Medical Teacher最新文献

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.

Error-Based Learning (EBL) represents a paradigm shift in Health Professions Education (HPE), moving from punitive approaches to embracing errors as learning opportunities. This AMEE guide targets educators, curriculum designers, clinicians, and learners, bridging theory with practical strategies to optimize EBL in training and assessment. The guide contrasts Error Management Theory (EMT), which emphasizes learning from errors, with Error Avoidance Theory (EAT). Core EBL components including psychological safety, structured reflection, deliberate error exposure, and feedback are detailed alongside actionable implementation strategies, including simulation-based scenarios with debriefing, contrasting case-based reasoning, structured error-logging through reflective portfolios and assessment for learning. Looking ahead, we discuss emerging innovations in EBL, including the potential reconceptualization of educational tools such as the 'escape room' as an 'error room' and AI. This guide challenges traditional paradigms and calls for a deliberate focus on error-embracing in HPE.

Introduction: Advising is essential for student success in graduate health professions education (HPE). Advising does not happen in a vacuum, yet most research focuses narrowly on advisor-advisee relationships. To address this gap, this study examines how institutional structures, policies, and programmatic dynamics influence the effectiveness of advising in graduate HPE.

Methods: We conducted semi-structured interviews with 15 HPE program leaders across six WHO regions. Using framework analysis guided by Activity Theory and the concept of knotworking, we analyzed how institutional systems shape advising practices.

Results: Five institutional factors were identified: (1) strategic advisor recruitment, (2) supportive advising cultures, (3) bureaucratic and resource constraints, (4) advisor training and evaluation, and (5) recognition and support for advisors. Leaders described advising as an adaptive, cross-system process shaped by institutional complexity and evolving student needs.

Discussion: Advising in graduate HPE operates beyond dyadic relationships. It is embedded within institutional activity systems and requires ongoing negotiation across structural boundaries. Programs must adopt systemic strategies, such as faculty development, workload alignment, and policy reform, to support effective advising networks.

Introduction: The integration of artificial intelligence (AI) tools into medical education presents new opportunities for enhancing students' research skills and scientific writing. However, concerns remain about the potential for cognitive disengagement and the ethical use of AI when lacking appropriate educational supervision. This study aimed to evaluate a novel educational strategy combining structured AI assistance with mentor guidance to support narrative review writing among third-year medical students.

Methods: A structured framework was implemented during the endocrine module, involving AI-assisted objective formulation, mentor-guided objective refinement, literature search and summarization, review drafting followed by AI-assisted rephrasing. Students worked in groups, each supervised by a trained mentor. A validated questionnaire assessed student perceptions across four domains: framework and guidelines, AI-generated objectives, skills developed and mentor role, and overall satisfaction. Descriptive statistics were performed and chi-square tests evaluated associations between perceptions and AI tool usage (ChatGPT vs. DeepSeek).

Results: Eighty-seven students completed the survey. Perceived improvement in research readiness was observed; confidence in literature searching rose from 29.8% to 69%, while 75.8% reported increased familiarity with PubMed/Google Scholar. Most students (80.5%) expressed satisfaction with the AI mentor hybrid approach, and 82.8% agreed it prepared them for future research. There were no significant differences in perceived outcomes between AI tools used. Mentor involvement was deemed essential by 69% of students, and a minority believed AI alone could replicate the same outcomes. Common challenges included limited access to articles and peer collaboration difficulties, while key learning outcomes included improved summarization and ethical AI use.

Discussion: This study supports the integration of AI tools within a structured, mentor-guided educational framework to enhance critical evaluation and scientific writing in medical education. Human oversight and mentorship drive skill development and minimize the risk of unmoderated AI use in academic settings.

Health Professions Education (HPE) cannot rely on assumptions of stability. Fragile contexts - wars, disasters, political upheaval, and systemic weakness - disrupt teaching and learning, assessment, accreditation, and the well-being of learners and faculty. This AMEE Guide provides a framework for building resilient HPE that survive crises and use them as opportunities for reform. The Guide identifies three types of fragility and explores their impact on institutions, human capital, clinical training, and social accountability. To boost resilience, the guide recommended adaptive strategies that include creating crisis management committees, implementing modular and competency-based curricula, allowing credit transfers for displaced learners, and incorporating tailored training programs. For curriculum delivery innovations range from hybrid and low-tech methods to peer-assisted approaches, diaspora involvement, and community-based services. A practical model for fair and feasible assessment in disrupted environments is suggested, with a focus on outcomes, flexibility, and cross-border recognition for rethinking accreditation and quality assurance. Systems thinking underpins the Guide, highlighting how destructive cycles such as brain drain can erode capacity, while virtuous cycles - driven by technology adoption, partnerships, and community integration - can foster recovery and growth. The guide also calls on educators, institutional leaders, and policymakers to move from reactive responses to proactive preparedness.