Teaching and Learning in Medicine最新文献

Medical education plays a crucial role in shaping how future physicians understand and approach the prescribing of teratogenic medications to individuals with the capacity for pregnancy. The teaching that we, as medical students, experienced on this topic relied on blanket cautions derived from current guidelines that either warn students to never prescribe teratogenic medications for "women of childbearing age" or to adhere to rigid contraceptive mandates that lack guidance on contraceptive counseling, reproductive goals, or individual risk. This educational approach erases patient diversity and undermines the principles of reproductive justice. As students who are invested in reproductive health both from an educational and personal standpoint, and with our clinical education taking place in an institution and geographic and political context supportive of comprehensive reproductive health, we felt a better approach was possible. We have witnessed thoughtful, nuanced conversations between patients and providers surrounding the friction between patients' fertility goals and treatment options for other medical conditions. We outline three anecdotes that exemplify the discordance between the limited preclinical instruction most of our classmates receive and the clinical practices we have observed that foreground reproductive justice, inclusivity, and patient-provider trust. Moreover, there is a lack of empiric evidence regarding medical students' knowledge and capacity to conduct teratogenic medication counseling. Existing literature reveals a fragmented and simplified approach taken by many clinicians in prescribing these drugs. These shortcomings are related to those that exist in the context of our personal education, and it is likely that medical education on the topic of teratogenicity, contraception, and fertility is institution dependent. Given that best practices and instructions for approaching these counseling situations are not yet formalized, it is reasonable to assume that students are likely graduating from medical school with varied levels of confidence, skill, and training in this area. We find it necessary that reproductive counseling and contraceptive care for patients on teratogenic medications is taught comprehensively to students to reflect our responsibility as physicians to respect individual reproductive goals, provide inclusive and affirming care, and build trust. The individual tension we have identified within our educational experience sheds light on an area of instruction that may hold significant potential in shaping a generation of thoughtful, effective physicians.

Issue: Global reforms under the banner of diversity, equity, and inclusion (DEI)-and more recently, justice-oriented frameworks such as justice, equity, diversity, decolonization, indigenization, and inclusion (JEDDII)-aim to strengthen belonging in medical education, yet DEI language and governance have become politicized in some jurisdictions, exposing institutions to audits, reputational attacks, and funding risks. Evidence: Self-Determination Theory (SDT) offers an evidence-based framework centered on relatedness-the universal psychological need for authentic connection-that can complement DEI/JEDDII efforts by translating inclusive aims into observable practices and measurable learner experiences, even amid contested discourse. This article situates belonging within relatedness, synthesizes international evidence, identifies structural barriers, and proposes multilevel strategies-policy, curricular, and bedside-for cultivating relatedness. Implications: By aligning belonging with universal psychological needs and defensible educational outcomes, institutions can sustain progress and meaningfully support medical learners in ethical and enduring ways.

Reflective Practice (RP) is a continuous process of analyzing one's experiences to inform or change future practice. Narrative Medicine (NM) uses humanities-based methods like close reading and writing to enhance one's ability to recognize, understand, and respond to patients' and clinicians' stories. Both RP and NM have been shown to professionally benefit medical trainees and healthcare providers. However, there is a paucity of published studies that describe the impact of longitudinal RP/NM curricula in medical schools. The Oregon Health & Science University (OHSU) School of Medicine curriculum includes a required four-year RP/NM curriculum. It consists of nine required sessions (seven small-group and two large-group sessions) across four years. Curricular activities include responding to prompts about patient care experiences via written notes and analyzing visual art pieces and poems. Two cohorts of medical students (Class of 2023 and 2024) completed two online surveys that assessed perspectives about RP (Survey A) and NM (Survey B) at five different timepoints during medical school. More than 600 (n = 617) post-session surveys (Survey A) were completed before didactics (Time 1), after didactics (Time 2), and after clinical rotations (Time 3), with a 66.7% response rate. Of these, 95.7% of respondents agreed that RP was an essential activity for physicians, and 85.7% indicated it was essential for medical students. We found a statistically significant increase in students practicing RP from the start of medical school compared to later time points. Survey B (response rate 81.7%) was completed during the clinical phase and indicated that students regard NM as a tool that improves their clinical skills (76.5%) and well-being (79.1%). Our study demonstrates a feasible, required, longitudinal RP/NM curriculum in undergraduate medical education that fosters students' ability to understand and engage with narratives of self and other, to enhance personal and professional identity, and to meet the national standards of developing self-directed, lifelong, and reflective learners.

