Joey Nicholson

Purpose Understanding medical students’ readiness to perform basic entrustable professional activities (EPAs) informs tailored support during transition to residency. Methods Night-onCall (NOC) was developed to assess medical student readiness to perform core EPAs on day one of internship. NOC is a complex, integrated simulation centered around three clinical cases. Assessments include standardized patient (SP), nurse (SN), physician attending (SA), and resident (SR) perspectives using clinical competency rating instruments mapped to EPAs and scored as Well Done (WD), Partly Done (PD) or Not Done (ND). Faculty rate clinical reasoning using a rubric evaluating written post-encounter notes as poor, beginning, competent, or strong. The ability to recognize lapses in patient safety is assessed based on written case responses. Medical librarians evaluate students’ ability to formulate a clinical question and search for evidence. Results Data was collected from ‘near-graduates’ from seven USA medical schools from 2020 to 2023 (n = 1116). Overall, SPs rated 75.0% of overall communication skills and only 56% of patient education items as WD. SNs rated interprofessional communication 57.0% WD, and SRs rated intraprofessional communication 61.0% WD. History gathering and physical exam skills varied by case. Faculty rated clinical reasoning as beginning (45%) or competent (44%) and librarians rated 16% of literature searches as WD. Conclusion Most near-graduates demonstrated competent basic patient communication skills but performed less well on patient education, communication with other team members, clinical reasoning, and accessing the evidence base to answer clinical questions. These overall trends, consistent across schools and year, provide benchmarks for clinical training.

Background: This case report describes the integration of a capstone Evidence-Based Medicine (EBM) assignment into a first-year medical student curriculum and presents an analysis of the correlation between search strategy quality and article selection quality within that assignment. Case Presentation: A whole-task EBM assignment, requiring students to address a clinical scenario by completing all EBM steps, was implemented after a curriculum-integrated EBM course. Student performance on their search strategy and article selection was assessed using a rubric (1-4 scale). Spearman’s rank correlation coefficient was used to assess the relationship between these two variables. Eighty-two students completed the assignment. Fifty-nine percent received a score of 3 for their search strategy, while 77% received a score of 4 for article selection. Spearman’s rank correlation coefficient was 0.19 (p-value = 0.086). Conclusions: While a weak, non-statistically significant correlation was observed between search quality and article selection, the analysis revealed patterns that may inform future instructional design. Educators should consider emphasizing the importance of selecting up-to-date and high-quality evidence and addressing common search errors. Further research, incorporating direct observation and baseline assessments, is needed to draw more definitive conclusions.

Key Points: Coronary artery disease is a barrier to kidney transplantation. Many transplant programs mandate routine coronary artery disease screening. It remains unclear how many patients meet class 1 indication for revascularization. We conducted a meta-analysis to estimate the prevalence. Despite high frequency of screening, we found a relatively low prevalence of class 1 indication for coronary revascularization. Background: Cardiovascular disease is the most common cause of morbidity and mortality in kidney transplant recipients. Screening for coronary disease is frequently required before kidney transplantation, but coronary intervention has not been shown to be beneficial except in complex coronary artery disease. The likelihood of finding significant coronary artery disease and the benefits of routine pretransplant screening are uncertain. Methods: We performed a systematic review and meta-analysis. Medical Literature Analysis and Retrieval System Online and Excerpta Medica database were searched to identify manuscripts published between 1998 and 2024 reporting the results of pretransplant screening. The primary end points were the frequency of detecting significant coronary lesions for which there are American Heart Association class 1 indications for revascularization: ( 1 ) >50% left main stenosis or ( 2 ) multivessel disease with ejection fraction <35% during prekidney transplant screening. Secondary end points included frequency of detecting multivessel disease, proximal left anterior descending artery disease, and number of patients who underwent invasive coronary angiography. Meta-regression was used to explore outcome heterogeneity according to the presence of hypertension, diabetes, and age. Results: We identified 1273 studies, out of which 44 met eligibility criteria. The mean prevalence of class 1 indications was 2%, although the heterogeneity was high with estimates ranging from 0% to 17%. Estimated prevalence of proximal left anterior descending disease was 2% and left main stenosis was 1%, whereas 10% of patients had multivessel coronary artery disease, and 35% were referred for invasive angiography. There was no evidence of significant heterogeneity according to sex of the population or prevalence of diabetes or hypertension. Conclusions: Identification of class 1 indications for revascularization during pretransplant coronary screening was rare. Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2026_01_08_ASN0000000890.mp3

