Larry D Gruppen

University of Michigan | U-M · Department of Medical Education

There is an urgent need to capture the outcomes of the ongoing global implementation of competency-based medical education (CBME). However, the measurement of downstream outcomes following educational innovations, such as CBME is fraught with challenges stemming from the complexities of medical training, the breadth and variability of inputs, and t...

As the global transformation of postgraduate medical training continues, there are persistent calls for program evaluation efforts to understand the impact and outcomes of competency-based medical education (CBME) implementation. The measurement of a complex educational intervention such as CBME is challenging because of the multifaceted nature of...

Health care revolves around trust. Patients are often in a position that gives them no other choice than to trust the people taking care of them. Educational programs thus have the responsibility to develop physicians who can be trusted to deliver safe and effective care, ultimately making a final decision to entrust trainees to graduate to unsuper...

The clinical learning environment (CLE) encompasses the learner's personal characteristics and experiences, social relationships, organizational culture, and the institution's physical and virtual infrastructure. During the COVID-19 pandemic, all 4 of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communic...

Background: The continuously changing health care context necesitates that medical trainees develop self-directed learning skills. This study examined the effect of coaching on the self-directed learning process in pre-clerkship medical students. Methods: We conducted a longitudinal educational intervention using standardised patient assessments...

Purpose: Internationally, health professions education scholarship units (HPESUs) are often developed to promote engagement in educational scholarship, yet little is known about how HPESUs change over time or what factors support their longevity. In hopes of helping HPESUs thrive, this study explored factors that shaped the evolution of 8 HPESUs o...

Introduction: Clinical reasoning is considered to be at the core of health practice. Here, we report on the diversity and inferred meanings of the terms used to refer to clinical reasoning and consider implications for teaching and assessment. Methods: In the context of a Best Evidence Medical Education (BEME) review of 625 papers drawn from 18 hea...

Purpose: Health professions education scholarship units (HPESUs) in the United States are large in number and diverse in purpose, activities, and contributions. Although each of these units shares a commitment to scholarship, there is no synthetic framework to accurately represent and evaluate their activities and contributions. This study aimed t...

Purpose An evidence-based approach to assessment is critical for ensuring the development of clinical reasoning (CR) competence. The wide array of CR assessment methods creates challenges for selecting assessments fit for the purpose; thus, a synthesis of the current evidence is needed to guide practice. A scoping review was performed to explore th...

The learning environment (LE) is an important and frequently discussed topic in the health professions education literature. However, there is considerable inconsistency in how the LE is defined and described. The authors propose a definition of the LE and a conceptual framework to facilitate health professions educators in understanding, studying,...

Our school introduced a new curriculum based on faculty-directed, intensive, small-group teaching of clinical skills in the third-year medical students. To examine its effects, we compared the mean scores on an OSCE between the third- and fourth-year medical students. Methods Third- and fourth-year students did rotations at the same five OSCE stati...

Purpose: To identify and describe interventions designed to affect the learning environment (LE) in health professions education, summarize factors that influence the LE, and determine gaps that require additional research. The LE can be thought of as a dynamic and complex construct co-created by people in a particular setting. A positive LE repres...

Because change is ubiquitous in healthcare, clinicians must constantly make adaptations to their practice to provide the highest quality care to patients. In a previous article, Cutrer et al. described a metacognitive approach to learning based on self-regulation, which facilitates the development of the Master Adaptive Learner (MAL). The MAL proce...

Purpose: Transforming a medical school curriculum wherein students enter clerkships earlier could result in two cohorts in clerkships simultaneously during the transition. To avoid overlapping cohorts at the University of Michigan Medical School, the length of all required clerkships was decreased by 25% during the 2016-2017 academic year, without...

Purpose: Many factors influence the reliable assessment of medical students' competencies in the clerkships. The purpose of this study was to determine how many clerkship competency assessment scores were necessary to achieve an acceptable threshold of reliability. Method: Clerkship student assessment data were collected during the 2015-16 acade...

As competency-based medical education is adopted across the training continuum, discussions regarding time-variable medical education have gained momentum, raising important issues that challenge the current regulatory environment and infrastructure of both undergraduate and graduate medical education in the United States. Implementing time-variabl...

The logical consequence of implementing competency-based education is moving to time-variable training. Competency-based, time-variable training (CBTVT) requires an understanding of how learners interact with their learning context and how that leads to competence. In this article, the authors discuss this relationship. They first explain that the...

The introduction of competency-based medical education has shifted thinking from a fixed-time model to one stressing attained competencies, independent of the time needed to arrive at those competencies. In this article, the authors explore theoretical and conceptual issues related to time variability in medical training, starting with the Carroll...

