Medical Education最新文献

Context: The transition to practice is a context in which junior doctors can feel vulnerable. Although we know junior doctors experience intense emotions during their transition to practice, we still do not understand the role of vulnerability in this process. Vulnerability may cause emotional suffering but also offers an opportunity for growth and connection. Set in the context of junior doctors' transition to practice, our research questions are: (a) What does feeling vulnerable mean to junior doctors? (b) What emotions arise when they feel vulnerable? (c) How do they make sense of their vulnerability experiences?

Methods: In this cross-sectional, observational, qualitative study, 14 junior doctors individually drew a rich picture of a vulnerability experience, after which a semi-structured interview was conducted. A rich picture is a visual representation of a situation and is well suited to capture (non-verbal elements of) complex experiences. Rich pictures and interview transcripts were analysed iteratively, for which we applied reflexive inductive thematic analysis.

Results: Junior doctors experienced vulnerability as feeling overwhelmed, uncertain, powerless and lonely. The mismatch between the doctor they believed they should be and the beginning and inexperienced doctor they in fact were was often at the core of vulnerability experiences. Due to this mismatch, junior doctors felt inadequate and often experienced shame, fearing to be judged as incompetent. Junior doctors had to find their own way to make sense of these vulnerability experiences. Left unsupported or neglected, vulnerability could result in isolation and disengagement from learning. When junior doctors did engage with their emotions, vulnerability experiences could also lead to reflection and change.

Conclusions: Acknowledging, expressing, regulating and making sense of emotions is crucial to seize vulnerability experiences as opportunities for transformative learning. In order to facilitate transformative learning, embracing emotions and engaging with critical reflection need to become an explicit part of clinical supervision-enabling not only junior doctors' personal and professional development but also social connection.

Introduction: There is urgency for health professionals to be better prepared to tackle health inequities. Transitioning to responsive and contextually relevant curricula is an important strategy to equip students to be both clinically competent and critically conscious of the contexts in which they provide health care. Although the literature suggests reframing medical education to be responsive, student engagement in this process remains limited. Little is known about how students understand and experience social responsiveness, or their involvement in reframing medical curricula to be more responsive. This paper, therefore, aims to explore how a medical curriculum has influenced undergraduate final-year medical students to become socially responsive.

Method: This was a qualitative exploratory case study positioned within a constructivist paradigm. Data were generated through focus group discussions and individual interviews. Rich picture drawings served as reflective prompts. Initially, 27 students participated. Three withdrew across the course of the study. Data were coded inductively and analysed using reflexive thematic analysis. All relevant ethical and institutional approvals were granted.

Results: The findings revealed that becoming socially responsive is a complex endeavour. Four intersecting themes were identified: (i) applying a socially responsive approach to health care; (ii) the culture and traditions of medicine; (iii) shattering of mindsets and (iv) the value of the student voice in the curriculum. The students expressed that the curriculum provided opportunities to engage with concepts related to social responsiveness. However, these opportunities were less frequent and were considered less valuable when compared to biomedical knowledge. Furthermore, the cultures and traditions of medicine were seen to create conditions that position students as consumers of the curriculum.

Conclusion: This paper argues that although the curriculum is an important aspect in developing social responsiveness in students, other aspects, such as the health system and what the student brings should also be considered. Additionally, the students should be considered co-constructors of their learning and key role players in transforming curricula to be socially responsive and contextually relevant.

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.