Michelle Daniel

• MD, MHPE
• Vice Dean for Medical Education at University of California, San Diego

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...

Background COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expand...

Background The COVID-19 pandemic caused graduate medical education (GME) programs to pivot to virtual interviews (VIs) for recruitment and selection. This systematic review synthesizes the rapidly expanding evidence base on VIs, providing insights into preferred formats, strengths, and weaknesses. Methods PubMed/MEDLINE, Scopus, ERIC, PsycINFO, Me...

From dual process to a family of theories known collectively as situativity, both micro and macro theories of cognition inform our current understanding of clinical reasoning (CR) and error. CR is a complex process that occurs in a complex environment, and a nuanced, expansive, integrated model of these theories is necessary to fully understand how...

Background: Artificial Intelligence (AI) is rapidly transforming healthcare, and there is a critical need for a nuanced understanding of how AI is reshaping teaching, learning, and educational practice in medical education. This review aimed to map the literature regarding AI applications in medical education, core areas of findings, potential can...

Purpose To avoid overreliance on metrics and better identify candidates who add value to the learning environment, some medical schools and residency programs have begun using holistic review for screening and selection, but limited data support or refute this use. This scoping review examines holistic review definitions and practice in medical edu...

Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency...

Introduction Human trafficking (HT) is a public health issue that adversely affects patients’ well-being. Despite the prevalence of trafficked persons in health care settings, a lack of educational modules exists for use in clinical contexts. We developed a 50-minute train-the-trainer module on HT. Methods After piloting the workshop for faculty,...

Mastery learning with fixed end points and variable training time leads to more consistent expertise but is difficult to implement. Here we piloted mastery learning of laryngoscopy with independent practice. 35 learners participated in independent mastery learning on a manikin that provides automated performance feedback. A pre- and postpractice as...

Background Coaching has been demonstrated to be an effective physician wellness intervention. However, this evidence-based intervention has not yet been widely adopted in the physician community. Documentation and implementation research of interventions to address physician burnout in real world settings is much needed. Objective Assess the impac...

Issue: Clinical reasoning is essential to physicians' competence, yet assessment of clinical reasoning remains a significant challenge. Clinical reasoning is a complex, evolving, non-linear, context-driven, and content-specific construct which arguably cannot be assessed at one point in time or with a single method. This has posed challenges for ed...

There is increasing interest in understanding potential bias in medical education. We used natural language processing (NLP) to evaluate potential bias in clinical clerkship evaluations. Data from medical evaluations and administrative databases for medical students enrolled in third-year clinical clerkship rotations across two academic years. We c...

Importance Procedural proficiency is a core competency for graduate medical education; however, procedural reporting often relies on manual workflows that are duplicative and generate data whose validity and accuracy are difficult to assess. Failure to accurately gather these data can impede learner progression, delay procedures, and negatively imp...

Background: Coaching has been demonstrated to be an effective physician wellness intervention. However, this evidence-based intervention has not yet been widely adopted in the community. Documentation and implementation research of interventions to address physician burnout in real world settings is much needed. Objective: Assess the impact of a vi...

Objectives In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the...

Background: Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners. Methods: Four online data...

Phenomenon: According to adult learning theories, effective cognitive integration of basic and clinical science may promote the transfer of knowledge to patient care. The placement of the U.S. Medical Licensing Examination (USMLE) Step 1 after the core clerkships is one strategy intended to facilitate cognitive integration, though learner experienc...

Background The COVID-19 pandemic spurred an abrupt transition away from in-person educational activities. This systematic review investigated the pivot to online learning for nonclinical undergraduate medical education (UGME) activities and explored descriptions of educational offerings deployed, their impact, and lessons learned. Methods The auth...

Background: The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectiv...

Introduction: Uncertainty is integral to clinical practice and clinical reasoning but has proven difficult to study and model. Little is known about how clinicians manage uncertainty. According to evidence-based medicine theory, clinicians should utilize new information to reduce uncertainty until reaching action thresholds for further information...

