Perspectives on Medical Education最新文献

This commentary amplifies the contributions of Horton et al.'s study on Black physician trainees' professional resistance, situating it within the broader landscape of health professions education (HPE). As Black women physician-educators, we reflect on the profound resonance of the study's themes-resistance as survival, as existence, and as professionalism. Horton et al. employ Endarkened Storywork and Black quilting to not only document Black trainee experiences but to disrupt conventional research paradigms that marginalize their truths. This commentary argues that their work challenges the field to reimagine equity by centering marginalized voices, redefining resistance as a daily, embodied practice, and questioning research frameworks rooted in whiteness. We emphasize the urgency of methodological transformation in HPE and the ethical imperative to design and interpret data in ways that affirm rather than exploit minoritized communities. By framing the acts of showing up, mentoring, and refusing assimilation as legitimate resistance, this work redefines professionalism and provides a roadmap for institutional accountability. To advance equity, educators and researchers must not only study resistance-they must practice it.

Introduction: Programmatic Assessment displays the comprehensive picture of a learner's competence through selection of assessment methods and design of organisational systems [1]. This paper describes how the Irish College of GPs (ICGP) designed and implemented a new, national, workplace-based assessment (WBA) system for GP training as part of an ongoing evolution towards Programmatic Assessment, with a focus on assessment-for-learning [1].

Methods: Six overlapping workstreams over five years led to success: iterative consultation and design, entrustable professional activities, software design, stepwise implementation, separation of mentor/assessor roles and WBA training embedded in feedback literacy and growth mindset learning.

Results: Our design focused on collecting longitudinal, low stakes assessments organised into core competences in a manner to support learners. 18 entrustable professional activities were developed and implemented, along with a software platform designed to enter and display accumulated data. Competence committees assess both qualitative and quantitative data periodically on the learner's journey to oversee progression and make high stakes decisions. We describe the development of the system along with aids and barriers to its adoption.

Discussion: Structured continuous consultation with the training community and constant reference to the educational literature were both important for success. Novel features of our system are the distancing of mentor and assessor roles, the avoidance of recommended minimum numbers of WBA entries, and consideration of the validity and reliability of the system as a whole rather than of the tools.

Introduction: Using Identity and Social Identity Theory as frameworks, we investigated the contribution of placement in an Interprofessional Training Unit (ITU) on a maternity ward to professional and interprofessional identity development, the interplay between these identities, and the association with some background factors.

Methods: A prospective pre-post-intervention design was used. Before and after ITU placement, students in two Dutch hospitals participated in an online survey, comprising background characteristics, and scales measuring professional (PI) and interprofessional identity (IPI). PI and IPI scores between T0 and T1 were compared by means of a paired t-test. A two-way factorial ANOVA was used to test for differences between groups, based on background factors.

Results: Out of 209 students, 179 students (89.9%) completed the pre- and post-placement surveys. We found no significant change in professional identity formation, but a significant increase in interprofessional identity formation across the placement for students from all three professions, with midwifery students having the highest increase. Students with higher PI scores had significantly higher IPI scores before placement compared to students with lower PI scores, without a significantly higher increase in IPI during the placement. No significant differences in IPI change were found for other variables.

Discussion: We found that a one-week interprofessional placement significantly increased students' interprofessional identity, with midwifery students showing the largest raise. Students with a higher PI also had a higher IPI before the ITU placement, suggesting a stronger PI is associated with a greater propensity for fostering IPI. Possible explanations for these findings are offered.

Introduction: Learning by concordance (LbC) is an educational approach designed to develop expertise, particularly in the field of clinical reasoning (CR) among healthcare professionals. It is based on the script concordance test (SCT) with the addition of feedback based on expert responses. The objective of this study was to map the scientific literature on this rapidly growing learning approach.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and the PRISMA-ScR guidelines. A systematic search was conducted in MEDLINE, Embase, CINAHL, Web of Science and Google Scholar up to March 10, 2025. Eligible primary studies had to focus on the LbC approach targeting healthcare learners.

