Perspectives on Medical Education最新文献

Background: The term 'talent' appears in health professions education (HPE) but is variably defined and often conflated with performance proxies. Through a scoping review, the authors sought to map how 'talent' and related terms are used/defined in medical education across stages and use cases.

Methods: A scoping review (Arksey-O'Malley; Levac; PRISMA-ScR) with descriptive mapping and content analysis of charted items was performed. The search was conducted across OVID-Medline, PubMed, Scopus, and Web of Science, focusing on studies related to talent in medical education from 1946 to May 20, 2024. The authors included not only the term talent but also broadened the review to include adjacent concepts, such as aptitude and giftedness. Two reviewers independently assessed titles, abstracts and full texts using predefined inclusion and exclusion criteria. A third reviewer resolved screening discrepancies. Relevant concepts were mapped for reporting, and a content analysis identified research gaps, trends, and patterns across global, regional and specialty contexts. The papers were tiered into two groups: Tier 1, directly mentioning the term talent; Tier 2, adjacent terms often related to talent.

Findings: The authors reviewed 189 studies loosely related to talent in medical education: 47 (25%) were Tier 1 papers that directly mentioned talent, and 142 (75%) were Tier 2 (adjacent terms). The literature primarily originated from North America (41%, 77/189) and Europe (30%, 56/189) Most papers focused on identifying individuals with high potential (74%, 141/189), particularly in medical school selection, while less attention was given to themes like retention, equity and leadership.

Conclusion: Although 47 papers contained the term "talent", there was a paucity of papers that defined talent within medical education or applied a framework/theory. Interdisciplinary research may be a way to better introduce this concept to our field.

Introduction: Professionalism is a core competency on which learners should, ideally, receive feedback to improve their performance. Feedback literacy conceptualizes how learners make sense of and use feedback. The contextual and subjective nature of professionalism, along with concerns about professionalism's potential to encode majority culture norms, add unique complexity to receiving and responding to professionalism feedback. This study used feedback literacy as a framework to explore how diverse learners experience and respond to professionalism feedback.

Methods: The authors conducted a multi-center qualitative study with a critical constructivist orientation. Fourth-year medical students and senior residents were interviewed about their experiences with professionalism feedback. Interviews were analyzed using reflexive thematic analysis. Feedback literacy provided an analytic lens for theme development.

Results: Thirty-one medical students and 18 residents were interviewed between 2021 and 2022. Learners saw little value in professionalism feedback when viewing professionalism as a character trait rather than a skill to be improved. Learners who received constructive professionalism feedback critically reflected on the quality of their own professionalism and of the feedback, specifically evaluating the feedback for racial or other bias. Constructive professionalism feedback generated protracted emotional responses, and learners often lacked agency to respond to professionalism feedback due to the method of feedback delivery.

Discussion: Learners engage with professionalism feedback by spending significant time examining the context of the feedback and searching for evidence of racial or other bias. Understanding how learners experience professionalism feedback is important for fostering strong professionalism feedback literacy for learners and educators.

Introduction: Medical education learning environments involve charged topics at the intersection of social, political, and cultural domains. Growing student diversity and political polarization add complexity to the discussion of charged topics, yet current literature lacks insight into student perspectives. This study explores how medical students position themselves during charged topic discussions and their preferences for educators' engagement.

Methods: Using educational cultural hegemony as a theoretical framework and a critical constructivist approach, the research team conducted semi-structured interviews with sensitizing scenarios addressing three charged topics: gun control, reproductive healthcare coverage, and affirmative action. Following IRB approval, twenty medical students across all training years were interviewed. Transcripts were analyzed using Braun and Clarke's reflexive thematic analysis.

Findings: We identified four themes: 'Constrained Voices' describes how power hierarchies influence student engagement with charged conversations. 'Burdened Voices' reveals how marginalized students bear a disproportionate burden when educator avoidance of discussions can reinforce dominant perspectives. 'Finding Voice' highlights how students use personal experience to center patient perspectives despite hierarchical constraints. In 'Guiding Voice', students describe the ideal educator as one who uses their experience and evidence-based knowledge to facilitate discussions.

Conclusion: Power hierarchies constrain student engagement in charged discussions, with marginalized students bearing a disproportionate burden when educators avoid these topics. Despite these constraints, students assert agency through personal experience to center patient perspectives. Students seek educators who actively guide discussions using expertise and evidence, viewing neutrality as itself a stance. The findings underscore the need for faculty development addressing these dynamics.

Introduction: A competency committee is a group of experts who make a consensus-based judgement about a learner's competence. While evidence-based practices for post-graduate committees have been described, research and standards are lacking in undergraduate medical education. Medical school competency committees often distribute student reviews to individual members; therefore, understanding how they interpret assessment data is critical.