Introduction Diagnostic processes in the emergency department (ED) involve multiple interactions among individuals who interface with information systems to access and record information. A better understanding of diagnostic processes is needed to mitigate errors. This paper describes a study protocol to map diagnostic processes in the ED as a foun...

The body of medical education research has exploded in recent years. A push for a communal effort amongst education researchers to answer the ‘big questions’ and support evidence‐based approaches to education has resulted in a significant rise in the number of medical education publications. Sifting through this expanding body of work can present a...

Phenomenon: In February 2020, the Federation of State Medical Boards and National Board of Medical Examiners announced that Step 1 of the United States Medical Licensing Examination would transition from a three-digit numerical score to a pass/fail outcome. While several opinion pieces have been authored on the potential implications of this change...

Although historically underutilized, direct observation (DO) represents a key component of competency‐based medical education by facilitating work‐based assessment, timely and focused feedback, and bedside teaching. In one study, half of emergency medicine (EM) residents recalled three or fewer faculty‐observed histories and physical exams (H&P). B...

The National Board of Medical Examiners’ decision to change Step 1 of the United States Medical Licensing Examination (USMLE) from a three-digit score to Pass/Fail (P/F) represents a disruptive change for students, faculty, and leaders in the academic community. In the context of this change, some schools may re-consider the optimal timing of Step...

Calls for curricular reform in medical schools and enhanced integration of basic and clinical science have resulted in a shift towards preclerkship curricula that enhance the clinical relevance of foundational science instruction and provide students with earlier immersion in the clinical environment. These reforms have resulted in shortened precle...

Phenomenon: Schools are considering the optimal timing of Step 1 of the United States Medical Licensing Examination (USMLE). Two primary reasons for moving Step 1 after the core clerkships are to promote deeper, more integrated basic science learning in clinical contexts and to better prepare students for the increasingly clinical focus of Step 1....

Introduction Mistreatment in the learning environment is associated with negative outcomes for trainees. While the Association of American Medical Colleges (AAMC) annual Graduation Questionnaire (GQ) has collected medical student reports of mistreatment for a decade, there is not a similar nationally benchmarked survey for residents. The objective...

The University of Michigan Medical School (UMMS) was founded in 1850. For much of its existence, the curriculum followed a traditional Flexnerian model. Over time, the preclinical curriculum shortened, and the clinical curriculum lengthened. In 2016, the curricular structure inverted. A 17 + 12 + 12-month model transitioned to a 12 + 12 + 17-month...

Background The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020. This rapid systematic review synthesised published reports of medical educational developments in response to the pandemic, considering descriptions of interventions, evaluation data and lessons learned. Methods The authors systematically searched four onlin...

Background The Master Adaptive Learner (MAL) theoretical framework describes an integrated approach to learning that combines features of educational theory on self-regulated learning and aspects of quality improvement. In order to develop MAL students, it is important to pay attention to the learning environment. Purpose To describe educators’ pe...

Background: The emergency department environment requires the clinician-educator to use adaptive teaching strategies to balance education with efficiency and patient care. Recently, alternative approaches to the traditional serial trainee-attending patient evaluation model have emerged in the literature. Methods: The parallel encounter involves...

The COVID-19 outbreak has sown clinical and administrative chaos at academic health centers throughout the country. As COVID-19-related burdens on the health care system and medical schools piled up, questions from medical students far outweighed the capacity of medical school administrators to respond in an adequate or timely manner, leaving stude...

Traditional teaching and assessment of clinical reasoning has focused on the individual clinician because of the preeminence of the information processing (IP) theory perspective. The clinician’s mind has been viewed as the main source of effective or ineffective reasoning, and other participants, the environment and their interactions have been la...

Several schools have moved the United States Medical Licensing Examination Step 1 exam after core clerkships and others are considering this change. Delaying Step 1 may improve Step 1 performance and lower Step 1 failure rates. Schools considering moving Step 1 are particularly concerned about late identification of struggling students and late Ste...

