Teaching and Learning in Medicine最新文献

Transgender and gender nonconforming (TGNC) individuals in the United States have faced escalating legislative hostility for more than a decade, with a marked acceleration following the legalization of marriage equality in 2015. Federal executive actions and state-level policies enacted in early 2025 represent an unprecedented escalation of this trend, sharply restricting access to gender-affirming care, legal recognition, and diversity, equity, inclusion, and belonging (DEIB) protections. Collectively, these actions constitute a policy-driven public health disaster with profound and potentially life-threatening consequences for TGNC communities. In this perspective, we reframe the current political climate as a policy disaster analogous to natural disasters, arguing that it demands an urgent, coordinated response from health professions educators and institutions. Drawing on disaster scholarship describing the disproportionate harms faced by LGBTQ+ communities during natural disasters, we propose a three-tiered framework for response grounded in cultural humility and critical resistance: (1) integration of structural competency, cultural humility, and advocacy training across undergraduate, graduate, and continuing medical education to prepare clinicians as frontline responders; (2) institutional efforts to address power imbalances and maintain healthcare access for TGNC individuals who are uninsured, undocumented, or living in hostile policy environments; and (3) development of mutually beneficial partnerships with TGNC-led community organizations that often deliver higher-trust and more adaptive care than traditional systems. Through narrative and critical analysis, we argue that medical education must move beyond neutrality to actively resist structural violence. In the absence of state protection, academic medical institutions have both the ethical responsibility and practical capacity to serve as a critical line of defense, mobilizing education, infrastructure, and community partnership to safeguard TGNC health during this unfolding policy disaster.

Despite the widespread application of artificial intelligence (AI) in medical education, limited research has been conducted on the acceptance of this technology from medical students' perspectives. Therefore, this study aims to highlight the factors influencing AI's acceptance in medical education from students' perspectives by extending the Unified Theory of Acceptance and Use of Technology (UTAUT) model with the components of trust and anthropomorphism. The developed model was validated based on data collected from 139 students in Tehran, Iran, over a three-month period from September to November 2024 using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique. The study's results revealed that performance expectancy, effort expectancy, social influence, and trust are directly related to the behavioral intention to accept AI. In contrast, facilitating conditions and anthropomorphism did not show a direct significant relationship with behavioral intention. Importantly, the findings supported the mediating role of trust in the relationship between both anthropomorphism and social influence with behavioral intention, emphasizing the central role of trust in students' decision-making about AI use in medical education. Additionally, the study's findings validated the direct relationship between facilitating conditions and behavioral intention with the acceptance of AI applications in medical education.

In this narrative recounting call-shifts at two separate points in his training, a pediatric resident reflects on the evolution of his heuristic thinking. Developed through pattern recognition and illness scripts, heuristic thinking enables clinicians to perform timely assessments and formulate organized diagnostic and management plans. However, beyond efficiency, the resident discovers-first in observation and later in practice-the benevolence that emerges with refined heuristic thinking.

Pharmacology learning plays a key role in medical education as the basis for prescribing and therapeutics, with direct implications for patients' health. Studies have found deficiencies in medical students' prescribing skills and a scarcity of pharmacology learning in the clinical context. The development of good prescribing skills requires innovative educational approaches. This quasi-experimental study aimed to determine the effects of simulated clinical interviews on the improvement of drug prescribing skills among medical students in Peru. In 2020, we led a research team from three local medical schools with competency-based curricula and an initial stage of simulation development. Using an expert-validated instrument constructed from the World Health Organization (WHO) Guide to Good Prescribing, we assessed students' prescribing skills during three simulated interviews: baseline, pre-, and post-intervention. The educational intervention took place between Interviews 2 and 3, consisting of simulated interview (Interview 2), plus debriefing (after Interview 2), and pre-briefing (before Interview 3) simulation strategies focused on prescribing skills. We assessed its effects on students' performance during Interview 3. Eligible participants were students from each institution who had taken pharmacology in the previous semester (pharmacokinetics, pharmacodynamics, and case studies). We sought their voluntary participation through social media, considering their availability of four hours over two days. Participants received the WHO Guide to Good Prescribing and information about the drugs to be used the following week in the simulated clinical interviews. We had to conduct the three interviews, to which participants were randomly assigned, in two groups-in-person in the first batch and remotely in the second batch-due to mandatory social distancing during the COVID-19 pandemic. Participants' prescribing skills and knowledge significantly improved over the three interviews only when participants experienced all phases of the intervention: pre-briefing, debriefing, and feedback. Pharmacology learning may benefit from the implementation of remote and in-person simulated clinical interviews aimed at developing good prescribing skills. The logical sequence of the WHO Guide for Good Prescribing may facilitate skill assessment and acquisition.

