Medical Education最新文献

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.

Introduction: Mistreatment toward peers, residents, and patients has been shown to trigger negative emotions among medical trainees. However, the impact of such experiences on trainees' learning needs to be further explored. This study reports on the impact of a situation of mistreatment experienced by a medical resident on novice medical students' learning of a scientific text.

Methods: Videos portraying a medical resident receiving feedback about his performance in caring for a patient who died were used. Participants were randomly assigned to watch either a video where the feedback is accusatory and disrespectful (emotionally negative group-ENG) or understanding and respectful (neutral group-NG). Subsequently, all participants studied a scientific text. Study time and cognitive engagement with the text were recorded. Finally, they did a recall test about the text.

Results: Data from 68 third-year medical students were analysed. Test scores were lower for the students in the ENG compared with the NG [10.82 (5.37) and 14.44 (7.02), respectively, p = 0.020, d = 0.58]. No differences in cognitive engagement [3.98 (0.60) and 4.10 (0.73) for ENG and NG, respectively, p = 0.45] or time spent studying the scientific text [5:05 (1:36) and 4:56 (1:37) for ENG and NG, respectively, p = 0.71] were observed.

Discussion: A simulated situation of mistreatment experienced by a resident negatively impacted the learning of a scientific text by novice medical students. These results extend the evidence on the negative impact of mistreatment on learning. It supports the relevance of mitigating mistreatment and adjusting training activities in situations of emotional distress.

Introduction: Management reasoning (MR) remains poorly understood in medical education. Current understanding is largely theoretical or based on studies of physicians in simulated settings or narrow clinical contexts. Little is known about how trainees themselves conceptualise and enact MR during routine care. This study explored how postgraduate trainees conceptualise MR and describe the process, as well as the contextual influences that shape their MR during training.

Method: We conducted a qualitative study using a constructivist paradigm and reflexive thematic analysis. Four semi-structured focus groups were held with 28 senior postgraduate trainees in Internal Medicine, Paediatrics, Family Medicine, and Medicine-Paediatrics across two U.S. academic medical centres. Focus groups were transcribed verbatim and coded inductively. Themes were developed through an iterative and reflexive process with attention to both semantic content and underlying meaning.

Results: Four themes captured how trainees conceptualise MR: how MR is understood within clinical reasoning, uncertainty and risk characterise the complexity of MR, core and variable components of the MR process, and contextual factors influencing the MR. Trainees viewed MR as linked to diagnostic reasoning but distinct in its pragmatic and action-oriented focus. They described ongoing negotiation of uncertainty and risk, emphasising flexibility and adjustment as conditions changed. The MR process commonly featured four core components-working diagnosis, delineation of management options, contextualisation and monitoring or follow-up-along with variable components that were applied flexibly depending on context. Trainees described a variety of contextual factors that influenced MR.

Discussion: Postgraduate trainees viewed MR as a dynamic, complex and flexible process. This study adds to the empirical literature on MR by confirming its patient-centred and context-dependent nature while introducing novel insights from the trainee perspective, especially the centrality of uncertainty and risk. Understanding how trainees conceptualise MR can help educators make MR more visible in clinical practice.

Background: Previous studies have shown that medical students demonstrate poorer performance when diagnosing pathology in skin of colour (SOC) compared to white skin (WS); it is important to understand the reasons underpinning this. If not addressed, poorer differential diagnostic ability in certain skin tones could entrench existing racial inequities in health care. We investigated whether exposure to a predominant patient skin colour during clinical practice affects diagnostic ability in WS and SOC.

Methods: Participants were international medical graduates (IMGs) and medical students from Imperial College London and the University of Dundee, recruited between January and May 2024. Participants were divided into two groups, based on whether they were predominantly exposed to white patients (WP) or non-white patients (NWP) in their practice. Participants sat a dermatology quiz, in which they were asked to provide a diagnosis for 22 image-based vignettes, covering 11 clinical presentations, each shown in WS and SOC. For each of the WP and NWP exposed groups, we compared their diagnostic ability in WS and SOC presentations.

Results: A total of 411 participants were analysed; 187 predominantly exposed to WP and 224 predominantly exposed to NWP. Both groups demonstrated a statistically significantly better diagnostic ability in WS compared to SOC (p < 0.01). Overall, there was no significant difference in differential diagnostic ability in WS and SOC between the WP-exposed and NWP-exposed groups (p = 0.731).

Discussion: Regardless of the predominant patient skin colour participants saw in their practice, participants were worse at diagnosing pathology in SOC. This highlights that clinical exposure to SOC is not sufficient to mitigate clinicians' inferior diagnostic ability in non-white skin tones. Therefore, effort must be made to improve the diversity of skin colours represented in medical education resources, to improve clinicians' familiarity with pathology in different skin tones and minimize the risk of patients being misdiagnosed due to their skin colour.

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.