Teaching and Learning in Medicine最新文献

Phenomenon: Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalizing SGM presence within healthcare spaces. Approach: Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to participants' relationship with their bespoke experiences, respecting differing narratives within the broad 'SGM' umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. Findings: The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modeling was often experienced more positively than vertical faculty-to-student role modeling. However, as expected, heteronormativity exerted an inhibitory effect on this process. Insights: We built upon existing social cognitive paradigms to develop a 'double-funnel' model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of student-led SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining 'normativity' in medical schools.

For over half of a century, there have been calls for greater patient and community involvement in U.S. medical education. Accrediting agencies, as the regulatory authorities for medical education, develop policies that impact every program in the U.S.; they have the ability to support patient involvement across the medical education system. In this article, we first review the requirements of U.S. accrediting agencies for undergraduate and graduate medical education to involve patients in educational programs. While agencies have patient members on their committees, they do little to encourage patient involvement through their standards or procedures. We then describe opportunities for accreditation to support patient involvement across teaching and learning activities, curriculum design and evaluation, policymaking and governance, and scholarly endeavors. We link these opportunities to specific standards that could be revised or have their data reporting requirements adjusted. U.S. agencies could also follow the examples of their counterparts outside the U.S., which have created new standards to encourage patient involvement. Ensuring patient representation on educational programs' governing and policymaking bodies is one among many immediate actions that could be taken by accrediting authorities to encourage system-level reforms. As medical school and residency training represent the beginnings of decades of practice for physicians, properly involving patients would maximize benefits for learners, educators, and society.

In the spirit (but not exact format) of Mr. Swift's "A Modest Proposal," this article is written to challenge the capitalist response to supply and demand and highlight the downsides of applying it indiscriminately to medical education. We approach this piece as satire and a pointed critique of our current approach to the training of physicians in the hopes that readers view it in that regard. We have chosen modern dairy production intentionally as an analogy to frame our criticism. The medical field's focus on rapid expansion has inevitably led to increased standardization without acknowledgment that our current approach to training physicians requires an efficiency that stifles individuality, positions diversity of medical students as dangerous, and uses professionalism and burnout as means of control. This creates a bewildering and incomprehensible system where aspiring doctors enter what they believe to be a noble profession, only to face overwhelming workloads and debt, discover limited relevance between their medical education and contemporary healthcare realities, and find that direct patient interaction now constitutes a small fraction of physicians' daily responsibilities.

Medical education plays a critical role in fulfilling medicine's social contract to improve health. An equitable medical education program is characterized by a sense of belonging, trainee-centered learning, transparent expectations, and an anti-oppressive learning environment. Achieving equity requires identifying and addressing systemic inequities and biases within educational policies and practices. Despite the importance of program evaluation and educational continuous quality improvement (ECQI) in medical education for decision-making, accreditation, and transformation, these efforts often have not prioritized equity. This paper examines the evolution of program evaluation in medical education and highlights the need for a paradigm shift that centers equity and justice. A case example illustrates how traditional evaluation metrics, such as board examination pass rates and mean learner satisfaction, obscure the experiences of minoritized learners. The authors propose recommendations for embedding equity into program evaluation and ECQI, aligned with the concept of equity described by the World Health Organization. These recommendations include establishing a shared commitment to educational equity, building equity-centered evaluation teams, employing social justice-oriented evaluation approaches, attending to the experiences and outcomes of minoritized participants, focusing on growth and success, and employing a critical lens. These strategies aim to transform evaluation practices to reflect a commitment to equity, ensuring that program evaluation not only measures outcomes but also identifies and addresses the underlying causes of inequities. By fostering an equitable habit of mind and building a quality culture that prioritizes continuous reflection and improvement, medical education can create a fair, supportive, and enriching environment for all learners. Ultimately, centering equity in program evaluation and ECQI is an important step in building equitable educational systems that lead to equitable healthcare outcomes for patients and communities.