Methods: Approaching our investigation from a social constructionist orientation, we conducted think aloud interviews with 22 competency committee members at 7 medical schools in the United States from 2023-2025. Participants were tasked with reviewing local student assessment data in preparation for a competency committee meeting and verbalizing thoughts to an investigator. We analyzed transcripts using an interpretivist approach, with sociocultural cognition theory as the primary interpretive lens.

Results: Two major concepts depicted how participants processed student assessment data to arrive at competency determinations: contextual influences and internal reasoning processes. Contextual influences (i.e. goals, data available, and standards for interpreting the data) were outside the direct control of participants. Internal reasoning processes included: first impressions, interpreting trends, and negotiating conflicting data. Contextual influences varied and served as the lens through which participants interpreted assessment data.

Discussion: This study provides the first examination into the thought processes used by medical school competency committee members to make their decisions. Participants used decision-making strategies that parallel those observed in other cognitive reasoning tasks. Contextual influences were foundational in how participants interpreted assessment data, highlighting how competence is socially constructed.

Introduction: This systematic review and meta-analysis evaluates the effectiveness of self-directed learning (SDL) in health professions education (HPE), examining its impact on knowledge, clinical performance, and behavioral outcomes. It investigates whether core SDL components influence educational outcomes, updating and extending the foundational work of Murad et al. (2010).

Methods: We searched CINAHL, Embase, OVID Medline, PsycINFO, and Web of Science (2009-2023) for comparative studies evaluating SDL interventions in HPE. From 6,786 screened articles, 125 studies met inclusion criteria, with 48 eligible for meta-analysis. We conducted a three-level random-effects meta-analysis and moderator analyses on profession, outcome type, SDL modality, and facilitator role. Five independent reviewers conducted screening and extraction, resolving discrepancies via consensus.

Results: The meta-analysis incorporated 74 effect sizes from 48 studies, revealing a small-to-moderate overall effect (Cohen's d = 0.34, 95% CI 0.04, 0.64) with significant heterogeneity (I² = 87%). SDL as intervention showed larger effects (d = 0.54 vs. d = -0.27, p = 0.004). Most studies involved Kirkpatrick Level 2 outcomes (knowledge/skills, 78%), with some Level 3 outcomes (skills/behaviors, 22%) and no Level 4 outcomes (patient/system) reported. Most teachers were absent or acted as facilitators, while learners were less likely to be involved in choosing resources (21%) or in assessments (25%).

Conclusions: This updated meta-analysis reaffirms that SDL reliably enhances knowledge acquisition but suggests that it may yield only modest gains in clinical skills and behaviors. The wide variability in how SDL is defined and reported underscores the need for a consensus definition of SDL.

The medical education system is not designed to recognize and support the nuanced needs of medical trainees from historically marginalized groups. Consequently, many from this cohort must persevere through their medical training with various unmet needs. Within the medical education system, there have long been systemic barriers, or structural inequities, that make training more difficult for trainees from historically marginalized groups; the situation is unfair and can translate into unequal educational outcomes. Regrettably, the convention of ignoring the impact of structural barriers and resultant inequities for trainees from historically marginalized groups may lead to assumptions of innate deficiencies. This deficiency discourse obscures the impact of structural barriers on these individuals' learning, well-being, and academic outcomes. In this paper, we present a novel framework to bring attention to these challenges. This framework emerges from Maslow's 'Hierarchy of Needs' theory to emphasize the importance of comprehensively considering trainee needs that ultimately support their learning and flourishing. Practically, this modified framework may be used directly by trainees themselves to reflect on their needs, and by educators charged with supporting them to more fully bear in mind the lived experiences of trainees. At the programmatic level, the framework may reveal inequities that may be differentially influential within a cohort - thereby informing efforts to support all trainees.

Introduction: Research engagement during undergraduate medical education is increasingly recognized as essential for developing physician-scientists and fostering evidence-based practice. However, evidence regarding its effectiveness, challenges, and long-term impact remains fragmented. This systematic review synthesizes current evidence on outcomes, motivational factors, barriers, and effective practices in undergraduate medical research programs.

Methods: Following PRISMA 2020 guidelines, we searched PubMed/MEDLINE, ERIC, Scopus, and Google Scholar for studies on undergraduate medical research engagement. Two reviewers screened 12,600 records and assessed 262 full texts for eligibility and quality (MERSQI, CASP). Eleven studies (n = 5,564 students, nine countries, 2010-2024) met the inclusion criteria. Owing to heterogeneity, a narrative synthesis was conducted across thematic domains.

Results: Publication rates ranged from 15-55% (I² = 87%), correlating with institutional resources. Students publishing before graduation were 1.9 times more likely to publish afterward (95% CI 1.6-2.3, p < 0.001). Experiential activities enhanced motivation (β = 0.45, p < 0.001) and self-efficacy (β = 0.38, p < 0.001), while grades showed no effect. Major barriers included curriculum demands (78.3%), limited funding (71.5%), and time constraints (61.7%). Prior academic performance did not predict research motivation.