Competency-based, time-variable medical education has reshaped the perceptions and practices of teachers, curriculum designers, faculty developers, clinician educators, and program administrators. This increasingly popular approach highlights the fact that learning among different individuals varies in duration, foundation, and goal. Time variabili...

Rationale and Objectives The aims of our study were (1) to describe a new educational intervention for first-year medical students that gave a substantial, early exposure to radiology and (2) to examine how this early exposure was received by the students. Materials and Methods Our new curriculum incorporated a new 2-week course very early in the...

Clinical reasoning is an essential component of a health professional's practice. Yet clinical reasoning research has produced a notably fragmented body of literature. In this article, the authors describe the pause-and-reflect exercise they undertook during the execution of a synthesis of the literature on clinical reasoning in the health professi...

Medical schools strive to administer high-quality exams. These exams are often authored and graded by basic science and clinical faculty with content expertise; however, these faculty may lack expertise in question writing as well as familiarity with the psychometrics involved in item analysis. This short communication overviews the background rela...

Medical school assessments should foster the development of higher-order thinking skills to support clinical reasoning and a solid foundation of knowledge. Multiple-choice questions (MCQs) are commonly used to assess student learning, and well-written MCQs can support learner engagement in higher levels of cognitive reasoning such as application or...

Purpose: This study investigates the contributions of self-assessment (SA) and external feedback on the development of learning goals (LG) and the influence on LG recall and implementation in medical students. Methods: Following a standardized patient (SP) assessment, 168 pre-clinical medical students completed a SA, received SP feedback and create...

Purpose: Learning to make decisions under uncertain conditions is a critical component of diagnostic and therapeutic reasoning. This study sought to determine treatment decisions medical students make when presented with different thresholds of diagnostic uncertainty and whether they appropriately adjust diagnostic probabilities with test informati...

Assessment drives learning; therefore, valid and robust assessments are important. To achieve trustworthy assessments with high-quality multiple choice questions, we established a rigorous system of exam quality improvement (QI). Our exam QI process helps ensure implementation of best practices and evidence-based approaches to student assessment, a...

Background : Although there is some consensus about the competencies needed to enter residency, the actual skills of graduating medical students may not meet expectations. In addition, little is known about the association between undergraduate medical education and clinical performance at entry into and during residency. Objective : We explored...

Background: The use of questioning to engage learners is critical to furthering resident education intraoperatively. Previous studies have demonstrated that higher level questioning and optimal wait times (>3 s) result in learner responses reflective of higher cognition and retention. Given the importance of intraoperative learning, we investigate...

Competency-based medical education (CBME) is both an educational philosophy and an approach to educational design. CBME has already had a broad impact on medical schools, residency programs, and continuing professional development in health professions around the world. As the CBME movement evolves and CBME programs are implemented, a wide range of...

Context: Although health professions education scholarship units (HPESUs) share a commitment to the production and dissemination of rigorous educational practices and research, they are situated in many different contexts and have a wide range of structures and functions. Objectives: In this study, the authors explore the institutional logics co...

Radiologists in teaching hospitals and in practices with residents rotating through are involved in the education of their residents. The Accreditation Council for Graduate Medical Education requires evidence that trainees are taught and demonstrate competency not only in medical knowledge and in patient care-the historic focus of radiology educati...

Purpose: Health professions education scholarship units (HPESUs) are organizational structures within which a group is substantively engaged in health professions education scholarship. Little research investigates the strategies employed by HPESU administrative leaders to secure and maintain HPESU success. Using institutional entrepreneurship as...

Competency-based medical education (CBME) aims to bring about the sequential acquisition of competencies required for practice. Although it is being adopted in centers of medical education around the globe, there is little evidence concerning whether, in comparison with traditional methods, CBME produces physicians who are better prepared for the p...

Purpose To examine, using a systems framework, the relative influence of individual-level and institution-level factors on student perceptions of the medical school educational environment. Method A series of hierarchical linear models were ft to a large, 18-school longitudinal dataset of student perceptions of the educational environment, various...

Background: The type of question asked elicits a particular response. The purpose of this study was to determine what types and levels of questions were asked in the operating room. These insights are important for understanding how questions are used to advance learners. Methods: 12 laparoscopic cholecystectomy operations were observed and reco...

Change is ubiquitous in health care, making continuous adaptation necessary for clinicians to provide the best possible care to their patients. The authors propose that developing the capabilities of a Master Adaptive Learner will provide future physicians with strategies for learning in the health care environment and for managing change more effe...

Problem: Health professions education scholarship (HPES) is an important and growing field of inquiry. Problematically, consistent use of terminology regarding the individual roles and organizational structures that are active in this field are lacking. This inconsistency impedes the transferability of current and future findings related to the ro...

