcomes contextualized. A structural vulnerability assessment tool is proposed to help clinicians screen patients who are likely to benefit from additional multidisciplinary health and social services. Operationalizing the concept of structural vulnerability in clinical practice and introducing it in medical education can help health care providers think more clearly, critically, and practically about the ways social structures make people sick. The assessment tool can promote “structural competence,” a potential priority for medical education to help flag upstream, macro-level forces and institutions contributing to the poor health of individuals and populations. Adoption of a structural vulnerability framework in health care could also justify the mobilization of hitherto scarce resources inside and outside clinical settings to improve a patient’s immediate access to care and improve long-term outcomes. Ultimately, the concept may orient younger generations of health care providers toward policy leadership to reduce health disparities and foster health equity.

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