Medical Education最新文献

Introduction: While medical school selection research has largely focused on the validity of tools and processes, less attention has been paid to the quality and impact of widening access (WA) pathways. Existing studies are often limited in scope, focusing on single institutions or interventions. This study aimed to develop transferable insights into WA selection practices through a realist evaluation across four Australian medical schools.

Methods: Building on a prior realist review, we employed the RAMESES II protocol to explore how contextual factors and mechanisms interact to influence WA outcomes through four case studies. Data collection included institutional document and website reviews, semistructured interviews and focus groups (41 staff and 17 students). The evaluation framework examined context (diversity within sociocultural settings), interventions (targeted pathways and adjusted selection scores), mechanisms (institutional, dispositional and situational) and outcomes (applicant diversity, selection success). Retroductive context-intervention-mechanism-outcome (CIMO) analysis clarified WA programme theory.

Results: Two key interventions were successful across all sites: (1) targeted pathways with selection score adjustments for under-represented groups (e.g., Indigenous, rural and low socio-economic backgrounds) and (2) sustained partnerships with these communities to raise awareness of medicine as a viable career. These partnerships aimed to enhance applicants' dispositions and readiness for selection. However, structural changes within institutions posed significant risks to the sustainability of WA. The resulting programme theory identified five mechanisms underpinning effective WA: visionary leadership, Indigenous cultural safety, longitudinal relational engagement, tailored applicant support and preparation for selection processes.

Discussion: This realist evaluation highlights how institutional commitment, shaped by federal policy and accreditation standards, has driven demographic shifts, particularly in rural and Indigenous representation, over a 10- to12-year period; however, the scope of WA remains narrow. We argue for a national, coordinated approach to WA in medical education, underpinned by long-term investment, robust evaluation and a broader conceptualisation of equity in access. WA must be embedded as a core institutional commitment rather than a peripheral initiative.

Background: Coaching is increasingly recognised as a valuable tool in health professions education (HPE), supporting learning, performance, and well-being. Yet, the term 'coaching' is used inconsistently, leading to confusion and limiting its potential impact. In this cross-cutting edge article, the authors draw upon a framework from the sport psychology and organisational development literatures to outline three distinct generations of coaching that can guide HPE away from treating coaching as a unitary construct. In doing so, we strive to clarify coaching's varied purposes and paradigms.

The three generations framework: Generation 1 emphasises performance management, focusing on goal-setting and problem-solving. Generation 2 shifts towards personal development, leveraging strengths and fostering long-term growth. Generation 3 centers on meaning-making and cultural transformation, prioritising values, identity and reflective dialogue. The authors argue that each generation offers unique benefits and limitations and that coaching in HPE should be deliberately aligned with the learner's context and goals. Through examples from clinical education, they illustrate how different coaching approaches can support technical skill development, professional identity formation and well-being.

Implications: Rather than advocating for a single model, the article encourages educators to adopt a flexible, context-sensitive approach to coaching. By understanding the generational distinctions, HPE professionals can better tailor coaching interventions to meet learners' evolving needs and foster sustainable development. As coaching continues to expand in scope and complexity, this framework offers a timely lens for enhancing clarity, intentionality, and impact in health professions education.