Medical Education最新文献

Background: Professional identity formation (PIF) plays a significant role in the development of medical students, with reflection expected to help learners align their personal values with the expectations of the profession. While theoretical models propose that reflection and PIF advance hand in hand, empirical studies suggest that the various types of reflection may evolve independently. In this study, we aimed to (a) investigate the levels of PIF, reflective practice and self-reflection and insight across academic years, and (b) assess whether reflective practice and self-reflection and insight are significant predictors of medical students' PIF.

Methods: We conducted a cross-sectional quantitative study that included 1401 medical students from four universities in Indonesia. Participants completed a demographic questionnaire along with the Professional Identity Formation (PIF) questionnaire, Reflective Practice Questionnaire (RPQ) and Self-reflection and Insight Scale (SRIS). We used one-way ANOVA to examine the differences of PIF, RPQ and SRIS across the academic years; Pearson correlations to examine the association between PIF, RPQ and SRIS; and regression analysis to assess the predictive value of RPQ and SRIS on PIF.

Results: Both PIF (F = 32.221, p < 0.001) and reflective practice (F = 6.796, p < 0.001) increased across academic years, while self-reflection and insight remained stable (F = 1.683, p = 0.136). Reflective practice correlated with PIF (r = 0.420; p < 0.001), while self-reflection and insight did not (r = -0.017; p = 0.528). Reflective practice was a significant predictor of PIF in the regression analysis (B = 0.674, p < 0.001).

Conclusion: Reflection on practice associates with professional identity formation in medical students, but self-reflection and insight do not.

Introduction: Uncertainty is intrinsic to medical practice. Improving trainees' uncertainty tolerance requires exploring their responses to clinical uncertainty in clinical contexts. Although previous research works have highlighted the role of self-assessment, contextual cues and responsibility, existing models-developed for experienced physicians-often fail to capture residents' intuitive, situated responses. This study explores residents' behavioural responses to clinical uncertainty, focusing on how contextual features shape their actions and decision making. Following Hillen et al., we define behavioural responses as the actions individuals take to cope with uncertain situations.

Methods: Using an interpretative paradigm, we conducted a thematic analysis of semi-structured interviews with residents from several medical specialties. Considering that age, gender and clinical experience shape responses to uncertainty, we used a maximum variation sampling strategy to ensure diversity in year of residency and gender among participants. Audio-recorded interviews were conducted following a pretested interview guide focusing on residents' lived experiences of uncertainty and transcribed into verbatims. Analysis combined deductive coding, informed by Hillen's framework and Han's taxonomy, with inductive theme generation to capture novel insights.

Results: Fourteen participants described three main behavioural responses to clinical uncertainty, aligned with Han's taxonomy: reducing uncertainty, protection and adaptation. Their responses were determined by situational determinants, including the patient, the problem at hand, the environment and their individual characteristics. Over time, participants progressed from avoiding uncertainty or relying on supervisors to taking a more systemic and situated approach, integrating a combination of complementary strategies to balance the objectives of patients and physicians. This approach fostered the development of competence in navigating complex clinical situations.

Discussion: Our study shows that uncertainty is a situated experience shaped by dynamic interactions between practitioners and context. Recognising this helps move beyond a purely cognitive view, framing uncertainty as a core competency developed through experiential learning and supported by adaptive strategies.

Introduction: Global collaborations, particularly those between low-income (LIC) and high-income countries (HIC), may inadvertently reproduce the very power differentials they aspire to overcome. The Toronto Addis Ababa Academic Collaboration (TAAAC) is a partnership model deliberately built to follow a relational and invited guest model of collaboration with in-person teaching visits by University of Toronto (UofT) faculty to teach within Addis Ababa University (AAU) programmes. The COVID-19 pandemic required that teaching be conducted virtually, which provided an opportunity to explore our assumptions that an in-person component ensured contextual and relational accountability.

Methods: This study used a qualitative case study approach that was both descriptive and intrinsic in nature. We sought to examine and describe the adaptations that emerged in response to a shift towards virtual teaching and to understand the experiences of key stakeholders from both AAU and UofT within the specific context of the TAAAC collaboration.

Results: Two foundational principles of the TAAAC model were disrupted during the COVID-19 pandemic: its emphasis on local context and its relational component. As virtual teaching replaced the historical on-site teaching of TAAAC programme curricula, these historical structures were unable to mitigate power differentials between AAU and UofT faculty, teachers and leaders.

Discussion: The relational and context-specific aspects of the TAAAC model were undermined with the use of a virtual platform. Virtual teaching reinforced one-sided knowledge exchange and decontextualized teaching, thereby perpetuating epistemic injustice within TAAAC programmes. This injustice was experienced as a loss of accountability to the relationships that had built and sustained a longstanding LIC-HIC partnership. While virtual teaching has an allure of being efficient and accessible, our experience suggests that it may be poorly suited within partnerships where context and relationality are cornerstones of efforts to reshape dimensions of power.