Results: Twenty-eight studies met the inclusion criteria: twenty focused on the implementation of the LbC approach and eight on its development. Most of the studies used mixed methods (quantitative and qualitative). The results mainly indicate that learners perceive the LbC approach as engaging and beneficial for decision-making. The articles mention five elements related to the development of LbC that would contribute to its success.

Discussion: The LbC approach could be applicable to a wide range of disciplines and learning levels. The variability in the procedures for developing the approach, as well as the variability of the objectives and methodologies of the studies, limit the comparability of the results.

Conclusion: LbC is a promising approach for promoting decision-making skills in a variety of uncertain clinical contexts. The concept of standardized development and evaluation frameworks for this approach could improve its applicability, effectiveness and reproducibility.

Medicine has long relied on standardization to ensure safety, consistency, and efficiency. From evidence-based guidelines to competency-based curricula, standardized practices have shaped both clinical care and medical education. Yet, as social conditions evolve and clinical complexity increases, this commentary argues that rigid adherence to standardized protocols can become a liability. We explore how excessive standardization can constrain expert judgment, perpetuate inequities in education, and hinder responsiveness to emergent societal needs. Drawing on examples from admissions, assessment, and clinical practice, we show how the very structures meant to promote fairness and safety can inadvertently undermine equity and adaptability. We call for a shift toward "adaptive standardization"-an approach that balances consistency with contextual flexibility. Such a shift requires not only individual discernment but also systemic support for clinicians and educators to tailor decisions to specific circumstances. Ultimately, we argue that fostering adaptability alongside standardization is essential for medical systems to remain responsive, just, and resilient in a rapidly changing world.

The COVID-19 pandemic dramatically disrupted traditional bedside teaching in medical education, emphasizing the need for innovative approaches to clinical training. This disruption highlights a critical opportunity to reassess and enhance medical education practices for future resilience. This paper examines the changes in bedside teaching brought about by the COVID-19 pandemic and explores the use of novel tools and technologies to support this essential educational practice. Key adaptations to bedside teaching involved virtual patient interviews, telemedicine clinics, and live-streamed surgeries. Hybrid models allowed for the co-location of some participants while integrating virtual supervision. Challenges included access disparities, technological limitations, and the inability to fully replicate hands-on training. Evidence supports the retention of traditional bedside teaching for high-contact encounters, hybrid models for limited-contact scenarios, and fully virtual teaching for non-contact educational needs. The pandemic has demonstrated the adaptability and resilience of medical education. By strategically incorporating virtual and hybrid approaches, we can enhance the quality, accessibility, and effectiveness of bedside teaching. These approaches not only address the challenges posed by the pandemic but also offer opportunities to prepare future healthcare professionals for a dynamic and technologically advanced healthcare environment.

Introduction: When considering personal characteristics in undergraduate medical admission, professional prequalification (i.e., previous work experience in the medical field) and performance on situational judgement tests (SJTs) are prominent criteria. Despite evidence on the ability of professional prequalification and SJT performance to predict general interpersonal skills, their benefit for students' concrete behavior in everyday situations remains unclear.

Methods: With the present study, we examined how undergraduate medical students with prior professional qualification and students with better SJT performance act in actual social situations by using a behavior-focused observer approach. Supervisors rated the students after a mandatory one-week practical training in general medicine on three distinguishable interpersonal dimensions, namely agency (i.e., assured-dominant), communion (i.e., warm-agreeable), and emotional stability (i.e., calm and stable). Prior to admission, participants (N = 210) completed a traditional SJT (i.e., HAM-SJT), a natural science test (i.e., HAM-Nat), and responded to sociodemographic questions.

Results: Controlling for cognitive admission criteria, age, and gender, students with prior professional qualifications were rated as more assured-dominant (β = 0.21; 95% CI [0.04; 0.39], p = 0.019), whereas students with better HAM-SJT performance were rated as more warm-agreeable (β = 0.17, 95% CI [0.02; 0.31], p = 0.024).

Discussion: The results value both admission criteria as complements to cognitive criteria in undergraduate selection but emphasize their differentiated focus on students' interpersonal behavior. Medical schools are invited to review their admission criteria based on the present findings and on the question of required and learnable skills.