Lectures are a long‐standing tradition in medical education, though in some settings they seem to be drawing their last breath. But the lecture _need not die! When presentations are designed in ways that are consistent with how the human mind works, they can be highly effective instructional tools. Mayer's work on multimedia learning provides evide...

This article was migrated. The article was marked as recommended. Introduction: Interdisciplinary co-teaching by physicians (MD) and social behavioural scientists (SBS) has emerged as an innovative teaching practice in clinical skills courses, but little is known about how co-teachers operationalize instruction. The purpose of this study was to exp...

Purpose: To investigate the effect of a change in USMLE Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag-time on Step 2 CK performance, and the relationship of incoming MCAT score to Step 2 CK performance pre- and post-change. Method: Four LCME-accredited schools that moved Step 1 after core clerkships between academic y...

Implementing competency-based medical education in undergraduate medical education (UME) poses similar and unique challenges to doing so in graduate medical education (GME). To ensure that all medical students achieve competency, educators must make certain that the structures and processes to assess that competency are systematic and rigorous. In...

Learning to self-regulate is an important aspect of professionalism. Thus, in 2015–16, the University of Michigan implemented a learner-centred ‘deferral’ policy called ‘trust and track’ in the preclinical phase. This gave students the autonomy to decide whether to attend required experiences, take quizzes and exams on schedule, or submit assignmen...

An increasing number of medical schools have moved away from traditional 2 + 2 curricular structures toward curricula that intentionally integrate basic, clinical, and health systems science, with the goal of graduating physicians who consistently apply their foundational knowledge to clinical practice to improve the care of patients and population...

Consensus on how to assess non-technical skills is lacking. This systematic review aimed to evaluate the evidence regarding non-technical skills assessments in undergraduate medical education, to describe the tools used, learning outcomes and the validity, reliability and psychometrics of the instruments. A standardized search of online databases w...

The exponential growth of the systematic review methodology within health has been mirrored within medical education, allowing large numbers of publications on a topic to be synthesized to guide researchers and teachers. The robust, transparent and reproducible search methodologies employed offer scholarly rigor. The scope and scale of many reviews...

For anyone who reads the health education literature regularly, journal sections that focus on “reviews” are common, yet the use of the term “systematic” to describe these reviews is sporadic. Further, we believe this term is used in a manner in the field that does not accurately reflect the methodological implications of the term in this context....

Purpose: Schools undergoing curricular reform are reconsidering the optimal timing of Step 1. This study provides a psychometric investigation of the impact on United States Medical Licensing Examination Step 1 scores of changing the timing of Step 1 from after completion of the basic science curricula to after core clerkships. Method: Data from...

Medical students must gain proficiency with the complex skill of case presentations, yet current approaches to instruction are fragmented and often informal, resulting in suboptimal transfer of this skill into clinical practice. Whole task approaches to learning have been proposed to teach complex skill development. The authors describe a longitudi...

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...

Objectives: The humanities, including narrative arts, are a valuable tool to foster reflection for professionally competent clinical practice. Integrating such study into traditional medical school curricula can prove challenging. A preclinical elective on opera and medicine was developed and piloted at the Warren Alpert Medical School of Brown Uni...

Purpose: Effective handovers (handoffs) are vital to patient safety. Medical educators investigated educational interventions to improve handovers in a 2011 systematic review. The number of publications on handover education has increased since then, so authors undertook this updated review. Method: The authors considered studies involving educati...

In just a few years of preparation, emergency medicine (EM) trainees must achieve expertise across the broad spectrum of skills critical to the practice of the specialty. Though education occurs in many contexts, much learning occurs on the job, caring for patients under the guidance of clinical educators. The cognitive apprenticeship framework, or...

Phenomenon: Interdisciplinary coteaching has become a popular pedagogic model in medical education, yet there is insufficient research to guide effective practices in this context. Coteaching relationships are not always effective, which has the potential to affect the student experience. The purpose of this study was to explore interdisciplinary c...

