Medical Teacher最新文献

Purpose: The well-being of resident physicians is a globally recognized concern, with high rates of burnout, stress, and attrition. Studies proposed grit-a personality trait defined as perseverance and passion for long-term goals-as a protective factor against poor psychological outcomes. Although studies in Western countries have linked grit with lower burnout and depression among residents, evidence from collectivist cultures, such as Japan, remains limited.

Method: This nationwide cross-sectional study included data from 2,876 postgraduate year (PGY) 1-2 resident physicians across 553 hospitals in Japan. Participants completed self-administered surveys following the 2024 General Medicine In-Training Examination. Grit was measured using the validated Japanese version of the Short Grit Scale (Grit-S); wellness outcomes-including burnout, job satisfaction, stress, and depressive symptoms-were assessed using the single Mini-Z 2.0 item and the two-item Patient Health Questionnaire. Multilevel logistic regression models with a random intercept for hospital were used to evaluate the associations between grit and wellness outcomes, adjusting for demographic and institutional covariates.

Results: Higher Grit-S scores were significantly associated with lower odds of burnout (adjusted odds ratio [AOR], 0.54; 95% CI, 0.45-0.64), high stress (AOR, 0.63; 95% CI, 0.55-0.71), and depressive symptoms (AOR, 0.54; 95% CI, 0.48-0.62). Grit was also associated with greater job satisfaction (AOR, 2.09; 95% CI, 1.80-2.43).

Conclusions: In this national sample of Japanese resident physicians, higher grit was consistently associated with improved psychological well-being, including lower burnout, reduced stress, fewer depressive symptoms, and increased job satisfaction. These findings suggest that grit is a critical protective trait for residents, even within a collectivist culture. Future research should explore whether the identification of residents with lower grit, especially those with reduced perseverance or inconsistent interests, can help inform customized support programs such as mentoring or structured stress management to enhance well-being.

What was the educational challenge?: Resuscitation debriefing requires accurate timeline reconstruction for effective team learning. Standard documentation captures medications and interventions but lacks granular communication patterns, team dynamics, and teachable moments essential for educational debriefing. Video review addresses this gap but requires extensive manual annotation, limiting scalability.

What was the solution?: We developed a structured prompting methodology using commercially available multimodal AI (Google Gemini). This reproducible approach enables educators to generate automated debriefing timelines by uploading resuscitation recordings and applying a structured prompt framework, without requiring custom software development or programming expertise.

How was the solution implemented?: Feasibility was validated using three simulation videos (8-11 min each): two ACLS cardiac arrests and one postpartum hemorrhage. Videos were processed using a 14-question structured prompt framework. Across scenarios, the approach detected most clinician-identified events with temporal accuracy of ±10-15 seconds.

What lessons were learned?: Automated timeline generation using existing AI tools is feasible across diverse acute care contexts. Uploading complete videos after the event significantly outperformed real-time analysis. The prompt framework is adaptable to other multimodal AI platforms, democratizing access to high-quality debriefing.

What are the next steps?: Next steps include clinical validation using real resuscitation events, integration with electronic medical records for added context, and assessment of impact on team learning outcomes. The complete prompt framework and implementation guide are available on GitHub.

Introduction: In view of the increasing numbers of older patients with complex health problems, doctors, especially general practitioners, need to learn to provide complex elderly care. This study aimed to ascertain how general practice trainees regulate the process of learning to provide complex elderly care.

Method: Semi-structured in-depth interviews were conducted with 10 GP trainees and five recently graduated GPs at four universities in Belgium and the Netherlands. Data analysis was guided by concepts of self-regulated learning and long-loop learning.

Results: Interviews with GP trainees and recently graduated GPs showed that use three strategies to regulate their learning process: creating, recognizing and choosing, and using learning experiences. Creating implies influencing learning opportunities. For recognizing and choosing, it is important to be aware of learning opportunities and to decide which opportunities to use. Using learning experiences entails trying and evaluating new knowledge or skills, often repeatedly in the same case. During long-loop learning, these three strategies are used stand-alone or in connection with each other.