Introduction: Interprofessional Training Units (ITUs) on hospital wards offer a way to prepare healthcare students for collaborative care in the Landscape of Practice (LoP), where professional communities and patients intersect. While learning in ITUs aims to enhance teamwork and patient outcomes, little is known about patient perspectives on care and interprofessional education (IPE) in fast-paced ITU settings. This prompted our research question: What are patients' and their partners' perceptions of the care they received and of the educational dynamics in an ITU on a maternity ward? Methods: Using semi-structured interviews, we collected qualitative data from 14 pairs of patients and their partners in the ITU of a maternity ward in a Dutch teaching hospital between February and May 2025. We adopted an inductive constructivist thematic analysis, using sensitizing concepts from LoP and Core Competencies for Interprofessional Collaborative Practice to guide coding and interpretation. Results: We identified three interrelated themes concerning patients' and their partners' perceptions about care and education in the ITU: 1) Patients' need for trust in the student-team was the key condition for patients' acceptance of interprofessional care on the ITU. For patients to feel they could trust the student team, students needed to convey confidence while being transparent about their limitations and show genuine care for patients and their partners; 2) Patients' and partners' recognition of the value of IPE at multiple levels: for themselves, for the students, and for future patients; 3) Patients' and partners' view of their role in the ITU: when patients felt they were able to trust the student-team, and even more when they recognized the value of IPE, they expressed willingness to facilitate students' learning. However, they described this contribution as limited in scope: they were open to supporting IPE in practice as 'boundary spanners' but did not wish to take on a formal teaching role as 'boundary brokers.' Conclusion: Our study shows that learning with and from patients in an ITU requires shifting beyond a focus on students understanding each other's roles and responsibilities. Instead, it calls for an approach that also acknowledges the needs as well as desired roles of patients and their partners within the LoP. As 'boundary spanners,' patients and their partners can help bridge the gap between their lived experiences of care and students' different professional perspectives. We also offer some practical implications for ITU tutors.

Autistic doctors bring valuable contributions to healthcare but face challenges like managing healthcare's unpredictable nature and difficult colleague interactions. Significant life changes, such as the shift from medical student to resident doctor, can be stressful for autistic people. No research yet has examined how autistic doctors experience and make sense of the critical transition from medical student to qualified doctor, which is what this study aims to do. We utilised an interpretive phenomenological approach for this study, conducting qualitative interviews between October 2024 and February 2025 that we subsequently analysed using interpretive phenomenological analysis. Participants were UK-based doctors recruited through the Autistic Medical Students or the Autistic Doctors International online support groups. Ethical approval was obtained from the Brighton and Sussex Medical School Research Governance and Ethics Committee. Five people took part in the study, and we identified five Group Experiential Themes (GETs). Participants felt powerless due to a system driven by luck (GET 1), where their placements and support were unpredictable, leaving them with little control or agency. This feeling of powerlessness (GET 2) was compounded by a medical culture that felt misaligned with their identities as autistic doctors and made them feel subordinated and excluded from the rest of the medical team. This led to attempts to claw back control (GET 3) by carefully managing their identity, staying hypervigilant of social dynamics, and lowering their expectations. However, this led to internal conflict, exhaustion, and sacrifices in their personal lives to survive in this system (GET 4), leading participants to struggle to reconcile their professional identity (GET 5) with the expectations placed on them. This study highlights how transitioning into a work environment can be stressful for newly qualified autistic doctors and how work environments can inadvertently exacerbate this experience by disrupting long-developed coping strategies, pressuring autistic people to mask and increasing stress and isolation. Creating environments that embrace diversity and support autistic doctors' needs is vital for them to thrive.

