Hello COMSEP!
What holiday will you celebrate today September 18th?
- National Cheeseburger Day
- Rice Krispies Treat Day
- Hug a greeting card writer
- National Cartonnage Day
- Other (email Amit at pahwa@jhu.edu)
For this month’s journal club, the Survey and Scholarship Committee reviewed journal articles that used a survey in their methods. We hope this motivates you to submit questions to the annual survey for 2026 -https://www.comsep.org/annual-survey/. We will be opening up for submissions on October 23rd (due December 2, 2025).
We also welcome anyone who wants to apply to be on the committee. The purpose of the committee is to facilitate scholarship of our members and enhance the diffusion of knowledge within the organization by providing a mechanism for streamlined administration of targeted surveys about members’ views and practices on relevant educational issues. Please click and fill out this link to apply: Survey Committee Application
Enjoy!
Amit, Amy, Erin, Jessica, Sarah
COMSEP Journal Club
September 2025
Editors: Karen Forbes, Amit Pahwa, Jon Gold
Are you professional (Y/N)? Choose one
Montgomery, MW, Petersen, EM, Weinstein, AR et al.. Moving Beyond the Dichotomous Assessment of Professionalism in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors. Academic Medicine 2024; 99(2): 208-214. https://dx.doi.org/10.1097/ACM.0000000000005308
Reviewed by: Amy Creel
What were the study questions?
How do internal medicine clerkship directors conceptualize and assess medical student professionalism and do these assessments impact grades? What challenges are experienced in supporting the development of students’ professional behaviors?
How was the study done?
Employing the 2021 Clerkship Directors in Internal Medicine (CDIM) annual survey, 22 questions were included related to professionalism. Responses were collected from one designated respondent per school. Questions explored how faculty: 1) assess professionalism, 2) report concerns 3) feel prepared to respond to issues, 4) document behaviors, 5) communicate about professionalism, and 6) support improvement.
What were the results?
Clerkship directors from 103 U.S. allopathic medical schools responded (75.2%). Most (94.2%) require formal professionalism assessments. Fewer (62.1%) factor them into the final clerkship grade. Lapses in involvement (82.4%) and introspection issues (58.8%) occur more commonly than integrity or communication issues. Only 23% report lapses as documented formally in the student record. While 65% reported a formal remediation process, 26.2% were unsure whether one existed. Identified barriers to addressing professionalism with students include logistics, lack of training, concerns for subjectivity of assessments, and potential adverse effects on the student if they are labeled unprofessional.
How can I apply this to my work in education?
As professionalism assessments are often school-wide, these findings are likely relevant to pediatrics. The results reveal gaps in consistency, transparency, and support. A binary approach – labeling a student as either “professional” or “unprofessional” - may foster fear and uncertainty for students and faculty. Missteps, like struggles with introspection, might better be viewed as opportunities for continued growth. Educators should continue to advocate for and invest in shared expectations. faculty training, transparent and non-punitive documentation, and remediation plans that emphasize growth over judgment.
Editor’s Comments: The authors propose shifting from a dichotomous characterization of professionalism that is deficit focused (professional or unprofessional) to a developmental model whereby professionalism is viewed on a continuum, with students acquiring professional skills throughout training much like clinical skills and medical knowledge. This developmental model makes sense (especially for pediatricians) and challenges us to reconceptualize professionalism. I also note the CDIM annual survey is similar in nature and process to that of COMSEP and they had a 94% response rate – can we hit that target this year? (KFO)
Students want us to talk about AI
Issa, W.B., Shorbagi, A., Al-Sharman, A. et al. Shaping the future: perspectives on the Integration of Artificial Intelligence in health profession education: a multi-country survey. BMC Med Educ 24, 1166 (2024). https://doi.org/10.1186/s12909-024-06076-9
Reviewed by Jessica Patrick-Esteve and Erin Pete Devon
What was the study question?
What are medical students’ knowledge, attitudes, and perceived barriers to AI integration in health professions education (HPE)?
How was the study done?
