Medical Education最新文献

Introduction: Impaired wellness among residents has become a global concern, with burnout, stress and fatigue linked to negative outcomes for both residents and patients. To date, most of the existing research has come from Western contexts, where cultural norms and training structures may significantly differ from those in other regions. However, there remains limited understanding of how residents in non-Western settings experience and interpret impaired wellness. This study aims to explore the perceptions and experiences of residents' impaired wellness within the context of residency training in China.

Methods: We conducted a constructivist qualitative study. Participants were recruited through purposive and snowball sampling from a teaching hospital in Shanghai. Semi-structured interviews were conducted in Chinese between March 2024 and February 2025, guided by a six-dimensional wellness framework developed from existing literature. We used reflexive thematic analysis to analyse the data both deductively and inductively.

Results: Chinese residents perceived some degree of wellness impairment across physical, psychological and social dimension as acceptable, often framing such impairments as contributing to professional and personal growth, reflecting cultural values emphasising acceptance of and growth through hardship. In contrast, impairments in the intellectual and financial dimensions, exacerbated by unfair compensation, limited supervision and research pressure, were seen as unreasonable yet preventable. Residents' recognition of these challenges as rooted in systemic and structural conditions of residency training, largely beyond their control, often led to resignation, passive endurance, and in some cases, consideration of leaving the profession. Harmonious work relationships were described as central to navigating impaired wellness, serving as vital buffers when present but vulnerabilities when absent, largely echoing cultural ideals of harmony.

Discussion: This study sheds light on how the inherently demanding nature of clinical practice, cultural values and local systemic and structural conditions of residency training intersect to shape residents' perceptions and experiences of impaired wellness.

Background: This scoping review explores the impact of coaching on the professional identity formation (PIF) of postgraduate medical trainees. Although coaching is well-documented in undergraduate medical education, its role in postgraduate medical education (PME) remains underexplored. This review aims to identify enablers and barriers to coaching in PIF, examine modalities employed and assess coaching's contribution to developing well-rounded, resilient physicians.

Methods: Following Arksey and O'Malley's scoping review framework and reported in accordance with the PRISMA-ScR guidelines, the research question was formulated using the Joanna Briggs Institute's Population-Concept-Context (PCC) framework. A comprehensive, peer-reviewed search strategy was executed across PubMed, Embase, Web of Science and Google Scholar (first 20 pages). Grey literature was included, and no date limits were applied. Studies of any design focusing on coaching in PME were eligible. Titles and abstracts were screened using Rayyan, and full-text reviews were conducted independently by three reviewers using a negotiated consensual validation approach. An additional study was identified through snowballing. Data were extracted using a structured charting framework and analysed thematically.

Results: Of the 336 records identified through database searches, 20 studies met the inclusion criteria, including one added through snowballing. The literature highlighted diverse coaching modalities and their positive impact on PIF. Coaching supported trainees in professional development, identity evolution, career planning, resilience and well-being. It fostered psychologically safe environments for self-reflection, self-assessment and development of both technical and non-technical skills. However, qualitative and longitudinal research on coaching's effectiveness in PME remains limited.

Conclusions: This review emphasises coaching as a valuable tool in shaping postgraduate medical trainees' professional identity. A conceptual framework of coaching has been identified, and its integration into medical curricula may enhance reflective capacity, communication skills, resilience and overall well-being. Future research should prioritise the validation of this evidence-based coaching framework and its impact on fostering communities of practice to support identity formation, holistic physician development and care.

Introduction: The transformative learning potential of feedback, a key pillar of competency-based medical education, can only be fully realised when a learner's preferences are integrated into the feedback process. However, there is limited understanding of medical residents' preferences, which could better inform this process. This study investigates patterns in emergency residents' perspectives on preferences for feedback features and their potential implications on learning.

Methods: We used Q-methodology, which combines quantitative and qualitative data to systematically rank and compare shared and distinct perspectives on a specific topic. Thirty-two purposively sampled emergency medicine residents from 11 teaching hospitals were each invited to participate in a Q-sorting exercise and post-sorting interview. We analysed the Q-sorts to identify patterns in residents' preferences for feedback features. Qualitative insights from the interviews facilitated a structured interpretation and understanding of the differences and similarities between the generated viewpoints. Viewpoints represent subjective yet shared patterns of similarity in opinions about the most and least desirable feedback features, based on how residents ranked statements reflecting these features.

Results: Of the 32 Q-sorts, 27 (84.4%) successfully loaded onto four different viewpoints reflecting prevailing perspectives of feedback preferences during residency training: (i) specific and comprehensive feedback; (ii) safe and evidence-based feedback; (iii) timely and relationally grounded feedback; and (iv) growth-focused and motivational feedback. Despite differences, residents across all viewpoints stressed the importance of obtaining feedback during crucial moments in their learning process.

Discussion: Residents' preferences for feedback vary, suggesting that a universal approach to providing feedback may not be effective. Instead, various characteristics must be considered, reinforcing the necessity for innovative feedback practices to meet individual learners' unique needs in the clinical workplace.