Medical Teacher最新文献

Introduction: Affirmative action policies have been implemented to promote equitable access to higher education for socially vulnerable students, although their influence on student outcomes remains debated. This study compared the academic performance of students admitted through the regular path (RP) and affirmative action (AA) system, at a Brazilian public medical school.

Methods: This prospective cohort study included 236 fifth-year medical students from the School of Health Sciences (ESCS), between 2022 and 2024. Sociodemographic and economic data were obtained from institutional and national databases. Academic performance was assessed through cognitive, practical, and professionalism evaluations, as well as the final annual grade.

Results: Of 236 students, 134 (56.8%) entered via RP and 102 (43.2%) via AA. AA students were older, less often self-declared white, had lower parental education, and worse socioeconomic indicators (all p < 0.001). In univariate analyses, RP students scored higher in three of four evaluations (p < 0.001). After adjustment, admission type was not associated with performance. Cognitive scores correlated with younger age at admission (β: -0.039; 95% CI: -0.065 to -0.014; p < 0.001). Mini-CEX showed no significant associations. Professionalism scores were higher among female (β: 0.165; 95% CI: 0.013 to 0.316; p = 0.033), married (β: 0.589; 95% CI: 0.151 to 1.027; p = 0.009), those with a parent holding higher education (β: 0.242; 95% CI: 0.036 to 0.448; p = 0.021), and younger entrants (β: -0.033; 95% CI: -0.055 to -0.011; p = 0.003). Final grades were higher among female (β: 0.146; 95% CI: 0.032 to 0.261; p = 0.013), married (β: 0.376; 95% CI: 0.044 to 0.708; p = 0.027), and younger students (β: -0.032; 95% CI: -0.048 to -0.015; p < 0.001).

Conclusion: After adjusting for sociodemographic and economic factors, RP and AA students performed similarly, supporting AA as an effective inclusion policy.

Introduction: Although women now comprise most U.S. medical students, male physicians continue to dominate leadership roles, earn higher salaries, and hold more full professorships. These disparities suggest that cultural dynamics contributing to gender inequities may emerge early in medical training. This mixed-methods study investigated gender differences in perceived and actual participation in mandatory educational sessions during the first two years of medical school.

Methods: First, a survey assessed student perceptions of gendered participation across mandatory first- and second-year educational sessions. Subsequently, these sessions were observed for eight weeks at a single institution. Observed sessions included full-class Didactic and Social/Ethical sessions (120 students) and smaller Clinical sessions (30 students). For each participation instance (asking or answering a question), the gender of the student and instructor was recorded. Students could opt out.

Results: Survey responses indicated that most students perceived no gender-based differences in Social/Ethical or Clinical sessions. Female students, however, reported that men participated more frequently in Didactic sessions, while male students perceived no disparity (p = 0.001).

Observational data showed male students accounted for 72.4% of 311 participation events (p < 0.001). Men contributed significantly more in Didactic (81.2%) and Social/Ethical sessions (67.1%; both p < 0.001), with no significant difference in Clinical sessions (54% male; p = 0.19). Male participation decreased in sessions led by female instructors compared with male (p = 0.036) or mixed-gender faculty (p = 0.023).

Discussion: Despite objective gender disparities in participation, most first- and second-year students did not perceive differences. Notably, only female students perceived this discrepancy in their pre-observation surveys, and only in the context of didactic sessions. This imbalance may reinforce early professional norms favoring male visibility and engagement, perpetuating gender inequities in academic medicine. Addressing these dynamics is essential for fostering equitable learning environments and promoting diverse leadership in medicine.

Introduction: Simulation is essential for teaching procedural skills in obstetrics, yet access to high-fidelity simulators remains limited. Augmented reality (AR) offers an innovative and scalable way to enhance pre-simulation learning. This study evaluated whether AR-based training improves student performance in simulated vaginal births compared with traditional text- and video-based preparation.