Context Competency-based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time-based training, and promotion of learner cent...

Clinical reasoning assessment is an essential component of determining a health professional’s competence. Clinical reasoning cannot be assessed directly. It must be gleaned from a health professional’s choices and decisions. Clinical knowledge and knowledge organization, rather than a general problem solving process, serve as the substrate for cli...

https://deepblue.lib.umich.edu/bitstream/2027.42/136446/2/tct12525_am.pdf

Purpose: Accreditation and professional organizations have recognized the importance of measuring medical students' perceptions of the learning environment, which influences well-being and professional competency development, to optimize professional development. This study was conducted to explore interactions between students' perceptions of the...

Professionalism and ethics are difficult to define, and it is often a case of "you know it when you see it." In recent years, there have been calls to renew the focus on professionalism and ethics and their teaching in the medical and allied professions, part precipitated by a perceived and probably real decline in doctors' professional values. Med...

Purpose: For the busy clinician-educator, accessing opportunities that develop the skills and knowledge necessary to perform education research can be problematic. The Medical Education Research Certification at Council of Emergency Medicine Residency Directors (MERC at CORD) Scholars' Program is a potential alternative. The current study evaluate...

Medical education research suffers from a significant and persistent lack of funding. Although adequate funding has been shown to improve the quality of research, there are a number of factors that continue to limit it. The competitive environment for medical education research funding makes it essential to understand strategies for improving the s...

Writing an educational research grant in health profession education is challenging, not only for those doing it for the first time but also for more experienced scholars. The intensity of the competition, the peculiarities of the grant format, the risk of rejection, and the time required are among the many obstacles that can prevent educational re...

Background: This large, multi-institutional study examines the relative contribution of residency specialty and institution to resident satisfaction with their learning environment and workload. Method: Survey responses from 798 residents were linked to institution (N = 20) and specialty (N = 10) and to characteristics of individual residency pr...

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a te...

This chapter aims at familiarizing you with the basic concepts that underlie power calculation so that you can improve the effectiveness of your own educational research and communicate more clearly the strength of the effects you find. A power analysis gives you the answer by estimating the number of measurements necessary in order for a statistic...

This chapter introduces self-regulated learning (SRL) theory to medical education researchers, particularly those who might be interested in applying SRL frameworks to study and improve healthcare profession education. It first provides a broad definition of SRL, followed by a review of the common assumptions that underlie SRL theories. The chapter...

There is a growing demand for health sciences faculty with formal training in education. Addressing this need, the University of Michigan Medical School created a Master in Health Professions Education (UM-MHPE). The UM-MHPE is a competency-based education (CBE) program targeting professionals. The program is individualized and adaptive to the lear...

To investigate the difficulties Japanese female doctors face in continuing professional practice. A qualitative study using the Kawakita Jiro method. A survey conducted in 2011 of 13 private Japanese medical school alumni associations. 359 female doctors. Barriers of balancing work and gender role. The female doctors reported that professional prac...

https://www.aamc.org/download/427350/data/assessingchange.pdf

One model of faculty development that is growing in popularity is the longitudinal, intensive fellowship program. Typically, these programs seek to instill a higher level of educational knowledge and skill than a single workshop, although they require less time and financial commitment than a formal advanced degree. This chapter will begin with a d...

ver the past 2decades, com-petency-based edu-cation (CBE) hasrapidly become thepredominant frame-work for medicaleducation innovationand change. It formsthecoreofgraduatemedicaleducationac-creditation in NorthAmerica and muchof Europe, and ismaking inroads intoundergraduate edu-cation. CBE is an approach to preparing physicians forpractice that is...

Medicine in the United States is changing as a result of many factors, including the needs and demands of 21st-century society. In this commentary, the authors review the 2014 Research in Medical Education (RIME) articles in the context of these changes and with an eye toward the future. The authors organized the 12 RIME articles into four broad th...

Studies have found unprofessional behavior in medical school was associated with disciplinary action by state medical boards. For medical schools, promotions committees are responsible for identifying which students do not demonstrate academic performance and professional behavior acceptable for promotion and graduation. The objective of this study...

Background Addictive disorders receive little attention in medical school and residency program curricula.Objective To evaluate an innovative learning approach encouraging and stimulating residents to focus on key competencies by testing before and after their addiction psychiatry rotation.Methods We developed a 50-item test on substance use disord...

Background: This study evaluated a simulated pages curriculum that was developed to assess communication and clinical decision making in medical students and interns. Methods: A curriculum consisting of 14 simulated pages was administered across 5 institutions to 150 senior medical students. A 3-case subset was administered to interns who did no...