Phenomenon: Continuing professional development (CPD) providers innovate and adopt alternate delivery models to better meet the needs of contemporary healthcare professionals (HCPs). This study aims to investigate HCPs' CPD preferences and needs. Approach: In April 2024, we conducted a cross-sectional, Q-methodology study to investigate the preferences and needs of healthcare professionals (physicians, nurses, allied health professionals, etc.). We recruited 47 participants for three main study phases: concourse generation, Q-sort, and by-person factor analysis and interpretation. We also recorded demographic characteristics, including age, geographic location, healthcare discipline, and years of practice. Findings: We derived a Q-sample containing 40 statements related to HCPs' CPD preferences and needs following a review of CPD program evaluation data and a comprehensive literature review. The study participants' age and occupation were evenly distributed but a large majority practiced in Ontario, Canada. We identified four factors, representing different types of CPD participants and their training needs. Value and productivity-focused clinicians preferred convenient and time-efficient CPD activities due to heavy clinical workloads and perceived consequences of work absence. Application and competency-based learners consisted of senior HCPs who prioritized learning activities that were relevant and applicable to clinical practice. Respite seekers and growth-oriented professionals were younger and more interested in training involving nontechnical topics (e.g., leadership, equity, diversity and inclusion). Respite seekers viewed CPD as a retreat while remaining in-practice, but growth-oriented professionals sought to develop skillsets that were transferrable and facilitated role transition. We also identified a single consensus statement that highlighted neutral viewpoints toward the need for CPD activities to have "appropriate difficulty and volume of content." Insights: Q-methodology facilitated deeper understanding of regional CPD preferences and needs, uncovering viewpoints masked by social desirability and professional expectations. These preferences and needs were also potentially influenced by structural issues and demographic factors (age, levels of experience). Greater needs-matching and alignment with government policies and profession-specific regulatory standards can improve meaningful learning and CPD uptake. Future research should conduct more in-depth analysis of the identified factors through comprehensive demographic data collection and longitudinal designs.

Background: Radiology readouts, which involve student-teacher (mentored) and student-student (peer) interactions, are a cornerstone of medical education; however, communication dynamics in these settings, and students' perceptions of them, are underexplored. This qualitative study examined medical students' perceptions of peer and mentored learning during radiology readouts and analyzed associated verbal communication patterns. Methods: This qualitative observational study was conducted at Maastricht University in the Netherlands between April and May 2023. We conducted the study in three stages: (1) observation of student-student interactions, (2) observation of student-teacher interactions, and (3) semi-structured interviews with students about their perceptions of these interactions. We categorized verbal communication data using an adapted Verbal Response Modes (VRM) taxonomy, grouping intents into cognitive structuring, instructing, and questioning. We analyzed the interview data thematically. Results: Verbal communication analysis revealed that cognitive structuring during student-student interactions primarily involved disclosure and confirmation, while student-teacher interactions also included interpretation. Questioning was consistent across both interaction types, but instructing, such as advisement, was more prevalent in student-teacher interactions. We identified two key themes in the interview data. Theme 1: Peer interactions fostered uncertainty, while teacher interactions provided certainty through accurate information. Theme 2: Peer interactions facilitated verbalization of thoughts, whereas teacher interactions enhanced thought processes through meaningful prompts and insights. Conclusion: These findings indicate that student-teacher interactions are more responsive (interpretation) and directive (advisement), promoting certainty and deeper discussion, whereas student-student interactions, though more egocentric (disclosure), support thorough articulation despite perceived uncertainty. This study informs the design of radiology education by highlighting the complementary roles of peer and teacher interactions in fostering diagnostic reasoning and managing uncertainty.

