Perspectives on Medical Education最新文献

Background: Role-playing is widely used to foster empathy and perspective-taking in medical education, but the underlying psychological mechanisms remain unclear. This study investigated whether actual role enactment enhances engagement compared to imagination alone, and how immersive role-play influences students' emotional and cognitive processes.

Methods: Sixty second-year medical students participated in a two-stage intervention: the Imagination Stage (imagining being a patient or caregiver) and the Role-Playing Stage (actively enacting both roles in a counterbalanced design). After each stage, students wrote reflections. Language use was analyzed using the Chinese version of the Linguistic Inquiry and Word Count (LIWC) tool. Function word frequency was used to calculate the Level of Engagement (LOE). Along with affective and cognitive word usage, these measures provided insights into students' psychological processes. Human ratings of empathy and perspective-taking were conducted by trained psychology students.

Results: Reflections from the Role-Playing Stage-particularly in the caregiver role-showed significantly higher LOE compared with the Imagination Stage. Higher LOE scores correlated with increased human-rated empathy and perspective-taking. LIWC analysis revealed that patients used more first-person pronouns and negative emotion words, while caregivers used more third-person pronouns, conjunctions, causation, and discrepancy words. Role-playing also led to a decrease in first-person pronouns, negative emotion words, and anxiety words, with an increase in conjunctions and certainty words.

Conclusion: Immersive role-play enhances students' emotional and cognitive engagement beyond imagined scenarios. Objective linguistic analysis provides valuable insights into learners' psychological processes, highlighting the pedagogical value of immersive role-play in fostering empathy and perspective-taking in medical education.

Introduction: The field of medical education (ME) has grown substantially over the past decades, yet questions remain about its scope and boundaries. This study examines how research topics and institutional collaborations have evolved in ME from 2000 to 2019.

Methods: Adopting a post-positivist stance and using bibliometric network analyses, we examined metadata from 31,338 publications across 22 core ME journals indexed in the Web of Science. We analyzed trends in institutional collaboration and the development of research themes. Extracted metadata included authors' institutional affiliations and KeyWords Plus (n = 18,218). Bibliometric analyses were conducted using VOSviewer, a widely used tool for network mapping. We generated co-authorship networks to trace institutional collaboration and co-word networks to identify thematic clusters.

Results: Co-authorship networks revealed increasing collaboration, with U.S. institutions remaining central and Canadian and Dutch institutions gaining prominence. Co-word analyses identified three stable clusters-teaching and learning, quantitative, and psychosocial-with teaching and learning dominant across all periods and the quantitative cluster expanding in recent years.

Discussion: Findings show the consolidation of teaching and learning as the foundation of ME, alongside diversification through quantitative and psychosocial themes. Growing collaborations suggest the field's maturation, though geographic imbalances persist. Limitations include reliance on a restricted set of Web of Science journals, which overrepresent English-language and highly cited publications, and the use of KeyWords Plus as a proxy for themes. This study offers an evidence-based mapping of ME's evolution and provides a framework for future research on the interdisciplinary and global dynamics of the field.

Introduction: Social media has transformed medical education by facilitating learner-led digital communities that co-construct knowledge. Previous studies position it as a passive information delivery tool. This fails to capture complex relationships between learners and technologies that may create new potentials for learning, teaching, and participation in the educational process. Our aim was to explore the interactions and patterns of information flow emerging within "What is, this is" (WITI), a social media-based peer teaching community of medical students.

Methods: This was a qualitative study using a digital ethnography approach. We collected multiple sources of data comprising screenshots of WITI pages (n = 35), observations of participant interactions on WITI, and individual semi-structured interviews (n = 14). Data were analysed using abductive thematic analysis with relational transfer as a theoretical framework.

Results: We identified three themes: 1) engagement in a connective space; with 2) decentralization of knowledge and authority; leading to 3) co-production of knowledge as a community. We found that learners actively shaped the use of social media technology and learner practices were patterned by social media affordances in a dynamic and symmetric relationship. This gave rise to a decentralized, collaborative and self-regulated knowledge-sharing digital community wherein the roles of teachers and learners were fluid and non-exclusive.

Discussion: Our study provides insight into new and potentially disruptive learning practices and teacher-learner relationships within student-led digital learning spaces. Our findings highlight the potential of social media to support peer teaching amongst medical students, and the need to reimagine the role of the medical educator as a guide for, and collaborator with, students.

Introduction: Medical educators are central to guiding students through the emotional challenges of moral dilemmas in end-of-life (EoL) decisions. However, the literature often overlooks how medical educators support students during these moments. This study explored strategies medical educators employed and challenges they encountered in supporting students facing moral dilemmas in EoL care.