Conclusion: GP trainees are learning complex elderly care by using three strategies: creating, recognizing and choosing, and using learning opportunities. These strategies are used as stand-alone or interconnected. Insights can be used by curriculum developers, university staff, and GP-supervisors to help GP-rs find a balance between the strategies, but also to develop new curricula for complex elderly care.

An important hallmark of rigorous research in Health Professions Education (HPE) research is the use of theory. There are many ways to use theory in qualitative research, and so being a savvy user of theory in such research can be a difficult goal for researchers to obtain. Therefore, this AMEE Guide aims to assist (novice) HPE researchers in navigating theory-use in qualitative research by: (a) articulating what theory is; (b) describing why researchers use theory in a research project; (c) describing how to select a theory to inform a study; (d) adressing when theory can be incorporated into a qualitative study's design; (e) and defining what a theoretical framework is and illustrating how to construct one. Each of these elements is illustrated with an example to help readers follow the implications of their decisions. Then, to support understanding, we present a fictional case and illustrate how two different theories can be applied to inform research addressing the case. We highlight how the two theories identify different research problems, and we highlight how each theory brings different aspects of the case into focus as central to the study, while simultaneously diminishing other aspects.

Introduction: Educators often view stress as a threat to learning, yet under the right conditions it may enhance it. Ideally, supervisors identify an optimal stress zone that supports learning, an ability that likely depends on how they conceptualize the stress-learning relationship. Our study explores how supervisors conceptualize this optimal stress zone and the factors that shape it.

Methods: Using constructivist grounded theory methodology, we interviewed pediatric supervisors who were nominated by residents for their ability to use stress to support learning. We analyzed the interviews through open and focused coding, with regular team discussions to develop categories and a theoretical model.

Results: Participants described a curvilinear relationship between stress and learning, conceptualized as a four-zone Stress-Learning Model: comfort, optimal stress, caution, and crisis. Learning was perceived to peak in the optimal stress zone, where stress is manageable and shaped by individual, situational, and supervisory factors. The "tipping point" between caution and crisis marked a sharp decline in learning and wellbeing but was difficult to recognize.

Discussion: Pediatric supervisors believe there is an optimal stress zone for learning but find it difficult to identify. Our findings suggest supervisors do not view stress as inherently harmful, but as a force that can enhance learning.

Introduction: Anecdotes from university faculty and educational leaders suggest that medical school admissions policies are driving aspirant behavior in unintended ways. This paper reviews the existing literature for evidence of admission policies' upstream impact on applicant behavior.

Methods: We used a scoping review to summarize research published between 1980-2025, written in English, with empirical evidence of medical school applicants' behaviors being driven by admissions policies.

Results: Fifteen papers were included in the review. These revealed three types of policy-mediated admissions practices that influence aspirant behaviour: (1) high weightings of grade point averages and standardized tests, (2) value placed on activities reported on curricula vitae, and (3) the rating of essays and personal statement submissions, interview responses, and letters of recommendation. These policies influenced how aspirants made academic choices, sought supports, and marshalled their time and resources. Notably, aspirants' interpretations of selection policies were partially influenced by information not explicated articulated by the policies.

Discussion: Admissions policies that incentivize behaviours misaligned with the values of medical practice may have harmful effects on applicants and the profession. Medical schools should consider the unintended consequences of their selection approach and establish policies that protect aspirant well-being and promote behaviours valued within physicians.

Purpose: Medical mistakes evoke intense emotions among trainees and are often framed through shame and distress. This study explores how medical students respond emotionally to clinical mistakes and how they regulate those emotions through reflective writing after hearing health professionals share stories of error.

Methods: We conducted a qualitative descriptive study analyzing reflective essays from 21 medical students following a panel on clinical mistakes. Thematic analysis was guided by Gross's Process Model of Emotional Regulation, while allowing for inductive themes to emerge.

Results: Students described a range of emotional responses, including fear, guilt, and shame, rooted in personal histories and the culture of medicine. Emotional regulation strategies included cognitive reappraisal, response modulation, and metacognitive reflection. Students demonstrated self-awareness, growth mindset, and commitments to personal accountability. Students also emphasized the importance of help-seeking and social support in navigating emotionally challenged experiences.