While ableism and racism have been acknowledged separately as harming, marginalizing, and excluding medical students, research has not explored their interconnected workings in the lives of disabled and racially marginalized medical students. In this qualitative interview study, we used theoretical and heterogenous sampling to recruit US racially marginalized disabled medical students. The semi-structured interview guide and analysis process used the seven DisCrit tenets as sensitizing lenses to identify counterstories, further using horror story tropes as analytic metaphors to deepen analysis and strengthen the narrative. The 12 participants included first- through fourth-year medical students ages 24-29, with a range of disability experiences, races and ethnicities, and gender identities. Participants were impacted by both racism and ableism inside a house of horrors while strategically fighting those horrors. Participants entered medical school despite edicts against trespassing, indicating their intersection of race and ability was not welcome. Once inside, learners found themselves trapped in a hall of mirrors, fighting for accommodations and survival in medical school. Navigating the house, it became clear that, as in horror stories, the call was coming from inside the house: those responsible for support were often agents of discriminatory systems. Yet participants fought systemic injustices and built misfit squads with others for protection. Participants intentionally left something akin to an apocalyptic log, to show that they existed and to help future generations of trainees. Our analysis illuminates horrifying experiences and resistant action at the nexus of racism and ableism in U.S. medical education. Rather than offer solutions, we invite readers to grapple with the discomfort of this horror.

Background: Time can serve as a form of oppression when one has control over another's schedule, activities, and timetables. Yet, time as a form of oppression has received little attention in medical education. Students who are considered marginalized, such as low-income (LI) students and LI/first-generation (FGLI) students, have a strained relationship to time because of their unique social positions. In this study, we investigated the temporal experiences of LI and FGLI students using the language they used to talk about time. Methods: This was a secondary analysis of a larger dataset that interviewed 42 students, recruited via listservs and social media. We completed the original interviews between November 2021 and April 2022 and conducted the secondary analysis in 2024. Using methodological bricolage, we analyzed the interview data by: (1) identifying excerpts where a participant discussed time, (2) using functional linguistics to examine these excerpts for participants' representation of agency with respect to time, and (3) analyzing the data for evidence that participants created simultaneous temporalities (i.e., historically contextualized experiences of time). We interpreted agentic acts as a form of resistance, one that is understudied in medical education and resistance studies. Results: LI students resisted medical education's expectation of time by maintaining multiple, simultaneous temporalities that connected them to their communities, family, and themselves. They took time away from medicine to engage in activities including teaching, mentoring, and connecting with others in their communities. They reclaimed time to reflect the values they grew up with and invested time in themselves to support who they are as a person, beyond being a physician. Conclusions: Though the concept of time has received attention in medical education literature, less attention has been paid to time as mechanism for suppressing students' other identities so that a professional identity can be created. This study demonstrates that LI students are aware of this coercive act and actively resist the norms and expectations of medical education by creating new temporalities. These additional temporalities offer glimpses into acts of resistance as protection and promotion; protecting what students care about and promoting a new way of being in medicine.

Despite widespread calls for greater inclusion of disabled people in the healthcare workforce, significant barriers remain. These barriers exist even before admission to training, when applicants are considering study options and future careers. In Australia and Aotearoa/New Zealand (NZ), the Medical Deans of Australia and New Zealand (MDANZ) have developed guidelines for inclusive pre-admission practices, but the extent to which these are enacted is unclear. This study aimed to explore the extent to which Australian and NZ schools have adopted these guidelines and whether their websites communicate to prospective applicants in a way that explicitly recognises disability as a valued dimension of diversity. We used these data to develop a set of reflective questions intended to help medical schools improve their pre-admission communication to applicants. In January-September 2024, we conducted an audit and content analysis of all Australian and NZ public-facing medical school websites. Domains examined included the use of Inherent Requirements and/or MDANZ Guidelines for Inclusive Medical Education and how these documents framed program requirements from organic or functional perspectives. We also explored the accessibility of relevant information, the transparency of pre-admission discussions, and identified where schools framed disability as a deficit versus using positive and strengths-based language. While we found examples of inclusive practices, many schools could improve the clarity and framing of the information provided to applicants. Many schools framed disability as a deficit or avoided explicit reference to disability. Clear information regarding procedures for confidential discussion of applicant circumstances and access to accommodations prior to admission was often absent, potentially leaving applicants uncertain about the impact of disability disclosure. Only half of the schools referenced the MDANZ Guidelines. Those that used Inherent Requirements often employed organic framing which did not acknowledge the role of accommodations. Establishing the state of current practice illuminates opportunities to make medical programs more inclusive from the early stages of the student lifecycle. These findings illustrate the potential gap between policy and practice. Here, we identify the practical importance of reviewing pre-admissions communication through a disability-inclusive lens, and provide a series of recommendations and reflective prompts to support medical schools as they work towards more inclusive practice.