Methods: We conducted a multicenter, prospective, randomized controlled trial with blinded evaluators involving 401 undergraduate medical and midwifery students from two universities (Chile and Colombia). Participants were assigned to AR-based training (experimental group) or conventional preparation (control group). All students completed high-fidelity childbirth simulations assessed using a validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of the minimum competency threshold; secondary outcomes included mean DOPS scores, critical task performance, and student satisfaction.

Results: Students trained with AR achieved significantly higher DOPS scores (11.9 ± 0.14 vs 10.6 ± 0.15; p < .001) and greater critical task completion (3.6 ± 0.07 vs 3.3 ± 0.07; p < .001) than controls. The proportion reaching the competency threshold doubled in the AR group (12.8% vs 6.2%; RR 2.23; 95% CI 1.07-4.01; p < .05). Both groups reported high satisfaction, though AR users noted opportunities to improve realism.

Discussion: AR-based pre-simulation training enhances performance and competency attainment in simulated vaginal birth care. This scalable and cost-effective approach complements traditional simulation, supporting competency-based medical education while broadening access to high-quality procedural training in obstetrics.

Purpose: Challenges with developing a strong professional identity can have adverse consequences like burnout and misconduct. While conceptual models describe how medical students internalize the attitudes, behaviors and norms ascribed to physicianhood, a comprehensive catalog of the processes students employ to drive PIF is lacking. This study aimed to use qualitative evidence to deconstruct and codify so-called 'mechanisms' for professional identity formation (PIF) and generate a practical construct for educators.

Methods: We undertook a cross-sectional qualitative multi-institutional study of 52 graduating medical students from four U.S. medical schools to explore their experiences during medical school. Pairs of investigators coded semi-structured interview transcripts identifying passages relevant to PIF with audit by a third coder for additional validation. Excerpts were reviewed to identify mechanisms and characterize patterns.

Results: Analysis of 52 transcripts identified 20 discrete mechanisms that despite overlap, could primarily be categorized into one of three domains: action (experiencing/role enactment, observing, learning from role models, experimenting, acting with agency, isolating oneself, and stepping back), reflection (metacognition/reflection, self-evaluation, evaluation/feedback from others, turning negatives into learning, compartmentalization, and imagining/visualizing) and connection (having support, talking, attachments to others, being trusted, trusting others, teaching, and asking). Students used multiple mechanisms to develop their professional identities with interplay across domains.

Conclusions: Discrete mechanisms actively employed by medical students to develop their professional identities can be categorized within domains of action, reflection, and connection (ARC). The ARC construct helps validate existing theories and could be used by educators and advisors to systematize and optimize interventions for PIF.

Contemporary medical education is increasingly dominated by the imperatives of efficiency, measurable outcomes, and technological optimization. While these frameworks aim to improve educational quality, they risk marginalizing essential but non-linear learning experiences. This commentary introduces the concept of "temporal diversity" as a necessary ecological shift in curriculum design. By situating the obsession with efficiency within the broader context of New Public Management and social acceleration, we argue for legitimizing "slow time"-relational, reflective, and unstructured moments. Reclaiming temporal diversity is vital for fostering professional identity formation, preventing burnout, and ensuring a humane foundation for medical education.

What is the educational challenge?: Implementation of Competency-Based Medical Education (CBME) requires a systematic approach and evaluation plan that includes processes to identify and address opportunities for continuous improvement.

What are the proposed solutions?: Maturity assessment models-frameworks widely used in business and data governance-are an innovative approach to support evaluation and improvement of CBME systems. Maturity models describe progressive levels of capability across key dimensions of change: vision, leadership, governance, and technology. Institutions can adapt existing maturity models, such as quality management or data maturity frameworks, or develop customized models aligned with local priorities. A structured approach in using these models includes selecting or designing a model, defining dimensions and capacity levels, conducting assessments, analyzing results, and implementing targeted improvement strategies.

What are the potential benefits to a wider global audience?: Maturity models offer a scalable, adaptable method for advancing CBME across diverse educational settings. Benefits include improved data integration, enhanced stakeholder engagement, clearer alignment with accreditation standards, and a shared framework for monitoring progress across programs.