Objective: We expect medical students to be able to apply evidence-based medicine (EBM) skills in the context of the clinical care of patients. Previous assessments of this domain have primarily utilized decontextualized knowledge tests, which provide limited insights into students’ understanding of EBM skills in the context of patient care. New performance-based EBM competence assessments using Objective Structured Clinical Examinations (OSCEs) are being developed and tested. Understanding how students experience and interact with a simulation-based assessment of EBM competence would enable us to improve the modality. Methods: We recruited 13 graduating medical students from one medical school who had recently completed an immersive multi station readiness-for-residency OSCE (Night onCall) which included a case-based EBM assessment. We conducted individual interviews to explore their perceptions of participating in this OSCE as a method of EBM assessment. The interviews were transcribed, coded, and analyzed using Dedoose by three health science librarians. Results: Students discussed their experience and perceptions in six main areas: connection to clinical practice, curricular timing and content coverage, feedback, station instructions, awareness of their own limitations, and an OSCE as a format for assessing EBM. Conclusion: Medical students appreciated the EBM OSCE because it enhanced their learning about how to integrate EBM into clinical practice. They proposed implementing multiple such opportunities throughout medical school because it would improve their competence and provide highly impactful opportunities to build toward EBM mastery. They endorsed that this would be well-accepted by medical students.

Medical students may arrive at medical school with some research background but not necessarily evidence-based medicine (EBM) skills. First-year preclinical medical students require foundational skills for EBM (formulating background and foreground questions, navigating information sources, and conducting database searches) before critically appraising evidence and applying it to clinical scenarios. We developed a flipped classroom EBM workshop for preclinical students combining prework modules and a 60-minute in-person session. After completing the online modules on foundational EBM skills, students participated in an in-person activity based on patient cases. In small groups, students formulated background and foreground questions based on a case and looked for evidence in resources assigned to each group. Small groups reported back to the whole group how they searched for information for their patient cases. A total of 105 first-year medical students were required to complete this workshop after concluding their basic sciences courses. Because current EBM assessment tools do not assess the early steps of EBM, we developed an assessment tool for foundational EBM tools. Before the modules, students completed a pretest on formulating questions and searching for information. After the workshop, students completed a posttest. Students showed improvement in differentiating background and foreground questions (p < .001), formulating answerable clinical questions (p < .001), and developing appropriate database searches (p < .001 and p = .002). This flipped classroom approach to teaching foundational EBM skills may be adapted for different contexts, but educators should consider time limitations, group size, and tools for interactivity.

Amy Blevins served as the Medical Library Association president from 2023-2024. In this presidential biography, authors outline a history of Blevins' recruitment to the career, career development, and impact on the association and the profession.

Key Points: Among the studies included, women were first authors of minority of the publications, and this trend persisted over the 20 years. Crude citation rates were lower in papers with female first authors; the gender of the author was not independently associated with citation metrics. Background: Historically, women's scientific contributions have been under-recognized. We investigated whether the number of citations, a key metric used for academic promotions and scientific productivity, differs in nephrology high-impact publications on the basis of author's gender. Methods: We identified randomized clinical trials from 2000 to 2021 in ten high-impact journals. We assessed author gender, citations, h-index, m-index, years of active publishing, education, and grant funding. The main predictor of interest was the gender of the first author. The main outcome was the standardized citation count for analysis of the selected publications. In addition, we evaluated standardized author citation counts using the author, rather than the article. Results: Among the selected publications, women were first authors of 65 (17.1%) and men of 315 (82.9%) articles. In crude analyses, publications with male first authors had a significantly higher median number of standardized citations (14 versus 10, P = 0.01). Adjusted analyses revealed m-index (β=29.48, P ≤ 0.01) and journal impact factor (β=0.78, P < 0.001) were significantly associated with the standardized citation index. By contrast, neither the gender of the first author (β _{male gender}=1.42, P = 0.71) nor of the last author (β _{male gender}=8.89, P = 0.38) were significantly associated with the standardized citations. Similarly, in adjusted analyses on the basis of author profiles, male authorship was not significantly associated with the standardized author citation number (β _{male gender}=−7.79, P = 0.08). Conclusions: Our study highlights marked disparities in the overall number of women publishing high-impact nephrology trials and the number of articles with female scientists as first authors of high-impact trials in the nephrology literature. Although crude citation rates were lower in articles with female first authors, the gender of the first author was not independently associated with citation metrics. Addressing gender disparities in academic recognition requires nuanced approaches extending beyond authorship and a broader focus on complex factors that influence academic recognition and scientific contributions.

