Background: Medical students face numerous stressors during their clinical years, including difficult clinical events. Fostering resilience is a promising way to mitigate negative effects of stressors, prevent burnout, and help students thrive after difficult experiences. However, little is known about medical student resilience. Objective: To characterize medical student resilience and responses to difficult clinical events during clinical training. Design: Sixty-two third-year (MS3) and 55 fourth-year (MS4) University of Chicago medical students completed surveys in 2016 assessing resilience (Connor Davidson Resilience Scale, CD-RISC 10), symptoms of burnout, need for resilience training, and responses to difficult clinical events. Results: Medical student mean resilience was lower than in a general population sample. Resilience was higher in males, MS4s, those without burnout symptoms, and students who felt able to cope with difficult clinical events. When students experienced difficult events in the clinical setting, the majority identified poor team dynamics among the most stressful, and agreed their wellbeing was affected by difficult clinical events. A majority also would prefer to discuss these events with their team later that day. Students discussed events with peers more than with attendings or residents. Students comfortable discussing stress and burnout with peers had higher resilience. Most students believed resilience training would be helpful and most beneficial during MS3 year. Conclusions: Clinical medical student resilience was lower than in the general population but higher in MS4s and students reporting no burnout. Students had some insight into their resilience and most thought resilience training would be helpful. Students discussed difficult clinical events most often with peers. More curricula promoting medical student resilience are needed.

Context Further restrictions in resident duty hours are being considered, and it is important to understand the association between workload, sleep loss, shift duration, and the educational time of on-call medical interns.Objective To assess whether increased on-call intern workload, as measured by the number of new admissions on-call and the number of previously admitted patients remaining on the service, was associated with reductions in on-call sleep, increased total shift duration, and lower likelihood of participation in educational activities.

patients' experience, that feedback changes physicians' performance, and people will inevitably use the Internet to voice opinions, so why not capture this information in a useful form. 3 Arguments against using this data include the selection bias by those leaving reviews, the lack of meaningful data on technical quality of health care, and straining of physician-patient relationships. 2,5 Although our results do not counter all of these arguments against, they suggest that discretionary patient ratings, obtained through a Web site, may be a more useful tool than previously considered for both patients and health care workers. If patients are making choices based on this information, they can be reassured that the ratings are not entirely misleading and may be providing relevant information about health care quality. In his book The Wisdom of Crowds, James Surowiecki 7 argues that a diverse collection of "independently deciding individuals" is likely to make better predictions and decisions than single individuals or even experts. At least to an extent, the self-selecting crowd of patients appears to be wise. The use of Web-based patient ratings has become common in other industries such as hotels and restaurants, and consumers value these rankings in making choices. We believe that the information provided by these Web sites, although flawed, represents a potentially important development in the measurement of health care quality.

Background Improving patients' ability to identify their inpatient physicians and understand their roles is vital to safe patient care. We designed picture cards to facilitate physician introductions. We assessed the effect of Feedback Care and Evaluation (FACE™) cards on patient: (1) ability to correctly identify their inpatient physicians, and (2) understanding of their roles. Methods In October 2006, team members introduced themselves with FACE™ cards, which included a photo and an explanation of their roles. During an inpatient interview research assistants asked patients to name their inpatient physicians and trainees, and rate their understanding of their physicians' roles. Results 1686 (80%) patients in the baseline period and 857 (67%) in the intervention period participated in the evaluation. With the FACE™ intervention, patients were significantly more likely to correctly identify at least one inpatient physician (attending, resident, or intern) [baseline 12.5% vs. intervention 21.1%; p<0.001]. Of the 181 patients who were able to correctly identify at least one inpatient physician in the intervention period, research assistants noted that 59% (n=107) had FACE™ cards visible in their rooms. Surprisingly, fewer patients rated their understanding of their physicians' roles as excellent or very good in the intervention period (45.6%) compared to the baseline period (55.3%) (p<0.001). Conclusions Although FACE™ cards improved patients' ability to identify their inpatient physicians, many patients still cannot identify their inpatient doctors. The FACE™ cards also served to highlight patients' misunderstanding of their physicians' roles.

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Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Background New resident work-hour restrictions are expected to result in further increases in the number of handoffs between inpatient care providers, a known risk factor for poor outcomes. Strategies for improving the accuracy and efficiency of provider sign-outs are needed. Objective To develop and test a judgment-based scale for conveying the risk of clinical deterioration. Design Prospective observational study. Setting University teaching hospital. Subjects Internal medicine clinicians and patients. Measurement The Patient Acuity Rating (PAR), a 7-point Likert score representing the likelihood of a patient experiencing a cardiac arrest or ICU transfer within the next 24 hours, was obtained from physicians and midlevel practitioners at the time of sign-out. Cross-covering physicians were blinded to the results, which were subsequently correlated with outcomes. Results Forty eligible clinicians consented to participate, providing 6034 individual scores on 3419 patient-days. Seventy four patient-days resulted in cardiac arrest or ICU transfer within 24 hours. The average PAR was 3±1 and yielded an area under the receiver operator characteristics curve (AUROC) of 0.82. Provider-specific AUROC values ranged from 0.69 for residents to 0.85 for attendings (p=0.01). Interns and midlevels did not differ significantly from the other groups. A PAR of 4 or higher corresponded to a sensitivity of 82% and a specificity of 68% for predicting cardiac arrest or ICU transfer in the next 24 hours. Conclusions Clinical judgment regarding patient stability can be reliably quantified in a simple score with the potential for efficiently conveying complex assessments of at-risk patients during handoffs between healthcare members.

Context Medicine is practised in complex systems. Physicians engage in clinical and operational problems that are dynamic and lack full transparency. As a consequence, the behaviour of medical systems and diseases is often unpredictable. Medical science has equipped physicians with powerful tools to favourably impact health, but a reductionist approach alone is insufficient to optimally address the complex challenges posed by illness and public health. Concepts from complexity science, such as continuous quality improvement and teamwork, strive to fill the gap between biomedical knowledge and the realities of practice. However, the superficial treatment of these systems‐thinking concepts in medical education has distorted their implementation and undermined their impact. ‘Systems thinking’ has been conflated with ‘systematic thinking’; concepts which are adaptive in nature are being taught as standardised, reductionist tools. Methods Using concepts from complexity science, the history of science and psychology, this problem is outlined and a theoretical model of professional development is proposed. Results This model proposes that complex problem solving and adaptive behaviour, not technical expertise, are distinguishing features of professionalism. Discussion The impact of this model on our understanding of physician autonomy, professionalism, teamwork and continuous quality improvement is discussed. This model has significant implications for the structure and content of medical education. Strategies for enhancing medical training, including interventions in recruitment, the curriculum and evaluation, are reviewed. Such adjustments would prepare trainees to more effectively utilise biomedical knowledge and tools in the complex high‐stakes reality of medical practice.