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The authors began a curriculum reform project to improve the experience in a Renal Physiology course for first-year medical students. Taking into account both the variety of learning preferences among students and the benefits of student autonomy, the authors hypothesized that adding digital chalk-talk videos to lecture notes and live lectures would improve student knowledge, course satisfaction, and engagement. The authors measured performance on the renal physiology exam before (the traditional curriculum) and for 2 yr after implementation of the new curriculum. During the traditional and subsequent years, students took a Q-sort survey before and after the Renal Physiology course. Satisfaction was assessed based on ranked statements in the Q sort, as well as through qualitative analysis of student commentary. Compared with the traditional curriculum, mean scores on the renal physiology final exam were higher after implementation of the new curriculum: 65.3 vs. 74.4 ( P < 0.001) with year 1 and 65.3 vs. 79.4 ( P < 0.001) in the second year. After the new curriculum, students were more likely to agree with the statement, "I wish other courses were taught like this one." Qualitative analysis revealed how the video-based curriculum improved student engagement and satisfaction. Adding digital chalk-talk videos to a traditional Renal Physiology course that included active learning led to improved exam performance and high levels of student satisfaction. Other preclinical courses in medical school may benefit from such an intervention.

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Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.

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Attention-deficit/hyperactivity disorder (ADHD) is the most frequently diagnosed neurodevelopmental disorder; 6.4 million children and adolescents have been diagnosed with ADHD as of 2011. However, only 3.5 million children and adolescents are taking medication for ADHD. Adolescents with ADHD are much less willing to pursue or adhere to medication or psychosocial therapy, often because of their perceptions of side effects or perceived value of treatment, which places them at greater risk for difficulties at school, work, and home environments. Providing adolescents with increased autonomy through patient-centered approaches can increase their involvement and ability to manage their ADHD symptoms and treatment.

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BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. PURPOSE: We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. METHODS: We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. RESULTS: An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. DISCUSSION: The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

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CONTEXT: Since the 1990s, there has been a heightened awareness of the value of teaching medical students about how aspects of spirituality and religion may affect patient care. OBJECTIVE: To determine the prevalence of spirituality-in-medicine instruction at colleges of osteopathic medicine (COMs) in the United States. METHODS: Prescreened subjects at 20 COMs were contacted by electronic mail and asked to complete a 25-item Web-based survey. The survey instrument consisted of questions about spirituality-in-medicine instruction at their institutions. If an institution was not represented in our survey results through subject response, we reviewed that institution's Web site to locate material suggestive of an extant spirituality-in-medicine curricula (eg, prospective student information). RESULTS: Surveys were submitted to investigators by representatives of 12 COMs for a response rate of 60%. Subjects from 8 COMs reported a structured spirituality-in-medicine curriculum currently in place at their institutions. Osteopathic medical students generally receive a total of 2 to 20 hours of instruction on spirituality and religion. Of the 10 unrepresented institutions, 4 COMs had material available on their Web sites that suggested spirituality-in-medicine topics were embedded in their curricula. Therefore, approximately 55% of all COMs have some form of spirituality-in-medicine program in place. CONCLUSION: Some form of spirituality-in-medicine instruction is available at slightly more than half the COMs in the United States. As the need for spirituality-in-medicine curricula is increasingly recognized, improved methods of documenting ongoing curricular development and student competency will be required.

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