Method: This qualitative study analyzed interviews with fifteen medical educators from diverse clinical settings, focusing on how they support students during EoL decisions to withhold or withdraw life-sustaining therapy.

Results: Medical educators initially offered equal support to all students but progressively adapted their strategies based on perceived student engagement. These strategies were not pre-planned or fully conscious, but emerged in real time as educators navigated the emotional and cognitive demands of EoL decisions. Medical educators increased personalized support to students perceived as "highly engaged", while gradually reducing support for those perceived as "less engaged". They struggled to balance their role as comprehensive supporters with time constraints, administrative duties, and a hidden curriculum prioritizing clinical skills over emotional connections and patient-centered care.

Discussion: Building on our previous investigation into medical students' experiences of moral dilemmas in EoL care, this study shifts the lens to medical educators. It reveals a critical oversight: students feeling emotionally overwhelmed may be misinterpreted as disengagement. This misalignment can hinder educators' support strategies, potentially reducing support when most needed. The study advocates for an 'Educational Alliance' grounded in trust and mutual respect, and calls for structural reforms to sustain educators' capacity to provide consistent, emotionally attuned support.

Background: Global frameworks of medical professionalism are often grounded in Western liberal values, which may misalign with ethical expectations in non-Western contexts. In Taiwan, where Confucian traditions shape clinical interactions, professionalism is rooted in relational ethics, family-centered care, and emotional labor. This study explored how professionalism is culturally defined and negotiated among key stakeholder groups in Taiwanese healthcare.

Methods: A qualitative, constructivist-interpretivist design guided the study. Eleven focus groups were conducted with 78 participants from a major teaching hospital and surrounding community in northern Taiwan, including practicing physicians (n = 25), medical students (n = 20), and members of the public (n = 33). A constructivist-interpretivist paradigm informed data collection and thematic analysis using Braun and Clarke's six-phase approach. Coding was conducted in Mandarin and triangulated by an interdisciplinary research team with clinical, sociological, and educational expertise.

Results: Eleven subthemes were identified and organized into three themes: (1) humanistic and relational values (e.g., empathy, moral character, emotional labor); (2) professional expectations (e.g., communication, accountability, lifelong learning); and (3) cultural tensions (e.g., service orientation, family obligations versus patient autonomy). Stakeholders expressed divergent views of professionalism, particularly between public expectations and formal curricular ideals.

Discussion: Findings underscore the need for culturally responsive professionalism education in Confucian-influenced contexts. Integrating relational ethics, emotional attunement, and family-centered values into curricula, assessment, and faculty development may better align training with societal expectations. This study offers a contextualized framework for professionalism that reconciles global standards with local moral landscapes.

Background: Workplace learning of health care professionals benefits from a cyclical process of self-regulated learning (SRL), in the phases of forethought, performance, and reflection. This SRL process can reduce safety incidents, a particular concern in high-risk situations of surgical practice. Surgeons who endorse a growth mindset and are motivated professionals may engage more actively in SRL. However, the interrelations between mindset, motivation, and SRL remain unclear. Therefore, we investigated how surgeons' mindset is associated with SRL, and whether this association is mediated by motivation.

Methods: We invited surgeons of Dutch surgical associations to complete a web-based survey containing validated instruments on growth and fixed mindset, autonomous and controlled motivation, and the three phases of SRL. Data were analyzed using path analysis in a sample of 170 surgeons.

Results: Growth mindset was positively associated with all three phases of SRL: forethought (β = 0.30, 95% CI [0.164, 0.441]), performance (β = 0.22, 95% CI [0.076, 0.373]), and reflection (β = 0.18, 95% CI [0.040, 0.323]). Additionally, fixed mindset was indirectly negatively associated with the forethought phase of SRL through lower autonomous motivation (β = -0.03, BC 95% CI [-0.082, -0.002]).

Discussion: Surgeons holding a stronger fixed mindset reported lower levels of autonomous motivation, which were subsequently associated with less frequent use of SRL in the forethought phase. Conversely, more frequent use of SRL across its three phases was reported by surgeons holding a stronger growth mindset. These findings call for support of surgeons' growth mindset, to facilitate surgeons' roles as motivated and self-regulating learners striving for continuous performance improvement.

Introduction: Lack of diversity in the healthcare workforce harms patient care and outcomes, driving calls for more inclusive medical education. Physicians from disadvantaged backgrounds often serve underserved areas, and diversity improves cultural competence and trust. However, admissions still favour higher socioeconomic applicants, with barriers like standardized exams limiting access for underrepresented groups. This review examined barriers and enablers to medical school access for underrepresented groups, aiming to inform fairer admissions practices.

