Background: Distraction may increase cognitive load. Cues may decrease it. But what happens if we cue in distracted learning environments? Does effective instruction buffer against the detrimental effects of distraction?
Methods: In a 2 × 2 factorial experiment, 117 s-year medical students without prior knowledge watched a standardised instructional video on abdominal ultrasound. Distraction was induced via a concurrent mental arithmetic task, and supportive cues were instructed via eye movement modelling examples of an expert's gaze. Image interpretation performance and cognitive load were measured before and after training.
Results: As expected, cueing alone reduced extraneous cognitive load and improved learning. Distraction alone impaired learning. However, when both interventions were combined, the performance benefits of cueing disappeared. Distracted learners receiving cues performed no better than uncued distracted learners, indicating no compensatory effect. Thus, distraction not only weakened learning but blocked the effectiveness of instructional benefits.
Conclusions: The disappearance of instructional benefits under distraction suggests a load interference mechanism: Learners cannot benefit from helpful educational instructions when their working memory is already taxed by competing demands. Importantly, this blocking effect represents more than a simple additive effect-it demonstrates a qualitative breakdown where helpful instructional elements become ineffective rather than merely weakened. We discuss the implications for medical education in increasingly distraction-rich learning environments characterised by AI, smartphone notifications and electronic health record alerts.
Background: Medical students' career intentions and choices are shaped early in their education, at a time when their interaction with various specialties and professional influences is both formative and essential. Despite this being a pivotal period, the literature offers limited insights into what drives students' specialty choices during these early stages. Our study seeks to address this gap by exploring how medical trainees engage in sensemaking around specialty choice, navigating the interplay between individual aspirations, institutional contexts and perceived professional expectations.
Methods: We conducted an interpretive descriptive study with two consecutive student cohorts at a francophone university in Canada during the implementation of a new medical campus site. Using purposive convenience and snowball sampling, we held 10 focus groups (in-person and virtual): six with first- and second-year medical students and four with clinical teachers. Inductive thematic analysis was employed to interpret the data, enabling us to identify key patterns and relationships between participant perspectives.
Results: The participants' perspectives organised around five key themes including (a) navigating career indecision and decision-making processes, (b) role of lifestyle, work-life balance, and career sustainability, (c) role of early educational experiences in career selection, (d) influence of mentorship and role models on career orientation, and (e) hidden curriculum and perceptions of specialty prestige.
Conclusion: This study offers insights into the factors influencing medical students' specialty choices early in their training. By identifying actionable elements within the undergraduate medical curriculum and the broader learning environment, training programmes can better support students in making well-informed career decisions.
Background: Medical schools worldwide are integrating social accountability into admissions to address health inequities, improve workforce distribution and enhance population health outcomes. While foundational frameworks exist, implementation outcomes of specific admissions policies remain underexplored. This scoping review maps how social mission mandates are operationalized within medical school admissions and examines reported impacts on applicant diversity, geographic representation and workforce alignment.
Methods: We conducted a scoping review using the Joanna Briggs Institute and Arksey & O'Malley frameworks. MEDLINE, Embase, Web of Science, ERIC and Education Source were searched from inception to 8 August 2024. Studies were included if they examined MD admissions incorporating defined social mission objectives and reported selection or enrolment outcomes. Screening and data extraction were performed in duplicate, and findings were synthesized descriptively and categorized inductively, and we reported findings following PRISMA-ScR guidelines.
Results: Seventeen studies (1994-2022) met inclusion criteria, spanning North America, Australia, Oceania, Europe, Africa and the Caribbean. Although searches ran to 8 August 2024, the newest eligible studies meeting our inclusion criteria were published in 2022. Three main categories of social accountability emerged: (1) Geographic and Practice Location, with admissions strategies targeting rural and underserved regions and reporting improved local retention; (2) Sociodemographic Equity, emphasizing admissions pathways for applicants from Indigenous, low-income, racialized and marginalized groups; and (3) Workforce Composition, focusing on recruiting future primary care and generalist physicians for underserved areas. Despite promising outcomes, including increased diversity, rural representation and generalist intent, several studies reported implementation challenges, inconsistent alignment with institutional missions, and limited long-term outcome tracking.
Conclusion: Social mission-driven admissions frameworks can advance physician workforce equity and alignment with community needs. However, their success depends on sustained investment, supportive institutional structures and integration across the education continuum.
Background: Indigenous peoples around the world continue to experience systemic racism and discrimination within health care, as a direct consequence of colonisation. In settler-colonial states, such as Canada, current approaches to tackling anti-Indigenous racism are often designed by non-Indigenous peoples. Combating racism necessitates that health care policies and practices be co-constructed with Indigenous communities.
Objective: This study explored insights from Indigenous health professionals, educators and community members. It aimed to identify pathways for justice and equity-based medical curricular reform that, while being Indigenous-led, also engage practitioners in institutional accountability.
Methods: Semi-structured interviews were conducted with 12 Indigenous individuals with extensive experiential, professional and academic experience with the health care system and health professions education.
Results: This study highlights the ongoing impacts of anti-Indigenous racism in medical education and health care settings. Indigenous-specific racism within medicine manifests through the dehumanisation of Indigenous peoples, deficit-based approaches to Indigenous health education, and the erasure, omission, or other types of violence and epistemic injustices in educational settings and curricula design. Indigenous approaches to addressing it pivot around sovereignty and self-determination. These include nurturing the Indigenous principle of relationality within institutions, policies, education and interactions; challenging dehumanising narratives by centring Indigenous voices; and re-humanising medical practice through skills that foster connectedness and by embedding justice and equity as core tenets of medical practice.
Conclusion: Indigenous knowledge, principles and insights offer promising approaches for paving the way towards equity- and justice-centred medical practice and education. This study underscores the need to centre Indigenous voices, incorporate Indigenous knowledge and meaningfully engage with communities to embed health equity and justice at the core of medical education and practice.
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