Accumulating evidence points to the benefits of narrative medicine for healthcare workers (HCWs), but how positive outcomes from narrative medicine workshops emerge is not entirely clear. Experimental psychological research suggests potential mechanisms through which narrative medicine may achieve its outcomes. However, in experimental research, the mechanisms of reading and writing usually are studied separately and with a focus on group-level effects, leaving participants' singular experiences unexamined. To address this gap, we investigated clinicians' experiences of combined close reading, guided creative/reflective writing, and group discussion in a seven-week narrative medicine training course for healthcare and social-work professionals in Finland. After the course, we conducted individual semi-structured interviews (n = 14). We analyzed all data using inductive reflexive thematic analysis. We generated five themes: Experiences of group reading and writing involved (1) a sense of wondrous transcendence of the everyday; (2) feelings of unexpected mercy towards oneself and others; (3) the strengthening of listening, self-reflection, and self-disclosure skills; (4) transformation of relationships and a novel sense of relatedness; and (5) ethical reflections of patient-centered ideals in daily practice. These themes extend prior findings in healthcare education and psychology by illustrating how potential benefits of narrative medicine workshops can emerge in multifaceted ways. We suggest future avenues for exploring the topic in other cultural and care settings.

Introduction: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the disorders that persists in adulthood and poses unique challenges in high-demand professions like medicine. While existing literature often frames ADHD through a deficit-based lens, the lived experiences of medical students and professionals with ADHD remain underexplored. Methods: This study employed transcendental phenomenology to investigate the lived experiences of 13 medical students and professionals diagnosed with ADHD in Türkiye. I conducted semi-structured interviews between February and April 2025 via Zoom. I transcribed and analyzed the interviews using Moustakas's five-step phenomenological framework. Researcher reflexivity and external auditing ensured analytical rigor. Results: Participants described a cyclical experience of chronic procrastination, time management difficulties, impulsivity, memory lapses, and emotional distress-frequently exacerbated by institutional stigma and lack of accommodations. Despite these barriers, many reported adaptive strengths such as hyperfocus, rapid decision-making in emergencies, and creativity in problem-solving in a cyclical pattern. Coping strategies included structured planning, therapy, mentorship, and personalized productivity tools. Participants consistently emphasized the need for formal institutional support, including flexible scheduling, neurodiversity awareness, and tailored mentorship. Discussion: ADHD among medical students and professionals entails a duality of cognitive-emotional challenges and situationally advantageous traits. Without adequate support, these medical students and professions risk experiencing burn out, self-doubt, and underperformance. Yet, with proper accommodation and cultural shifts in medical institutions, individuals with ADHD can thrive and contribute uniquely to clinical care.

Introduction: Patient experiences of obesity bias are commonplace in healthcare. The harmful assumptions, beliefs, and discrimination associated with obesity bias contribute to poorer health outcomes and reduced engagement in care. Furthermore, medical students are susceptible to repeating the bias and stigma they observe in medical training. This study explored medical students' observations of obesity bias during their clinical training to inform future medical education curricula development on obesity bias. Method: In June 2022, 173 third-year medical students completing an extensive course on obesity at George Washington University School of Medicine & Health Sciences were asked to write a reflection on the obesity bias they had observed in clinical settings prior to and during their medical school education, to date. We used inductive coding techniques to identify themes from students' observed obesity bias using the software program Dedoose Version 8.3.35. Results: We identified four main themes based on students' observations of obesity bias, including 1) Don't worry, it's because of your weight (undue focus on weight above other health-related issues), 2) Your weight defines your worth (equating patients' worth to their weight and justifying inadequate treatment), 3) Ok, now I can be honest (harsh and transparent stigmatizing language directed towards absent/unconscious patients), and 4) I'm just a medical student (difficulties speaking out about obesity bias as students). Discussion: Systematic changes for dismantling obesity bias in medical education and healthcare, more broadly, are in their infancy. This research highlights various ways obesity bias permeates healthcare as observed by medical students in addition to concerns about how patients with obesity are treated in clinical settings. In light of our findings, early intervention in medical education is needed to address and reduce obesity bias in healthcare settings, with additional educational support for practicing providers in identification and attenuation of bias towards patients and families.