An anonymous, validated web-based survey was administered to HPE students at four public universities in Jordan, the United Arab Emirates (UAE), the Kingdom of Saudi Arabia (KSA) and Egypt. The survey was organized into 3 domains: sociodemographic data, prior AI knowledge and training, and attitudes toward AI including perceived benefits, negative impacts, curricular integration, and challenges. A total of 642 students across medicine, nursing, physiotherapy, and nutritional sciences voluntarily participated between February and October 2023. Data were analyzed using descriptive statistics, Chi-square tests and ANOVA with Cronbach’s alpha values (0.78 to 0.89) supporting internal consistency.
What were the results?
- Most (66%) reported low AI knowledge.
- Only one-third had formal AI coursework, and fewer than 20% encountered AI in practicum training; 66% learned about AI via social media.
- Despite limited exposure, attitudes were positive: 51% demonstrated “high attitude” scores, and 91% endorsed AI benefits like efficiency, reduced administrative burden, and decision support.
- Support for integrating AI into curricula was strong (77.6%),
- Concerns included reduced patient trust (43.5%) and, less commonly, negative impacts on professional roles (18%).
- Barriers identified were lack of expert training (53%), lack of awareness (50%), and lack of interest (41%).
How can I apply this to my work in education?
Students’ reliance on social media highlights the need for structured curricular content ensuring accurate understanding. Their positive attitudes and support for integration provide a favorable environment for curricular innovation. Concerns about patient trust emphasize the importance of coupling technical training with ethics, professionalism, and humanism. Finally, barriers such as lack of expert training underscore the need for faculty development and interdisciplinary collaboration, ensuring educators are prepared to teach this evolving content.The study also illustrates how validated instruments can capture perspectives across diverse contexts to inform curricular reform.
Editor’s Note: This was a voluntary survey so there may be some selection bias here. Nonetheless, it is almost certainly true that many HPE students are enthusiastic about AI and using it regularly, while faculty may be more cautious. As with any disruptive technology, what should be included in a curriculum about AI still needs to be worked out. (JG)
4 + 4 is greater than 4 +1
Heppe D, Baduashvili A, Limes JE, et al.; Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation. JAMA Netw Open. 2024;7(2):e240037. https://dx.doi.org/10.1001/jamanetworkopen.2024.0037
Reviewed by Sarah Korte
What was the study question?
The study evaluated the impact of a 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks), compared with a prior 4 + 1 block schedule (4 inpatient weeks plus 1 outpatient week), on resident wellness, burnout, and self-reported professional engagement and clinical preparedness.
How was the study done?
A pre/post survey study was conducted at one academic internal medicine residency program with first- and second-year residents from June 2019 - 2021. Burnout was assessed using the MBI–Human Services Survey for Medical Personnel (MBI-HSS[MP]) and encompassed 22 items across 3 subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Achievement (PA). Secondary outcomes were assessed through in-training exam (ITE) scores and a 15-item questionnaire from the iCOMPARE study looking at self-perceived impact of the new rotation structure on outcomes, including the ability to acquire clinical skills, access to educational and scholarly opportunities, job satisfaction, and health. Surveys were administered within 3 months before the intervention and at 1- and 2-years post-intervention.
What were the results?
Out of the 313 residents, 216 (69%) completed the survey. Before the intervention 48.2 % of residents had EE decreasing to 14.3% and 19.1% in the postintervention years (P < .001 DP prevalence also decreased from 44.7% to 20.6% and remained unchanged at 20.6% during the postintervention period (P < .001). The change in PA scores did not reach statistical significance.
For the secondary outcomes, 12 of the 15 items reached statistical significance and standardized mean differences indicated a large positive association for 11 of those items, especially for time for scholarly activities, experiences outside of the clinical setting, time with family and friends, and overall well-being. No statistically significant change in ITE percentile ranks was noted.
How can I apply this to my work in education?
This study suggests implementation of a 4 + 4 schedule was associated with markedly improved EE and DP domains of burnout to a degree not previously documented with any other intervention. The change in schedule also did not negatively affect clinical knowledge. There should be continued work in balancing student, resident, and faculty wellness with performance as a physician.
Editor’s note: This was quite an interesting way to assess how a schedule change can affect a resident’s wellness with a balancing measure of clinical knowledge. While it is nice to know self-perceived clinical skill change, other measures like milestone achievement would be nice. (AP)