Discussion: Early research engagement fosters long-term scholarly identity but depends on mentorship, protected time, and funding rather than intrinsic motivation alone. Programs emphasizing authentic research experiences outperform grade-based models. Expanding access and addressing systemic barriers are essential to sustain research-oriented medical education and equitable scholarly development.

Introduction: Despite widespread investment in teamwork training, coordination failures persist in acute healthcare environments. Traditional team-based education tends to focus on large teams or isolated technical skills, often overlooking the smallest and arguably most critical unit of collaboration: the healthcare dyad. This study explored how expert healthcare dyads; two individuals working closely in high-stakes clinical settings developed and sustained collaborative expertise. Furthermore, we considered how their practices might have an impact on health professions education.

Methods: We conducted a limited realist-perspective study comprising 10 semi-structured dyadic interviews (20 participants) of expert healthcare dyads in acute care settings. Participants were purposively sampled. Using template analysis, we began with a preliminary coding template based on relational coordination and distributed cognition, then iteratively revised it. We undertook deductive indexing using the template, followed by open coding of uncaptured data. Codes were charted, and our analytical framework constructed by clustering themes, and refining relationships. Interpretation was theory driven.

Results: Using template analysis, we identified four core collaborative strategies: connectedness, situation awareness, physical communication, and reflective practice, all embedded in a foundation of trust. From these findings, we developed the Expert Dyad Framework (EDF), which characterizes relational and cognitive behaviors, comprising of collaborative micro-practices, essential to high-functioning clinical partnerships.

Discussion: The expert dyad framework contributes a practice-informed conceptual tool for educators, highlighting dyadic collaboration as a developmental target for those conducting health professions' education. This study extends existing models of teamwork by focusing on the micro-interactions that underpin team performance.

Background: Clinical reasoning is a critical aspect of clinical practice, though there is considerable variation regarding how and when to teach this skill. This systematic review and meta-analyses examined the effectiveness of interventions that explicitly taught clinical reasoning in undergraduate medical education and the optimal timing for introducing interventions.

Methods: A systematic (PRISMA 2020) search of the SCOPUS, MEDLINE, CINAHL, PsycINFO, ERIC, and Informit databases was conducted from 1 January 2014 to 31 December 2024. The quality of studies was assessed using the Quality Assessment with Diverse Studies tool. Pooled estimates and 95% confidence intervals (CIs) were estimated using both random and fixed effects meta-analyses.

Results: The final sample included 50 studies, of which 46 (92%) reported a measurable improvement. Small-group teaching generally achieved better outcomes, with technology and serious game innovations further improving them. Meta-analysis of six randomised control trials using a random effects model showed an overall significant result (MD 2.23; 95% CI: 0.67, 3.80; I² = 88%). A subgroup analysis indicated that interventions undertaken in pre-clinical years (MD 0.32; 95% CI: -3.99, 4.64; I² = 88%) did not result in significant improvements, whereas interventions in the clinical years were significant (MD 1.89; 95% CI: 1.06, 2.72; I² = 88%). A second subgroup analysis showed that interventions based on face-to-face workshops (MD 1.74; CI: 1.19, 2.28; I² = 88%) were significant.

Conclusions: The findings suggest that small-group activities, such as interactive online modules, may lay a foundation for early-year students, while skills-based workshops and serious games progressively refine and enhance clinical reasoning. Future research should focus on longitudinal outcomes and standardised assessment measures across diverse educational contexts.

Background & need for innovation: Medical education must prepare students to navigate diverse cultural, linguistic, and community contexts. In Malaysia, students' funds of knowledge (FoK) are often marginalized in curricula, despite their potential to inform curriculum design. Traditional didactic norms reinforce educators as primary knowledge sources, leaving students' knowledge and lived experiences underutilized.

Goal of innovation: The Ethnographic Learning Circle (ELC) was designed to transform and generate FoK-informed curricular assets.

Steps taken for development and implementation of innovation: ELC engaged 30 Year 3 medical students during community medicine postings. Students first participated in structured community walkthroughs, documenting observations using a four-component FoK template (place, factors, impact, reflections). Subsequently, two 90-minute facilitated circle discussions guided students in collectively reframing their FoK into curricular assets, using an asset-deficit rubric to ensure student-centered reflection.

Evaluation of innovation: Using a modified Fuzzy Delphi Method, an expert panel reached a 90% consensus that the FoK-informed case study produced through ELC met expectations for transferability, context-specificity, novelty, and curricular alignment. Post-ELC student discussions highlighted enhanced engagement, joy in learning, and more holistic understandings of community health.

Critical reflection on your process: Five key lessons included the need for structured student preparation, trained facilitators, sufficient time, assessment alignment, and effective transferability. ELC offers a practical, effective model for embedding FoK-informed curricular assets into medical education.