Medical Education最新文献

Introduction: Case-based learning (CBL) has been adopted internationally, although there is significant heterogeneity in implementation and delivery. It is unclear how this pedagogical approach is experienced across contexts, among different groups of students, and the important aspects of implementation. The aim of this study was to understand the mechanisms that enable CBL to facilitate learning in undergraduate health professions education, for whom and in what contexts.

Methods: A realist review was adopted to explore the literature on CBL. Initial programme theories were derived from the CBL literature and based on adult learning theory and inquiry-based learning. 5731 abstracts investigating CBL in undergraduate HPE courses were screened in duplicate. 436 full-text papers were screened and assessed for rigour and relevance, resulting in 25 papers suitable for inclusion in the final analysis.

Results: Seven programme theories were developed from our review. Institutional, implementation and student-level factors were found to impact outcomes such as exam performance, participation and clinical reasoning. A lack of institutional support and recognition of faculty contribution to CBL results in poorer learning outcomes. Clinical facilitators promote student engagement, and authentic multimodal cases afford students the opportunity to step into their future roles. When assessment focuses solely on behaviours and teamwork is not fostered, negative group dynamics may result.

Discussion: Our realist review provides insight for healthcare educators on how best to implement CBL to optimise academic, skill and behavioural outcomes for undergraduate students. Fostering student trust in learning through access to clinician facilitators and authentic cases leads to improved learning outcomes. Recognition of faculty and student efforts to contribute to CBL is essential for successful implementation. The facilitation of a safe and secure group learning environment is required for students to meaningfully engage with CBL.

Objectives: Medical students who are first in family (FiF) to attend college navigate an education system with limited social capital compared to their non-FiF peers. This situation leads to difficult decisions regarding the use of their time. How these students balance their goals inside and outside of medical school is an under-explored area within medical education research. By illuminating how FiF students decide what noncurricular activities to perform, this study aimed to better understand how they relate to and manage their time.

Method: Drawing on aspects of constructivist grounded theory, we interviewed 15 US FiF students between September 2023 and May 2024 regarding the noncurricular activities they participated in and how they made decisions with their time. We collected and analysed data iteratively, adjusting the interview protocol as needed to probe deeper into ideas and themes. Formal data analysis included open and focused coding to identify patterns and relationships within and across the data to understand what drives FiF students in their decision-making processes and how this affects their activities.

Results: FiF students are constantly trying to secure their future, prioritizing their survival and that of their communities. They described how persisting through a lifetime of inequity instilled a skill for resourcefulness, and they draw on this experience when choosing activities. Their choices reflected a sense of what they must do, based on alignment with their personal values and a deep sense of responsibility to others.

Conclusions: FiF students must choose activities that contribute to their survival and that of their communities. By illuminating that survival is at the centre of their decision-making, their narratives challenge the ways that medical training emphasizes extracurricular activities. By not necessarily choosing those activities that are expected of medical students, FiF students exert agency to reclaim aspects of their identity deemphasized by school expectations.

Introduction: Mixed-methods research (MMR) intentionally combines (variously) theories, study designs, data collection, analyses and/or syntheses associated with more than one approach to research. Despite a rich literature on the theory and practice of MMR, the authors were concerned that much MMR in medical education fell short of the state of the art. To substantiate the problem, the authors conducted a meta-study to explore the strengths and weaknesses of MMR in medical education and to propose a framework to improve the conduct and reporting of this research design.

Methods: Structured searches were conducted, and returns were filtered based on inclusion and exclusion criteria, establishing a corpus of 1070 articles. A series of purposive samples was taken from this corpus and put through full data extraction. The findings from these extractions were synthesized using descriptive statistics and a dialogical identification of core issues of concern.

Results: Descriptive statistics were produced for the full corpus, after which a series of samples led to 547 (51%) articles undergoing full data extraction. There was a significant increase in the number of articles reporting the use of MMR in the last 20 years. Several recurring issues were identified including a lack of theoretical and conceptual grounding in MMR, a lack of diversity in what constitutes MMR, questionable component rigour, a lack of integration (mixing), a tension between MMR as more than one thing and MMR as a methodology in its own right, and very little adaptation and innovation in MMR approaches. These issues had not improved over time.

Discussion: Major gaps in how MMR was justified and used were found. Integration, central to MMR, was notably lacking. Thus, the authors propose a checklist to help researchers and reviewers ensure that future use of MMR in medical education is more rigorous, transparent, complete and accurate.

Introduction: With an ageing population, future doctors must be prepared to care for older patients facing complex and often chronic needs. Despite curricular efforts, medical students often report less positive attitudes towards providing this care-shaped not only by knowledge gaps but also by cultural norms and the hidden curriculum. Little is known about how students themselves reflect on their clinical encounters with older patients. This study explores medical students' experiences providing care to older patients, and which aspects they find rewarding or frustrating.

Methods: We conducted a qualitative study based on a constructivist paradigm, using semi-structured interviews supported by a visual narrative method (rich pictures). Sixteen final-year medical students who had completed their senior internship were purposively sampled. Participants drew two 'rich pictures' representing one positive and one negative clinical experience involving the care of older persons. These drawings were used as prompts for in-depth interviews. Data were analysed using reflexive thematic analysis.

Results: We identified three themes that captured students' experiences: (1) feeling connected, (2) witnessing humane and compassionate care, and (3) making a difference. Rewarding experiences involved human connection, dignity and presence-particularly in end-of-life care or when guided by compassionate role models-leading to a sense of fulfilment. Frustrating experiences arose from poor communication, systemic barriers and unclear goals of care, leaving students feeling powerless, isolated and emotionally burdened.

Conclusion: Students experienced care for older patients as emotionally rich and qualitatively distinct from other clinical work. This practice demands patience, presence, and the ability to navigate complexity beyond mere clinical competence. Medical education should support students in valuing care beyond cure-through fostering reflective practice, peer support, and engaged supervision-helping them reframe what it means to make a difference for older patients and their families in complex, chronic and end-of-life care.

Purpose: Professional identities impact professional boundaries and hierarchies, influencing how physicians approach collaboration. Despite the growing emphasis on developing students to become effective collaborators, little is known about how other health professionals (OHPs) shape students' professional identity formation (PIF). This study explored how interacting with OHPs during clinical care contributed to medical students' construction of what it means to be a physician.

Methods: For this constructivist grounded theory study, researchers conducted 20 semi-structured interviews with medical students during clinical clerkships. Students drew rich pictures representing their interactions with OHPs and described these pictures during their interviews. Interviews were iteratively conducted and analysed, enabling the research team to theorize how interacting with OHPs contributed to medical students' PIF.

Results: Participants expressed a strong desire to contribute to patient care and described how interprofessional interactions provided opportunities to do so in ways aligned with their current capabilities. These opportunities were often more accessible than the roles and responsibilities of physicians, and participating alongside OHPs fostered participants' sense of their own developing capabilities and belonging on healthcare teams. Interactions with OHPs helped participants to see the expertise of OHPs and the value of collaborating with them in ways that shifted their focus away from becoming independent. Conceptually, participants' interactions with OHPs became both a mirror reflecting their present readiness to meaningfully contribute and a prism through which they could envision their future identities as physicians in new ways.

Conclusions: Interprofessional interactions influenced medical students' current and future professional identities, enabling students to see themselves as contributors on health care teams and highlighting collaboration and interdependence as core attributes of the physician profession. These findings highlight opportunities to amplify the impact of interprofessional interactions on the PIF of medical students and the need for research into how OHPs view their roles in these processes.