<p>Education on electronic health records remains highly variable despite their widespread use by medical trainees. This study interrogated the complex landscape of current EHR pedagogy by examining discourses of EHR use within the medical education literature. These discourses framed the EHR as a physical skill, a system of people and technologies, or a cognitive process influencing clinical reasoning and bias. Each discourse privileged certain stakeholders over others and rationalized educational interventions that could be beneficial in isolation yet were often disjointed in combination. Reforming EHR education will require engagement with these competing discourses.</p><p> <span>Huang, D</span>, <span>Whitehead, C</span>, <span>Kuper, A</span>. <span>Competing Discourses, Contested Roles: Electronic Health Records in Medical Education</span>. <i>Med Educ</i>. <span>2024</span>; <span>58</span>(<span>12</span>): <span>1490</span>-<span>1501</span>. 10.1111/medu.15428.</p><p>Institutional education leaders are often responsible for leading pre-determined major curricular changes in the complex adaptive systems of health professions education. This study explored how a group of institutional leaders navigated these systems during the change to competency-based residency education in Canada. Leaders set ensuring direction and maintaining momentum as change priorities and analyzed how their response to various threats and opportunities affected the priorities of direction and momentum. The article proposes a practical change framework for education leaders that addresses the non-hierarchal, complex, and uncertain nature of health professions education systems.</p><p> <span>Tam, H</span>, <span>Scott, I</span>. <span>Laying train tracks en route: How institutional education leaders navigate complexity during mandated curriculum change</span>. <i>Med Educ</i>. <span>2024</span>; <span>58</span>(<span>12</span>): <span>1528</span>-<span>1535</span>. 10.1111/medu.15464.</p><p>Learning and growth in postgraduate medical education (PGME) often require vulnerability, but being vulnerable can pose risks to residents’ credibility and professional identity. In this study, residents characterize vulnerability as a paradox, in which polarities exist between being a fallible, authentic learner and an infallible, competent professional. The authors explore factors influencing the experience and outcomes of vulnerability at the intrapersonal, interpersonal, and systems levels. This study begins to capture the complexity of vulnerability in PGME and offers insights into creating supportive learning environments that embrace the value of vulnerability while mitigating its risks.</p><p> <span>Nichol, H</span>, <span>Turnnidge, J</span>, <span>Dalgarno, N</span>, <span>Trier, J</span>. <span>Navigating the paradox: Exploring resident experiences of vulnerability</span>. <i>Med Educ</i>. <span>2024</span>; <span>58
尽管电子病历已被医学学员广泛使用，但其教育仍存在很大差异。本研究通过研究医学教育文献中有关电子病历使用的论述，对当前电子病历教学法的复杂情况进行了调查。这些论述将电子病历描述为一种物理技能、一个由人和技术组成的系统或一个影响临床推理和偏见的认知过程。每种论述都将某些利益相关者置于其他利益相关者之上，并使教育干预措施合理化，这些干预措施单独使用可能有益，但结合使用却往往脱节。改革电子病历教育需要与这些相互竞争的论述打交道。 Huang, D, Whitehead, C, Kuper, A. Competing Discourses, Contested Roles：医学教育中的电子健康记录》。2024; 58(12)： 1490-1501.10.1111/medu.15428.Institutional education leaders are often responsible for leading pre-determined major curricular changes in the complex adaptive systems of health professions education.本研究探讨了在加拿大向以能力为基础的住院医师教育转变的过程中，一群院校领导是如何驾驭这些系统的。领导者将确保方向和保持动力作为变革的优先事项，并分析了他们对各种威胁和机遇的反应如何影响方向和动力的优先事项。文章针对卫生专业教育系统的非等级、复杂性和不确定性，为教育领导者提出了一个实用的变革框架。 Tam, H, Scott, I. Laying train tracks en route：机构教育领导者如何在强制性课程变革中驾驭复杂性。Med Educ. 2024; 58(12)： 1528-1535.10.1111/medu.15464.医学研究生教育（PGME）中的学习和成长往往需要脆弱性，但脆弱性可能会给住院医师的信誉和专业身份带来风险。在本研究中，住院医师将脆弱性描述为一种悖论，在这种悖论中，存在着两极分化，即既要做一个容易犯错的、真实的学习者，又要做一个无懈可击的、称职的专业人员。作者从个人、人际和系统层面探讨了影响脆弱性体验和结果的因素。这项研究开始捕捉 PGME 中脆弱性的复杂性，并为创建支持性学习环境提供了见解，这种环境既能接受脆弱性的价值，又能降低其风险。 Nichol, H, Turnnidge, J, Dalgarno, N, Trier, J. Navigating the paradox: Exploring resident experiences of vulnerability.Med Educ. 2024; 58(12)： 1469-1477.10.1111/medu.15426.尽管有关不良事件和失败的医疗保健研究日益增多且意义重大，但有关干扰如何发生的人种学研究仍很少见。本研究加深了我们对医疗流程中断的理解，并概述了在复杂的医疗环境中，中断的修复如何成为稳定、学习和变革的源泉。这项研究在芬兰一所大学医院的外科手术室进行，其独特的贴近实践的研究方法为我们提供了能够改进教育和加强病人护理的见解。 Kajamaa，A，Lahtinen，P，Mattick，K，Bethune，R.《芬兰医院中作为稳定、学习和变革之源的中断护理流程修复：一项活动理论研究》。2024; 58(12)： 1502-1514.10.1111/medu.15407.
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