Background: Preparing medical students how to learn during clerkships is vital to support their transition from preclinical to workplace learning. However, training programs fostering students' workplace learning skills are sparse. To address this gap, the 'Learning to Learn at the Workplace' training program was developed, combining strategies for informal workplace learning with self-regulated learning (SRL) techniques.

Approach: Using the 'ADDIE' instructional design model, the training was developed, implemented and evaluated. It consists of four classroom sessions combined with workplace assignments, each addressing a different SRL theme for informal workplace learning: learning goals, asking questions, feedback, and reflection. Additionally, the influence of the clerkship context on SRL is addressed, with the aim to enable students to recognize and utilize informal workplace learning.

Outcomes: The training was piloted with medical students during their second or third clerkship (n = 33). Students provided written feedback following each session and completed a final questionnaire (n = 21). Teachers evaluated implementation fidelity after each session. Students reported that the training effectively supported their self-regulated workplace learning. They particularly valued its relevance, practical tools, and the opportunity to exchange clerkship learning experiences.

Reflection: Students gained valuable insights into self-regulated informal workplace learning at clerkships. To further stimulate application of taught skills during clerkships, better integration of transfer tasks into the training is suggested. Involving numerous stakeholders and extensive literature in the developmental process ensured this training aligned with students' needs and received positive evaluations from students, teachers, and curriculum developers. Subsequently, the training will become a mandatory part of the current curriculum.

Purpose: Attendings and trainees are expected to use basic science knowledge (BSK) in clinical practice and learning. Evidence of how is scant, and more research situated in clinical learning environments (CLEs) is needed. Our study aimed to characterize use of BSK during patient care in a CLE and the actions, interactions, materials, and beliefs that influence its use, to inform efforts to connect BSK education to clinical workplace learning and patient care.

Method: We conducted a constructivist grounded theory study, collecting data from eight inpatient Internal Medicine (IM) teams at one US institution from October 2022 to January 2023. Data included field notes from 27 hours observing inpatient rounds and 24 team member interviews. Iterative data analysis involved coding, memo writing, and constant comparison to develop a theory of BSK use on IM inpatient rounds.

Results: We found that BSK can be activated on rounds through social interactions (among team members, with patients), and in contact with materials (e.g. the electronic health record). Our findings describe BSK as activated when team members connect to and test BSK or when they explore uncertainty; and that activation is supported by beliefs that BSK use brings value to patient care. However, team members often left BSK not activated, accompanied by beliefs about it not being a good fit for patient care activities. Actions associated with leaving BSK not activated included delegating responsibility for using it, deferring discussion, or curtailing conversations about it.

Discussion: Much of the literature describes BSK use in the clinical setting as the product of individual cognition. Our findings extend this characterization, illustrating how social and material elements of the inpatient CLE influence BSK use on rounds. These elements can be leveraged to activate BSK to support integration of learning with patient care in the workplace.

Introduction: Power plays a crucial role in mentoring relationships as mentoring is inherently a social and relational practice. Power dynamics can function as a gatekeeper to students' learning opportunities and experiences, making it crucial to build a better theoretical and empirical understanding of how it operates in and through mentoring relationships. This study explores how students participate in power dynamics in mentoring relationships during their internship. It starts from the view that power is not solely tied to hierarchy, but is in a continuous flux, recognizing that students also participate in power dynamics and shape mentoring relationships.

Methods: The study draws on a multiple case-study of four mentoring dyads in undergraduate general practice internships. Non-participant observations were combined with periodic interviews and audio diaries. We took a discursive perspective on power dynamics that was operationalized through the integration of positioning theory and frame analysis.

Results: The analysis resulted in four enactments of power by students: resistance, imposed power, empowerment, and vested power. The four enactments can be situated on two axes, that is, doing power versus being enabled to do power; and whether the mentors' and students' frames align or not.

Discussion: The findings documented the potential power of the students by introducing a novel discursive framework. Students enact power by doing power themselves or being enabled to do power by their mentors; supporting that students also have responsibilities in the mentoring relationship. Making students' and mentors' expectations and goals explicit can provide insight in supporting students during mentoring experiences.