Medical Education最新文献

Phenomenon: Sexual and/or gender minority-identifying (SGM) medical students report lower levels of belonging and heightened discrimination in medical schools, especially among those who hold intersecting identities that are underrepresented in medicine (URM). Role modelling has been identified as a tool to combat this phenomenon. We used an intersectional approach to explore how interacting URM identities in relation to SGM identity mediate the experience of role models to influence feelings of belonging.

Approach: We employed interpretative phenomenological analysis to explore nuanced and heterogeneous role modelling experiences. We conducted semi-structured interviews with 10 medical students from six medical schools in the United Kingdom.

Findings: Participants described how cisheteronormativity often led to loss of identity control, fragmentation and accompanying self-inauthenticity to protect their sense of belonging. Intersecting URM identities heightened feelings of otherness, and mediating multiple URM identities was cognitively taxing to many participants, even within traditionally inclusive spaces. Role models empowered participants to reclaim control over their narratives, engage in activism and enact disruptive visibility that challenged hierarchical norms. Participants valued role models who shared their intersecting identities, although many also emphasised that anyone who visibly respected SGM and URM identities could equally effectively foster belonging. Hierarchy and power imbalances prioritised by medicine limited the positive effects of role modelling and perpetuated identity fragmentation and inauthenticity. Accordingly, role models were consistently most visible and positive when in positions of influence. Overall, when positive and available, role modelling relationships provided practical pathways for students to integrate fractured identity threads into a more coherent, authentic self.

What this paper adds: This study is the first to apply an intersectional lens to role modelling experiences of SGM medical students with multiple URM identities in the UK. We offer some practical steps for medical schools to cultivate inclusive role modelling.

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.