Purpose: While clinical reasoning in medicine traditionally values the ultimate goal of providing an accurate diagnosis of disease, insufficient emphasis has been placed on how students' decisions may affect their diagnostic efficiency. This study adds new empirical evidence about what makes students efficient problem-solvers in clinical reasoning. Methods: Seventy-five medical students participated in this study in 2015. The authors compared the differences in clinical reasoning behaviors between high- and low-performing students before they proposed any diagnostic hypothesis. The authors used the Cox proportional-hazards model to explore how certain characteristics of students and essential features of reasoning processes affect the life span of incorrect hypotheses. Results: High-performing students were more prepared than low performers to propose their first hypothesis. The more laboratory tests and hypotheses the medical students had, the longer it took for them to confirm a correct diagnosis. Male students tended to finalize the correct diagnosis earlier than females. There are no differences between the easy and the difficult cases in the aforementioned patterns. Conclusion: This study helps shift the emphasis away from a solitary focus on accuracy to one that considers the importance of diagnostic efficiency. The authors discussed two main take-home messages for physicians.

Background: Flipped teaching techniques have been gaining popularity in veterinary curricula. These methods of teaching are shown to increase students' engagement, promote students' self-directed learning, and can even improve their academic success. One barrier to their implementation, however, is the preparation time required by instructors to be ready to participate in active-learning activities in the classroom. Aims and Objectives: This article describes how 3^rd-year veterinary students prepare for a flipped classroom and if their learning strategies would influence their academic success. Results: Ninety-five percent (n = 87) of the students enjoyed the flipped course and the resources provided by the instructor. Seventy-five percent of students (n = 69) used the time blocked-off on their calendar to prepare for this course or to study for another one. The most student-used resources were the instructor-developed e-book and short recapitulative videos (98% and 61%, respectively). Students who emphasized critical thinking and effort regulation as their learning strategies were the most successful on their final examination. Conclusion: Flipping the course without adding to student's workload was a challenge and remained a main barrier to implementation.

Background: Many students believe that completing practice test questions improve their examination performance. This study was designed to investigate the effects of authoring and answering peer-generated multiple-choice questions. Methods: First-year Doctor of Veterinary Medicine students were voluntarily enrolled in the study. Each student was required to create at least three questions and encouraged to answer as many items as they wanted. Following the examination, participating students were required to complete a questionnaire characterizing the usefulness and enjoyability of the program. Results: A total of 94/101 students utilized the PeerWise program. Students believed that developing peer-generated questions improve their understanding of the material (79% agreed or strongly agreed). Fifty-six percent of students said that they would use peer-generated questions as a study tool if no extra credit was associated with it (agree or strongly agree); however, none of them used the technique when not incentivized. Of the 290 questions generated, only 4% of the questions required a deep understanding of the content, whereas 62% required recall only. Conclusions: We conclude that students generally perceived the program to be useful, but questionable quality items may have potentially limited students' learning gains.

Objectives: The aim of this study is to analyze and describe vignette elements and structure, and resulting difficulty, as a foundation for vignette construction in medical education, and ultimately automated vignette generation. Methods: Sixty-three vignettes representing a variety of disease states were sourced from the Objective Structured Clinical Experiences, published practice literature focused on pharmacy, and other training and assessment environments within the school. Three coders independently coded each vignette to identify underlying elements and structure. A consensus-building process was used by the coders to discuss and reconcile coding differences. Results: The coding process resulted in 36 vignette elements. The most common elements were age (n = 59, 93.6%), gender (n = 57, 90.5%), and medications (n = 54, 85.7%); others included race, medications, and chief complaint. Vignette structures and wording were found to be highly variable, with elements present in different magnitudes (range: 4–18 elements), being used with different descriptors, and given in different sequences. Conclusions: Vignette construction could benefit from further understanding of vignette structures and wording and their influence on the level of difficulty. This undertaking will allow educators to construct better vignettes for teaching and assessment to ensure that student performance accurately represents student knowledge and skills, rather than construct irrelevant variance due to vignette-level inconsistencies in content or structure. The defined elements and structure will also enable a systematic generation of vignettes for further consistency in teaching and assessment.

Purpose: There is a lack of data on the effectiveness of medical and nurse practitioner (NP) programs in preparing students to address the social determinants of health (SDH). The purpose of this study was to assess and compare medical and NP students' experience and self-efficacy caring for patients and families living in poverty. Methods: This descriptive, cross-sectional study was conducted via online survey administered to a sample of 4^th-year medical and 2^nd-year primary care NP students. Ninety-eight (72 NP and 26 medical) students completed the survey, 34.8% and 15.8% of the classes respectively participated. The survey was administered via E-mails sent by NP program directors and medical school course directors, with several reminder E-mails. Results: A small percentage of medical and NP students rated their educational programs as excellent in preparing them for primary care practice and addressing SDH, however NP students felt more comfortable providing care to low-income patients than did medical students. Lack of time and knowledge of resources was the most significant barrier cited by both medical and NP students. Discussion: Curricular redesign and intraprofessional education are areas of research to understand how to better prepare medical and NP program graduates to care for patients living in poverty.

Background: In recent decades, the topic of mindset has gained considerable attention in the education arena. According to Dweck, people hold beliefs about their personal traits that can be classified into one of the two beliefs: fixed and growth mindsets. Individuals with a fixed mindset believe that their traits cannot be changed. Individuals with a growth mindset believe that their traits can be cultivated over time and enhanced through effort. The purpose of this study was to explore the mindset of veterinary medical students as it pertains to traits such as intelligence, personality, attitude, and skills and abilities. Methods: Using a cross-sectional survey design, 298 veterinary medical students were enrolled in the study. Results: The overwhelming majority of the students believed that skills and abilities could be cultivated and improved over time. However, a considerable proportion of students believed that attitude, intelligence, and personality were largely fixed traits. Conclusions: Implications for mindset have far-reaching effects, including resilience, grit, motivations, and more.

Health system strengthening will only be possible if there is a comprehensive system of primary care. This, in turn, will only be possible with adequate numbers of high-quality general practitioner (GP) trainees. These trainees need medical education and clinical decision support. This paper reports on an educational workshop conducted with GP trainees that describes their needs and views on decision support. The workshop focused on the use of the clinical decision support resource BMJ Best Practice. GP trainees see clinical decision support as a feasible means of helping them to learn and improve their practice. They value content that is continually updated and evidence based and that will help them put what they have learned into practice. Clinical decision support needs to be easily navigable and to give users answers in seconds (rather than minutes). GP trainees most appreciate resources that are low cost or funded by their training institution.