For the last century, medical texts often have omitted or ignored the clitoris and its role in female health. Only in the last 30 years has a comprehensive description of the anatomy of the area been elucidated. Despite research establishing the clitoris's essential role in the orgasmic functioning of females, valid concerns exist about the extent to which physicians are trained about this important component of anatomy. In the broader context of medical training about female sexual anatomy and function, both undergraduate and graduate education are inadequately preparing learners for clinical practice in these important areas. With a substantial portion of the female population reporting sexual dysfunction worldwide, the global prevalence of female genital mutilation, and a growing interest in female genital cosmetic surgery, it is essential that physicians be adequately trained about these critical topics relating to the clitoris. A proposed longitudinal model for medical education about female genitalia, and the clitoris in particular, is provided, along with a roadmap outlining specific steps to ensure physicians are adequately trained and prepared for clinical practice.

Leadership development increasingly is recognized as essential to improving patient care and provider well-being, yet many medical education curricula lack clear theoretical foundations to guide the design and implementation. This article describes how six educational theories-deliberate practice, zone of proximal development, reflective practice, social cognitive learning theory, constructivism, and experiential learning theory-can be applied to develop robust, theory-informed leadership curricula in medical education. Drawing on both literature and real-world examples, we analyze the need for theory-informed design, outline the context in which these theories are most applicable, and categorize them into micro (individual), meso (group), and macro (systems) levels. For each theory, we provide practical examples of implementation within leadership training, highlighting how combining congruent theories can optimize learning outcomes, support professional growth, and meet academic standards for dissemination. Educators should use our analysis to (1) match leadership development goals with congruent theories, (2) combine and sequence theories to maximize educational impact, and (3) document the theoretical basis of their curricula to strengthen scholarly rigor and facilitate dissemination. While focused on leadership development, these approaches also offer guidance for other educational initiatives, such as promoting quality improvement and advancing diversity, equity, and inclusion. This report offers a detailed roadmap for educators seeking to engineer leadership curricula that are both evidence-informed and responsive to learners' diverse needs and contexts.

Introduction: Continuous quality improvement (QI) is crucial for successful curricular implementation and innovation in health professions education (HPE). Central to this is a favorable Quality Culture (QC), one that promotes people's beliefs, commitment, engagement, communication, and collaboration. However, the concept of QC remains underexplored in low-income settings, resulting in a limited understanding of its constitutive elements and how to foster them. This study was conducted to identify elements considered essential for fostering QC in Ethiopia's HPE institutions. Methods: In June-July 2024, we conducted a Modified Delphi study with a panel of 31 academic leaders, faculty, and students who had an interest and three years of experience in QI, accreditation, and/or HPE management. Using the Quality Culture Inventory tool, we identified 31 elements. Over three rounds, the panelists used a three-point scale to rate online the importance of targeting each element to foster QC, and proportions were calculated. We retained elements with ≥70% agreement as "essential" and discarded those with ≥70% agreement as "not so important." We reviewed the remaining elements in light of the panel's comments. At the end of each Delphi round, we shared feedback reports with the panelists, which guided the subsequent Delphi rounds. We concluded the ratings after the third round. Results: Of the 31 elements, 18 were considered "essential" to foster QC. Five elements reflected the individual psychological dimension: belief, commitment, participation, connectedness to quality goals, and leading change. Three elements reflected the collective psychological dimension: strong peer support, functional working groups, and experience-sharing practices. In the formal structural quality assurance (QA) dimension, priority was given to the presence of decentralized quality departments that facilitate regular self-assessments. Seven other elements were related to academic leadership and human resources development. Conclusions: To foster QC, HPE institutions enhance academic leadership, staff development, and motivation. Addressing people's psychological factors strengthens their beliefs, commitment, participation, connectedness to the quality agenda, and mentality for leading change. Equally important is decentralization of quality departments to enhance their responsiveness and ownership.