Introduction Clinical reasoning is a complex cognitive process that involves multiple steps. Diagnosing and remediating clinical reasoning difficulties requires faculty to have an understanding of the cognitive theory behind clinical reasoning, familiarity with terminology, and a framework to identify different domains of struggle in their learners...

A. Diagnosing and Remediating Clinical Reasoning Difficulties.ppt B. Clinical Reasoning Difficulties Pocket Card.pdf C. Clinical Reasoning Teaching Tools Handout.pdf D. Clinical Reasoning Participant Cases.pdf E. Clinical Reasoning Facilitator Cases.pdf F. Workshop Assessment Instrument.pdf G. Participant Self-Assessment Instrument.pdf

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...

Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student intera...

Introduction Medical decision-making is a cornerstone of clinical care and a key contributor to diagnostic accuracy. Medical decision-making occurs via two primary pathways: System 1, pattern recognition, is fast, intuitive, and heuristically driven and occurs largely unconsciously. System 2, analytic thinking, is slow, deliberate, and under consci...

However experienced we may be at giving presentations, there are always ways in which we may improve. Clinical educators new to presenting learn from role models and from observing what makes a good presentation engaging, and what turns off an audience when the speaker lacks charisma. This toolbox reminds us of the necessary skills for effective pr...

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise proc...

https://deepblue.lib.umich.edu/bitstream/2027.42/140039/2/tct12645_am.pdf

The majority of medical students complete the United States Medical Licensing Examination Step 1 after their foundational sciences; however, there are compelling reasons to examine this practice. This article provides the perspectives of eight MD-granting medical schools that have moved Step 1 after the core clerkships, describing their rationale,...

Introduction The ability to collaborate as a member of interprofessional teams is essential for patient care and a core competency for students in health professions education. We developed a yearlong course, the Interprofessional Clinical Experience (ICE), to introduce first-year medical students to team-based aspects of the health care environmen...

Cognitive biases can negatively impact patient care. Faculty development is needed to improve instruction about bias and debiasing strategies for all levels of trainees.

The emergency department (ED) is a high-risk environment where diagnostic error is not uncommon. Most errors (70%) are due to faulty reasoning.1 Decision making occurs through two primary pathways: 1) Pattern recognition is fast, intuitive, heuristically driven and occurs largely unconsciously; 2) Analytic thinking is slow, deliberate, and takes pl...

Abstract The Association of American Medical Colleges' Entrustable Professional Activity (EPA) 6 states that “the day 1 resident should be able to concisely present a summary of a clinical encounter to one or more members of the health care team (including patients and families) in order to achieve a shared understanding of the patient's current co...

Abstract The medical profession uses an apprenticeship model to train future generations of physicians. What sets medicine apart from traditional observation-based apprenticeships, however, is the need for clinician educators to externalize their heuristics to make their internal thought processes explicit and visible for a wide range of learners t...

Abstract Introduction This resource is designed for use within a preclinical skills course to teach first and second-year medical students fundamental physical exam (PE) skills. PE skills are a vital competency for medical students to master. Since bedside teaching of the PE during clerkships is infrequent, students entering clerkships must have a...

Abstract This resource is a curriculum designed to teach second-year medical students oral presentation skills. The curriculum was designed for use as a longitudinal thread within a preclinical skills course. The curriculum focuses on both the content and process of delivering an oral presentation, utilizing multiple instructional strategies that a...

During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distr...

The mechanisms by which Cryptosporidium parvum cause persistent diarrhea and increased morbidity and mortality are poorly understood. Three groups of Haitian children <18 months old were studied: case patients, children with diarrhea not due to Cryptosporidium and healthy control subjects. Compared with both control groups, children with acute cryp...

A review was conducted in Haiti to determine the timing and outcome of active tuberculosis (TB) in human immunodeficiency virus (HIV)-positive patients who had previously received isoniazid (INH) prophylaxis. Of 1005 HIV-seropositive patients who completed INH prophylaxis, 14 (1.4%) subsequently had active TB diagnosed. The median interval between...