What’s New and In the Queue for Academic Medicine

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What’s New: A Preview of the November Issue
The November 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. The November issue includes a collection of papers on mastery learning. Highlights from the issue include:

A Market Approach to Better Care at Lower Cost
In this New Conversations piece, Antos argues controlling cost while maintaining or improving access to quality care requires fundamental reform based on market principles, which means aligning the financial incentives of patients and providers to promote smarter spending. 

Mastery Learning: It Is Time for Medical Education to Join the 21st Century
McGaghie describes the origins of mastery learning and presents its essential features, then introduces the eight reports that comprise the mastery learning cluster for this issue of Academic Medicine.

Bringing Home the Health Humanities: Narrative Humility, Structural Competency, and Engaged Pedagogy
Tsevat and colleagues present three pedagogical pillars that educators can use to invite learners to engage more fully, develop critical awareness of medical narratives, and feel “at home” in the health humanities.

Beyond the Simulation Laboratory: A Realist Synthesis Review of Clinical Outcomes of Simulation-Based Mastery Learning
Griswold-Theodorson and colleagues found the 14 included studies reported improvement after simulation-based mastery learning training in procedure performance, patient discomfort, procedure time, complication rates, or T4 impacts (e.g., cost reduction).

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

Playing in the “Gutter”: Cultivating Creativity in Medical Education and Practice
Kevin T. Liou, MD, Daniel S. Jamorabo, MD, Richard H. Dollase, EdD, Luba Dumenco, MD, Fred J. Schiffman, MD, and Jay M. Baruch, MD

Abstract
In comics, “gutters” are the empty spaces between panels that readers must navigate to weave disjointed visual sequences into coherent narratives. A gutter, however, is more than a blank space—it represents a creative zone for making connections and for constructing meaning from disparate ideas, values, and experiences. Over the course of medical training, students encounter various “gutters” created by the disconnected subject blocks and learning experiences within the curriculum, the ambiguity and uncertainty of medical practice, and the conflicts and tensions within clinical encounters. Navigating these gutters requires not only medical knowledge and skills, but also creativity, defined as the ability to make connections between disparate fragments to create meaningful, new configurations.

To cultivate medical students’ creative capacity, the authors developed the Integrated Clinical Arts (ICA) program, a required component of the first-year curriculum at the Warren Alpert Medical School of Brown University. ICA workshops are designed to place students in a metaphorical gutter, wherein they can practice making connections between medicine and arts-based disciplines. By playing in the gutter, students have opportunities to broaden their perspectives, gain new insights into both medical practice and themselves, and explore different ways of making meaning. Student feedback on the ICA program highlights an important role for creativity and the arts in medicine: to transform “gutters” from potential learning barriers into opportunities for discovery, self-reflection, and personal growth.

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