To compare programs with and without 24-hour/7 days a week/365 days a year (24/7/365) in-house radiologist coverage regarding resident perceptions of their on-call experience, volume of resident dictations on call, and report turnaround time. Residents from six academic radiology departments were invited to participate in an 11-item online survey....

Many of the values and behaviours described in the original Hippocratic Oath are relevant to medical education. In particular, the values of intellectual humility and respect for one's colleagues are essential in all scientific disciplines. There are three contexts within medical education from which to consider humility and respect: uncertainty; t...

This chapter assures medical educator that self-regulated learning (SRL) can be taught and that educators play a pivotal role in helping learners to develop the relevant skills. It provides theoretical and practical information about a broader and more complex cycle of SRL, and proposes a model for its integration into medical curricula. The model,...

Objective Education about substance use disorders in medical schools and, subsequently, physicians’ identification of and intervention in these diagnoses lag behind that of most other disabling disorders. To reduce barriers and improve access to education about this major public health concern, medical schools are increasingly adopting web-based in...

As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also exami...

Introduction: The purpose was to evaluate the Bookmark standard-setting method for use on a performance-based assessment in medical education. Methods: We compared cutscores for Aseptic performance assessment using the modified Angoff, Hofstee and modified Bookmark methods. Results: The Angoff produced a cutscore of 62%, SD=18 and a percent pa...

Ob jective The learning environment impacts medical students??? motivation, attitudes, academic performance, and professionalism. Aspects of the learning environment??? faculty and administrative treatment of students, student social experiences, consequences for intellectual honesty and ethical integrety???constitute a ???hid- den curriculum??? wh...

The Anatomical Donations Program at the University of Michigan Medical School (UMMS) has begun a multiphase project wherein interviews of donors will be recorded and later shown to medical students who participate in the anatomical dissection course. The first phase of this project included surveys of both current UMMS medical students and donors c...

A plenary panel session at the 2012 Academic Emergency Medicine consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" discussed barriers educators face in imagining, designing, and implementing studies to address educational challenges. This proceedings article presents a general appr...

Funding is a perennial challenge for medical education researchers. Through a consensus process, the authors developed a multifaceted agenda for increasing funding of education research in emergency medicine (EM). Priority agenda items include developing resources to increase the competitiveness of medical education research faculty in grant applic...

Health care struggles to transfer recent discoveries into high-quality medical care. Therefore, translational science seeks to improve the health of patients and communities by studying and promoting the translation of findings from bench research into clinical care. Similarly, medical education practice may be slow to adopt proven evidence of bett...

This article presents the proceedings of the 2012 Academic Emergency Medicine consensus conference breakout group charged with identifying areas necessary for future research regarding effectiveness of educational interventions for teaching emergency medicine (EM) knowledge, skills, and attitudes outside of the clinical setting. The objective was t...

Outcome-based education (OBE) is a major reframing of how medical educators think about teaching, learning, and assessment. There are many alternative versions of OBE and the implications of this framework are not always well-understood. A review of the literature on OBE and an analysis of the educational implications suggest seven areas of contras...

Competency-based education (CBE) provides a useful alternative to time-based models for preparing health professionals and constructing educational programs. We describe the concept of 'competence' and 'competencies' as well as the critical curricular implications that derive from a focus on 'competence' rather than 'time'. These implications inclu...

The Learning Environment Study involves 28 medical schools belonging to the Innovative Strategies for Transforming the Education of Physicians (ISTEP): an initiative founded by the American Medical Association in 2006. ISTEP is a unique medical education research collaborative that brings together individuals and institutions across the continuum o...

The purpose of this qualitative study was to understand what meaning(s) preclinical students attributed to participation in one-week international service-learning trips (ISLTs) and what specific experiences during the trips accounted for such perspectives. Twenty-four first-year students who had participated in one-week ISLTs at the University of...

To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education. A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lym...

Medical school and residency training curricula across the country have undergone extensive revisions and, much like clinical quality improvement (QI) initiatives, require assessments of new programs. Because sharing knowledge is a hallmark of academic medicine, program evaluation may come under the purview of the institutional review board (IRB);...

The purpose of our study was to determine the prevalence, focus, time commitment, graduation requirements and programme evaluation methods of medical education fellowships throughout the United States. Medical education fellowships are defined as a single cohort of medical teaching faculty who participate in an extended faculty development programm...

Purpose: The purpose of our study was to determine the prevalence, focus, time commitment, graduation requirements and programme evaluation methods of medical education fellowships throughout the United States. Medical education fellowships are defined as a single cohort of medical teaching faculty who participate in an extended faculty development...

Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally...

The quality of the medical education research (MER) reported in the literature has been frequently criticized. Numerous reasons have been provided for these shortcomings, including the level of research training and experience of many medical school faculty. The faculty development required to improve MER can take various forms. This article descri...