Professional identity formation (PIF) of medical students is a critical component and foundational mission of medical education, as it is interconnected with students' striving for competence and effectiveness as future physicians. Activities that culminate in meaningful interactions and experiences positively influence students' PIF. In this study, we explored how medical students involved in extra-curricular activities (ECAs) experience ECAs' impact on their PIF. Using constructivist grounded theory, we completed 16 semi-structured interviews with Year 3 and Year 4 medical students at a medical school in Singapore from November to December 2023. Participants were purposively and theoretically sampled. We analyzed deidentified transcripts through open, axial, and selected coding. We constructed themes and identified relationships between themes that we refined through discussion and constant comparison with newly collected data. We constructed three main themes: (1) Participants' decision to pursue both medicine and ECAs was driven by their aspiration to live life fully and meaningfully, generating alignment between their personal and future professional identities. (2) Participants' participation in ECAs yielded positive affordances and gains in medical competence development, thereby strengthening their PIF. These experienced benefits from ECA participation for both their professional and self-identities reinforced participants' perseverance in both endeavors. (3) Pursuing ECAs, even when viewed as not a norm when medical training intensified, was an expression of self-advocacy for some participants to live out their passions and preserve important elements of their prior self-identities as they learned to accept a new professional identity as a doctor-to-be. The study results highlighted that participants' PIF evolved as they simultaneously lived and learned in two spaces - one within medicine and one outside of medicine, where they learned to advocate for other unique and non-negotiable aspects of their self-identities and fully live out their other passions. Medical educators must acknowledge that ECA participation has a self-autonomous nature and strong potential to foster students' holistic development as they become doctors. To maximize ECAs' benefits for students' PIF, medical educators could provide timely guided reflective practice to consolidate students' learning from their participation in ECAs. Finally, medical educators must consider personalizing their support for students as they navigate their unique PIF journeys.

The influence of hierarchical structures in maternity wards on supervision, learner autonomy, and professional development has been recognized, yet its impact on medical trainees in low-resource teaching hospitals remains poorly understood. This study explored how medical interns and residents perceive and navigate power relations in the maternity ward of Zewditu Memorial Hospital, a tertiary teaching hospital in Addis Ababa, Ethiopia. Using an interpretive phenomenological approach, we conducted in-depth interviews with 20 participants between November 2022 and February 2023, including medical interns, residents, and general practitioners involved in maternity care. We analyzed the data thematically to capture participants' lived experiences of hierarchy, supervision, and clinical responsibility. Findings revealed three interrelated subthemes-status-role interactions, activity-transferring, and blame shifting-which together illuminate how hierarchical relations structure clinical learning, professional identity, and emotional well-being. Participants described a supervisory environment dominated by OB/GYN specialists whose authority was enacted through evaluative control and largely non-negotiable decision-making. This hierarchical arrangement constrained trainees' autonomy, limited opportunities for critical engagement, and positioned interns and residents as responsible for patient care without corresponding decision-making power. Activity-transferring frequently placed trainees in situations that exceeded their experience and formal roles, generating fear of errors and ethical tension. Blame-shifting further intensified trainees' vulnerability, undermining confidence, psychological safety, and their willingness to speak up. The findings reveal that hierarchy in the maternity ward functioned as a double-edged structure for clinical education. While it supported supervision and accountability, it also constrained learning, ethical agency, and open communication. Rather than reflecting a negotiated learning environment, clinical training was largely obedience-based, with authority concentrated among senior physicians and risk distributed to trainees. Educational strategies that promote guided autonomy, respectful supervision, and psychological safety are essential to enhance learning and support professional development in maternity care training contexts.

Introduction: Neurodivergent individuals are increasingly recognised as playing a critical role in the health professions workforce. However, many face significant barriers during their education due to stigma, ableism, and institutional inflexibility. We have approached this work through the lens of the neurodiversity paradigm, reframing disadvantage as arising not from individual traits but from the social, structural, and cultural contexts that shape experiences within healthcare and education. Methods: We conducted an online survey (during May to July 2024) of neurodivergent graduates from a range of Australian health professions programs, exploring their diagnoses, use of accommodations, and experiences navigating their education. We also invited participants to share advice for future neurodivergent students entering health professions education. Thematic analysis of qualitative data was guided by Jain's framework of legibility, which describes how disability, or neurodivergence in this context, is recognised and understood by both individuals and institutions and how recognition shapes accommodations, inclusion, and learner experiences. Results: The 183 respondents had completed a range of health professions qualifications and, strikingly, often identified with multiple forms of neurodivergence. This allowed us to identify patterns of experience that spanned professional groups and rigid diagnostic boundaries. Many reported experiencing stigma and inadequate or inaccessible accommodations, where neurodivergence was framed within a deficit-focussed model. Even when formally granted, supports were inconsistently implemented. Participants described complex processes of self-recognition, often occurring during study or after graduation. Despite these barriers, self-recognition and peer connection were sources of empowerment and agency. The advice participants shared emphasized self-advocacy, self-compassion, connection with community, and the distinct value neurodivergent learners bring to healthcare. Conclusion: Our findings show that the way neurodivergence is recognised and understood by individuals and institutions profoundly shapes neurodivergent learners' educational experiences. When recognition is founded in deficit-based assumptions, it reinforces exclusion, stigma, and structural inequity. To support student agency, self-determination, and belonging, recognition of neurodiversity through a neuro-affirming lens is required. These insights highlight the urgent need for systematic reform to embed neuro-affirming principles within health professions education. Truly inclusive education must prioritise universal design, reduce reliance on diagnostic disclosure, and provide environments where all learners can thrive.