Acne is a common skin condition, but little data exist on the comparative efficacy of topical acne therapies. We conducted a systematic review and network meta‐analysis to evaluate the efficacy of topical therapies for mild‐to‐moderate acne. Searches in PubMed/MEDLINE, Cochrane CENTRAL via Ovid, Embase via Ovid and Web of Science were conducted on 29 November 2021. Randomized controlled trials examining ≥12 weeks of topical treatments for acne vulgaris in subjects aged 12 and older were included. Main outcomes were absolute or percent change in acne lesion count and treatment success on the Investigator's Global Assessment scale. Thirty‐five randomized clinical trials with 33,472 participants comparing nine different topical agents were included. Adapalene‐benzoyl peroxide (BPO), clindamycin‐BPO and clindamycin‐tretinoin demonstrated the greatest reduction in non‐inflammatory (ratio of means [RoM] 1.76; 95% CI [1.46; 2.12], RoM 1.70; 95% CI [1.44; 2.02] and RoM 1.87; 95% CI [1.53; 2.30], respectively), inflammatory (RoM 1.56; 95% CI [1.44; 1.70], RoM 1.49; 95% CI [1.39; 1.60] and RoM 1.48; 95% CI [1.36; 1.61], respectively) and total lesion count (ROM 1.67; 95% CI [1.47; 1.90], RoM 1.59; 95% CI [1.42; 1.79] and RoM 1.64; 95% CI [1.42; 1.89], respectively) compared to placebo. All single agents outperformed placebo except tazarotene, which did not significantly outperform placebo for inflammatory and non‐inflammatory lesion count reduction. Most combination agents significantly outperformed their individual components in lesion count reduction and global assessment scores, except for clindamycin‐tretinoin and clindamycin‐BPO, which did not significantly outperform tretinoin (RoM 1.13; 95% CI [0.94; 1.36]) and BPO (RoM = 1.15, 95% CI [0.98; 1.36]), respectively, for non‐inflammatory lesion reduction. There was no significant difference amongst most single agents when evaluating lesion count reduction. Combination agents are generally most effective for mild‐to‐moderate acne; however for non‐inflammatory acne, the addition of clindamycin in topical regimens is unnecessary and should be avoided.

Introduction: We must ensure, through rigorous assessment that physicians have the evidence-based medicine (EBM) skills to identify and apply the best available information to their clinical work. However, there is limited guidance on how to assess EBM competency. With a better understanding of their current role in EBM education, Health Sciences Librarians (HSLs), as experts, should be able to contribute to the assessment of medical student EBM competence. The purpose of this study is to explore the HSLs perspective on EBM assessment practices, both current state and potential future activities. Methods: We conducted focus groups with librarians from across the United States to explore their perceptions of assessing EBM competence in medical students. Participants had been trained to be raters of EBM competence as part of a novel Objective Structured Clinical Examination (OSCE). This OSCE was just the starting point and the discussion covered topics of current EBM assessment and possibility for expanded responsibilities at their own institutions. We used a reflexive thematic analysis approach to construct themes from our conversations. Results: We constructed eight themes in four broad categories that influence the success of librarians being able to engage in effective assessment of EBM: administrative, curricular, medical student, and librarian. Conclusion: Our results inform medical school leadership by pointing out the modifiable factors that enable librarians to be more engaged in conducting effective assessment. They highlight the need for novel tools, like EBM OSCEs, that can address multiple barriers and create opportunities for deeper integration of librarians into assessment processes.