Methods: A scoping review was conducted using Arksey and O'Malley framework to map literature on barriers and facilitators to medical school access for applicants from migration backgrounds and low socioeconomic status. A comprehensive search of PubMed, ERIC, and Google Scholar (Nov 2024-Apr 2025) included studies in five languages published in the past 10 years. Data were extracted in early 2025 and thematically analyzed using Braun and Clarke's method.

Results: Underrepresented groups face structural, institutional, economic, social and psychological barriers to medical school entry. Key challenges included financial hardship, inadequate academic support, lack of social capital, exclusionary institutional practices and psychological factors. However, targeted interventions - such as pipeline and outreach programs emphasizing mentorship and support networks - can help mitigate these barriers.

Conclusion: Despite ongoing efforts to widen participation, underrepresented groups continued to face complex, intersecting barriers to medical school admission. Addressing these challenges required more than general policy initiatives - it called for intentional, community-based approaches tailored to students' specific needs. This review highlighted the need for sustained, systemic change alongside targeted support strategies.

Introduction: In health professions education, assessment is increasingly viewed not merely as a tool for grading, but also as a means of shaping a productive learning environment. This shift promotes student-centered learning and enhances students' self-regulated learning (SRL). Consequently, faculty members are expected to take on the role of facilitators, providing rich feedback and coaching to support student learning. However, this is not easy in practice, and these underlying mechanisms are not yet fully understood. The research question of this exploratory study is: How do faculty perceive their roles and the tensions in supporting student learning and self-regulation through feedback and coaching in programmatic assessment?

Methods: This study adopted a qualitative constructivist paradigm. Seventeen faculty members participated in five semi-structured focus group interviews. Thematic analysis was employed, integrating both inductive and deductive approaches.

Results: The analysis produced four key themes: (1) Providing feedback at the task level is easier than giving suggestions for further development of competencies; (2) Tailoring narrative feedback to personalized learning paths is challenging; (3) The primary role of coaching is to foster students' reflection and autonomy, while adapting to students' needs when necessary; (4) Coaching requires a balance between stimulating autonomy and fulfilling graduation requirements.

Discussion: This study shows that faculty believe that programmatic assessment enhances learning, but they experience challenges and tensions in stimulating students' SRL in practice. It is not easy to tailor feedback to meet students' individual needs and to align coaching for SRL with graduation requirements.

Purpose: Mistreatment in medical training environments has been linked to emotional exhaustion, yet the underlying mechanisms remain underexplored. This study examines the mediating role of emotional regulation and social support in the relationship between mistreatment and burnout among graduate medical trainees.

Method: We conducted a cross-sectional survey of 266 graduate medical trainees from one of the largest GME institutions in the northeastern United State. The survey included measures of workplace mistreatment, emotional regulation, social support, and burnout. Path analysis was employed to test direct and indirect relationships among mistreatment, emotional regulation, social support, and burnout.

Results: Mistreatment was significantly associated with burnout, with personal attacks demonstrating a strong direct effect (β = 0.36) and a substantial total effect (β = 0.55). Emotional dysregulation partially mediated this relationship, with a significant indirect effect (β = 0.16). Suppressive emotional regulation strategies also contributed to burnout. Social support played a protective role, reducing the impact of mistreatment on burnout.

Conclusions: These findings underscore the detrimental impact of mistreatment on medical trainee well-being and the critical role of emotional regulation and social support in mitigating burnout. Institutional interventions should focus on strengthening peer and leadership support networks, and integrating emotional regulation training into residency programs. Addressing these factors can enhance resilience, improve professional fulfillment, and promote a more supportive medical training environment.

Background & need for innovation: Approximately 10% of medical students live with a chronic somatic or mental condition. They often feel alienated in the dominant culture of invulnerability in medical education. We developed the 'Medical Double Talents' (MDT) innovation to facilitate medical students living with chronic conditions - MDTs - to teach their fellow medical students.

Goal of innovation: The goals of the MDT sessions are to increase medical students' empathy and compassion for patients with chronic conditions, to challenge the implicit culture of invulnerability, and to help MDTs turn their patient experiences into a strength.

Steps taken for development and implementation of innovation: The MDT sessions were developed using a co-design approach, engaging medical students with chronic conditions at high levels of patient involvement. These students built a supportive community, received training, and shared their unique perspectives during teacher-facilitated guest lectures and small group discussions.

Evaluation of innovation: In November 2024, 263 medical students participated in 24 MDT sessions. They reported highly appreciating the personal insights shared. The MDTs felt empowered by the experience as lecturers. The student-led dialogue enhanced engagement, though some students desired more information about the medical context before the session. These sessions complement traditional training.

Critical reflection on your process: The MDT sessions challenge the implicit culture of invulnerability in medical education. The shared experiences can help foster empathy, self-reflection, and transformation in their peers. This innovation, integrated into Utrecht's curriculum, highlights the need for safe learning spaces and community building to implement similar programs elsewhere.