Phenomenon: A career as an undergraduate medical educational leader presents significant challenges, shaped by the complexity of the role and the limited availability of structured career pathways. To strengthen recruitment and retention, medical educational organisations must better understand the responsibilities and incentives involved. Approach: This study, based on a larger project, presents unexpected and distinct perspectives on educational leaders working in both universities and hospitals. It draws on survey data collected from 56 mid-level leaders in a Danish context from December 2023 to February 2024. We conducted a secondary qualitative thematic analysis of open-ended survey responses, focusing on the relationship between two questions, one on tasks and responsibilities and the other on incentives. We incorporated statistical data into the analysis of tasks and responsibilities to triangulate the thematic analysis. Findings: The results yielded insights into the relationship between leaders' daily tasks and the incentives that motivate their engagement in educational leadership. It reflects participants' views on their responsibilities and the factors that encourage them to pursue and sustain these roles. The findings highlight educational leadership practices at three responsibility levels: the interactional micro level (teaching responsibilities), the organisational meso level (coordination and development of the educational environment), and the society macro level (fostering the students' professional growth to meet future societal health care responsibilities). Micro- and meso-level responsibilities dominated educational leaders' daily practices, while macro-level responsibilities were present primarily in the overall aim of educational activities. Incentives to pursue educational leadership were threefold: personal career considerations, orientations towards the organisation (department), and holistic incentives to "make a difference." Insights: Findings indicate that undergraduate mid-level medical education leaders primarily undertake micro- and meso-level tasks, whereas macro-level incentives strongly influence their motivation. This discrepancy underscores a gap between their desire to have a broader impact and the time they spend on administrative duties and teaching tasks. Opportunities for macro-level responsibilities could bolster these leaders' motivation. Building on theories from public service motivation and the sociology of professions, we propose the concept of professional intrinsic motivation to reflect this broader view. Future retention strategies should emphasise tasks, responsibilities, and opportunities that align with professional intrinsic motivation. Alongside this, understanding responsibilities across micro, meso, and macro levels can help develop a shared vocabulary, thereby improving recruitment and retention conversations.

This study aimed to evaluate the psychometric properties of the Chinese version of the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) and assess its applicability among undergraduate students in medicine and health-related disciplines in China. Using Brislin's translation model, we translated and culturally adapted the original (English) scale to produce the Chinese version. Between May and July 2024, we used convenience sampling to recruit undergraduate students from a medical university in Changsha City, Hunan Province, China (population size = 520). We collected a total of 480 valid responses (participation rate = 92.3%) through the Wenjuanxing platform. We analyzed data using R and AMOS 29.0. Content validity was supported by two rounds of Delphi expert consultation, with item-level content validity indices (I-CVI) ranging from 0.80 to 1.00 and a scale-level index (S-CVI) of 0.95. The Chinese version of the MAIRS-MS showed good internal consistency, with a total Cronbach's alpha coefficient of 0.90 and subscale coefficients all exceeding 0.78. The split-half reliability was 0.94, and the test-retest reliability was 0.95. Exploratory factor analysis supported the instrument's original four-factor structure-Cognition, Ability, Vision, and Ethics-with a KMO value of 0.93, cumulative variance explained of 67.2%, and all item loadings greater than 0.40. Confirmatory factor analysis indicated a good model fit (χ²/df = 1.11, RMSEA = 0.02, CFI = 0.93, TLI= 0.99). In sum, the Chinese version of the MAIRS-MS demonstrated satisfactory content validity, internal consistency, and structural validity, supporting its use as a reliable tool for assessing AI readiness among Chinese undergraduate health professional students.