Advances in Health Sciences Education最新文献

In a world that is increasingly globalised and fragmented, medical education is shaped by complex political, social, and economic forces at local and international levels. This article argues that preparing for the future of medical education in such a changing landscape requires engagement with long-term historical perspectives. Drawing on the history of empires, it highlights how former imperial metropoles, entrenched colonial legacies, and inequities in medicine influence governance and the professional mobility of students and practitioners, notably through international accreditation standards. The article emphasises the importance of recognising historical and regional specificities, cautioning against overly uniform narratives - such as the "Global North-Global South" divide. Through case studies of China and Pakistan, it aims to demonstrate how historical insights can reveal comparable yet divergent trajectories in medical education. It concludes that our present is not outside of history but shaped by it, urging educators to critically examine inherited assumptions and to imagine more equitable futures by metaphorically seeing the world "upside down."

Health systems worldwide continue to face health inequities rooted in social, political, and economic structures. In response, health professions education (HPE) programs are increasingly aiming to prepare learners for socially accountable practice. Despite this growing attention, social accountability remains ambiguously defined and inconsistently taught, assessed, and enacted across curricula. The aim of this scoping review was to map the breadth and depth of educational approaches within HPE that promote social accountability. A scoping review was conducted following Arksey and O'Malley's six-stage framework and the Joanna Briggs Institute methodology. MEDLINE, EMBASE, CINAHL, ERIC, APA PsycINFO, and Education Source were searched for articles published from January 2000 to May 2020, with an updated search in 2024. Screening involved a calibration exercise at both title/abstract and full-text stages. Descriptive numerical analysis and reflexive thematic analysis were employed, supported by knowledge user consultation. Most articles originated in North America (n = 179; 82%) and focused on undergraduate medical education (n = 157; 71.7%), especially among future physicians (n = 122; 55.7%). Common strategies included reflection-based learning (n = 90; 41.1%), small group learning (n = 82; 37.4%), and didactic lectures (n = 80; 36.5%). Many studies described using multimodal approaches (n = 85; 38.8%). Educational approaches emphasized experiential, reflective, and community-engaged learning and were grouped into ten overarching categories. These were organized using the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET). By synthesizing how educational approaches to social accountability are reported, this review offers a basis for reflection, dialogue, and further inquiry into their development, delivery, and integration in HPE curricula.

Assessing clinical reasoning is a challenge in all stages of medical education. Beyond the verbal communication of clinical reasoning within the hierarchy of medical education, written communication is a multi-purpose complex adjunct to support the educational process. This study applied and validated a retrospective template analysis of clinical notes using a comprehensive clinical reasoning typology intended to broaden the measurement of clinical reasoning beyond predominantly cognitive activities. Applying the typology to written communication demonstrates that increasing complexity of the analysis is mediated by intra-textual and discourse coherence, as well as the semantic ambiguity of clinical writing. The findings from this study suggest that a significant amount of information during the clinical encounter is pertinent to clinical reasoning but inferred within the contextual medical knowledge held by the writing and reading physician. Ultimately the structure and purpose of the clinical narrative reinforces both a physician-relative and culturally shaped practice of documentation. Beyond specific findings from this study, as the electronic medical record further matures and is shaped by both technology and the computer itself in the exam room, educators must seek to teach the task of clinical reasoning explication through writing, yet pay attention to the technology within the encounter and medical record itself, which shapes the clinical narrative.