Medical Education最新文献

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.

Introduction: Mixed-methods research (MMR) intentionally combines (variously) theories, study designs, data collection, analyses and/or syntheses associated with more than one approach to research. Despite a rich literature on the theory and practice of MMR, the authors were concerned that much MMR in medical education fell short of the state of the art. To substantiate the problem, the authors conducted a meta-study to explore the strengths and weaknesses of MMR in medical education and to propose a framework to improve the conduct and reporting of this research design.

Methods: Structured searches were conducted, and returns were filtered based on inclusion and exclusion criteria, establishing a corpus of 1070 articles. A series of purposive samples was taken from this corpus and put through full data extraction. The findings from these extractions were synthesized using descriptive statistics and a dialogical identification of core issues of concern.

Results: Descriptive statistics were produced for the full corpus, after which a series of samples led to 547 (51%) articles undergoing full data extraction. There was a significant increase in the number of articles reporting the use of MMR in the last 20 years. Several recurring issues were identified including a lack of theoretical and conceptual grounding in MMR, a lack of diversity in what constitutes MMR, questionable component rigour, a lack of integration (mixing), a tension between MMR as more than one thing and MMR as a methodology in its own right, and very little adaptation and innovation in MMR approaches. These issues had not improved over time.

Discussion: Major gaps in how MMR was justified and used were found. Integration, central to MMR, was notably lacking. Thus, the authors propose a checklist to help researchers and reviewers ensure that future use of MMR in medical education is more rigorous, transparent, complete and accurate.

Introduction: With an ageing population, future doctors must be prepared to care for older patients facing complex and often chronic needs. Despite curricular efforts, medical students often report less positive attitudes towards providing this care-shaped not only by knowledge gaps but also by cultural norms and the hidden curriculum. Little is known about how students themselves reflect on their clinical encounters with older patients. This study explores medical students' experiences providing care to older patients, and which aspects they find rewarding or frustrating.

Methods: We conducted a qualitative study based on a constructivist paradigm, using semi-structured interviews supported by a visual narrative method (rich pictures). Sixteen final-year medical students who had completed their senior internship were purposively sampled. Participants drew two 'rich pictures' representing one positive and one negative clinical experience involving the care of older persons. These drawings were used as prompts for in-depth interviews. Data were analysed using reflexive thematic analysis.

Results: We identified three themes that captured students' experiences: (1) feeling connected, (2) witnessing humane and compassionate care, and (3) making a difference. Rewarding experiences involved human connection, dignity and presence-particularly in end-of-life care or when guided by compassionate role models-leading to a sense of fulfilment. Frustrating experiences arose from poor communication, systemic barriers and unclear goals of care, leaving students feeling powerless, isolated and emotionally burdened.

Conclusion: Students experienced care for older patients as emotionally rich and qualitatively distinct from other clinical work. This practice demands patience, presence, and the ability to navigate complexity beyond mere clinical competence. Medical education should support students in valuing care beyond cure-through fostering reflective practice, peer support, and engaged supervision-helping them reframe what it means to make a difference for older patients and their families in complex, chronic and end-of-life care.

Purpose: Professional identities impact professional boundaries and hierarchies, influencing how physicians approach collaboration. Despite the growing emphasis on developing students to become effective collaborators, little is known about how other health professionals (OHPs) shape students' professional identity formation (PIF). This study explored how interacting with OHPs during clinical care contributed to medical students' construction of what it means to be a physician.

Methods: For this constructivist grounded theory study, researchers conducted 20 semi-structured interviews with medical students during clinical clerkships. Students drew rich pictures representing their interactions with OHPs and described these pictures during their interviews. Interviews were iteratively conducted and analysed, enabling the research team to theorize how interacting with OHPs contributed to medical students' PIF.

Results: Participants expressed a strong desire to contribute to patient care and described how interprofessional interactions provided opportunities to do so in ways aligned with their current capabilities. These opportunities were often more accessible than the roles and responsibilities of physicians, and participating alongside OHPs fostered participants' sense of their own developing capabilities and belonging on healthcare teams. Interactions with OHPs helped participants to see the expertise of OHPs and the value of collaborating with them in ways that shifted their focus away from becoming independent. Conceptually, participants' interactions with OHPs became both a mirror reflecting their present readiness to meaningfully contribute and a prism through which they could envision their future identities as physicians in new ways.

Conclusions: Interprofessional interactions influenced medical students' current and future professional identities, enabling students to see themselves as contributors on health care teams and highlighting collaboration and interdependence as core attributes of the physician profession. These findings highlight opportunities to amplify the impact of interprofessional interactions on the PIF of medical students and the need for research into how OHPs view their roles in these processes.

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.