What are the next steps?: Additional evaluation locally, combined with broader adoption at other institutions, will further validate CBME‑specific maturity models, strengthen data literacy, and support iterative, sustainable continuous quality improvement.

Excellence in educational practice is recognised by the ASPIRE Award program at AMEE. The focus of this paper draws on exemplars from the ASPIRE-to-Excellence Award for Simulation to illustrate how excellence is built in simulation programs. Our focus is on institutional programs that support entry-level and practising clinicians in developing and maintaining clinical knowledge and skills, thereby impacting patient safety and quality of care. We briefly outline the history of the award and then describe the elements and criteria for the award. We position the award alongside the many standards of practice, professional guidelines, quality frameworks, accreditation and certification documents available to the healthcare simulation community. Selected sub-criteria are illustrated making explicit what excellence looks like. We then shift focus to characterise panellists' credentials and share their reflections on the process of reviewing applications, followed by reflections from awardees on the benefits of the award and their experience of preparing the application. We draw on all these reflections to offer tips for preparing an application. Institutional program review in comparison to established international standards for excellence can facilitate improvements to simulation programs, even if it does not progress to a formal submission or award.

Background: The rapid pivot to online assessment during COVID-19 raised concerns about the fairness and psychometric quality of high-stakes medical examinations. This study compared performance and integrity indices across three successive modalities of The University of the West Indies Final MBBS Medicine and Therapeutics written paper.

Methods: Institutional records for every candidate in 2019 (proctored physical, n = 508), 2020 (un-proctored online, n = 529) and 2021 (physically onsite proctored online, n = 361) were analyzed retrospectively (N = 1 398). Mean scores, score dispersion, categorical outcomes, Cronbach's alpha, and item-difficulty indices were contrasted with one-way ANOVA, χ² tests, and odds ratios.

Results: Examination modality significantly influenced performance. The mean (± SD) scores were highest in the unproctored online exam (2020: 68.4 ± 6.5), followed by proctored physical exam (2019: 64.2 ± 7.2) and proctored online (2021: 60.5 ± 7.3). The difference in the mean score of the three modalities was highly significant (p < 0.0001). Pass rates peaked in 2020 (92%) versus 2019 (81%) and 2021 (70%). The odds of failing the examination in 2021 were more than five times higher than in 2020 (OR = 5.652). Reliability (Cronbach's α) highest in 2019 (0.813) and 2021 (0.770) but very low in 2020 (0.307). Odds of failing in 2021 were 5.65 times higher than 2020.

Conclusions: Examination modality strongly impacted on performance and reliability. Unproctored online exams led to grade inflation, reduced variability, and low reliability, while proctored formats-physical or virtual-reinstated assessment rigor, fairness, and psychometric integrity, emphasizing the need for robust invigilation in high-stakes medical assessments.

Background: Despite implementing equity, diversity, and inclusion (EDI) policies, racialized minorities continue to be underrepresented in health professional programs report experiencing microaggressions and prejudice in the workforce. By not exploring the experiences of racialized students in entry-level health professional programs, EDI policies risk becoming irrelevant or performative.

Methods: A search was conducted in five databases with a grey literature search. Two reviewers independently screened articles against the criteria, and relevant data summarized. Studies exploring perspectives about racism and discrimination, or related concepts, among non-dominant ethno-racial, and health professional students were included.

Results: A total of 3606 studies were identified through database searching and 70 articles included and analyzed. Black students and nursing students were most frequently represented. Research primarily emerged from the United States (US). The key themes within the experiences of racialized students included isolation, otherness, discrimination and microaggressions. Key recommendations highlighted a need for mentorship opportunities and strategic retention programs.

Conclusions: Racialized students in health professional programs experience isolation and otherness. Geohistorical contexts might influence the locations, disciplines and terminology emerging among studies. Further investigation should explore any existing relationship. These findings warrant a call to action to educators, advocators and regulators to consider the experiences and recommendations. Future research should evaluate the implementation and effectiveness of these recommendations.