Conclusions: Mistakes in medicine are emotionally complex and shaped by systemic and cultural forces. Reflective writing can foster adaptive emotional regulation and support professional identity development. Structuring emotionally safe learning environments is critical to transforming the culture around medical errors.

Purpose: Moral distress arises when clinicians feel unable to act according to their ethical beliefs due to various constraints. Medical students transitioning from classroom to clinical settings are particularly vulnerable due to limited authority and fear of repercussions. This study examines how medical students experience and report moral distress, the role of supervising physicians, and the implications for professional development.

Method: 407 case reports from third-year students at a U.S. allopathic medical school were quantitatively and qualitatively analyzed to assess instances of moral distress and students' experiences and relationship with clinical mentors.

Results: Moral distress was reported in 170 (41.8%) cases. Of those, "actions by another" (n=56, 32.9%) and "systemic concerns" (n=39, 22.9%) were the most common causes of moral distress. Mentor status (attending vs. trainee) had no significant impact on moral distress scores (p=0.6). Students without moral distress were more likely to rate their mentors more positively than those with moral distress (73.9% vs 54.0%, p<0.001) and want to emulate them (79.7% vs 55.9%, p<0.001).

Conclusions: Moral distress is commonly experienced among medical students, frequently driven by observing others' behaviors. Positive role modeling and mentoring can significantly influence students' moral distress and professional development.

Introduction: Mobile learning (mLearning) is increasingly recognized as a valuable tool for supporting clinical education by offering students flexible, real-time access to information within clinical learning environments (CLEs). However, its implementation is often hindered by infrastructural limitations, lack of institutional support and training, and concerns related to professionalism and patient perception. There is a lack of evidence that considers both student and stakeholder perspectives across different health education contexts. This study aimed to explore perceived barriers and facilitators to the integration of mLearning in clinical education from the perspectives of undergraduate health occupation students and clinical stakeholders.

Methods: An exploratory qualitative design was used, involving six focus groups (FGs) with 25 students and 26 stakeholders from three European universities (Spain, Poland, and Germany). Data were analyzed thematically using the FRAME model (Framework for the Rational Analysis of Mobile Education). Research rigor was ensured through COREQ (COnsolidated criteria for REporting Qualitative research) guidelines and recognized qualitative research standards. Ethical approval was obtained from all institutions involved.

Results: A total of 51 participants - 25 students and 26 stakeholders - contributed to six FGs across three countries. Thematic analysis, guided by the FRAME model, revealed key benefits and challenges of mLearning integration in clinical education. Participants highlighted the potential of mobile technology to enhance flexibility, access to knowledge, and peer collaboration in clinical education. However, significant challenges remain, including ethical concerns, generational divides, limited infrastructure, and institutional resistance.

Discussion: Mobile technology offers clear benefits for clinical education - such as flexibility, access, and collaboration - but its integration requires addressing ethical, organizational, and generational barriers. Effective implementation demands inclusive, co-designed strategies supported by infrastructure, training, and cultural change.

This paper provides twelve practical tips for institutions preparing to submit successful applications for the ASPIRE Award in the category of Assessment of Students, part of AMEE's global initiative to recognize excellence in health professions education. This paper emphasizes the importance of achieving institutional buy-in, aligning assessment systems with the school's mission and context, assembling a strong submission team, and providing explanation of the award criteria. It highlights the collection and presentation of comprehensive evidence, including metrics like psychometric analysis and construct alignment, to demonstrate standards of excellence. Engaging students in the application process is critical, as their perspectives enhance transparency, equity, and accountability. Institutions are encouraged to address inconsistencies, demonstrate impact through quality improvement cycles, and showcase their commitment to continuous learning and professional development. The tips also include the value of engaging with the ASPIRE Academy for expert support and collaboration during the application process. This paper highlights that the ASPIRE award is an opportunity to foster reflection, collaboration, and innovation, while contributing to global standards of excellence in assessment in health professions education.