December In This Issue

Education on electronic health records remains highly variable despite their widespread use by medical trainees. This study interrogated the complex landscape of current EHR pedagogy by examining discourses of EHR use within the medical education literature. These discourses framed the EHR as a physical skill, a system of people and technologies, or a cognitive process influencing clinical reasoning and bias. Each discourse privileged certain stakeholders over others and rationalized educational interventions that could be beneficial in isolation yet were often disjointed in combination. Reforming EHR education will require engagement with these competing discourses.

Huang, D, Whitehead, C, Kuper, A. Competing Discourses, Contested Roles: Electronic Health Records in Medical Education. Med Educ. 2024; 58(12): 1490-1501. 10.1111/medu.15428.

Institutional education leaders are often responsible for leading pre-determined major curricular changes in the complex adaptive systems of health professions education. This study explored how a group of institutional leaders navigated these systems during the change to competency-based residency education in Canada. Leaders set ensuring direction and maintaining momentum as change priorities and analyzed how their response to various threats and opportunities affected the priorities of direction and momentum. The article proposes a practical change framework for education leaders that addresses the non-hierarchal, complex, and uncertain nature of health professions education systems.

Tam, H, Scott, I. Laying train tracks en route: How institutional education leaders navigate complexity during mandated curriculum change. Med Educ. 2024; 58(12): 1528-1535. 10.1111/medu.15464.

Learning and growth in postgraduate medical education (PGME) often require vulnerability, but being vulnerable can pose risks to residents’ credibility and professional identity. In this study, residents characterize vulnerability as a paradox, in which polarities exist between being a fallible, authentic learner and an infallible, competent professional. The authors explore factors influencing the experience and outcomes of vulnerability at the intrapersonal, interpersonal, and systems levels. This study begins to capture the complexity of vulnerability in PGME and offers insights into creating supportive learning environments that embrace the value of vulnerability while mitigating its risks.

Nichol, H, Turnnidge, J, Dalgarno, N, Trier, J. Navigating the paradox: Exploring resident experiences of vulnerability. Med Educ. 2024; 58(12): 1469-1477. 10.1111/medu.15426.

Despite the growing amount and significance of health care research on adverse events and failures, ethnographic studies on how disruptions unfold are still rare. This study deepens our understanding of disruptions of care processes and outlines how the repairing of disruptions can be sources of stability, learning and change in complex health care settings. Conducted in a surgical operating unit of a university hospital in Finland, this study and its unique close-to-practice research methodology provides insights that can lead to educational improvements and enhanced patient care.

Kajamaa, A, Lahtinen, P, Mattick, K, Bethune, R. Repairing disrupted care processes as sources of stability, learning and change in a Finnish hospital: an activity-theoretical study. Med Educ. 2024; 58(12): 1502-1514. 10.1111/medu.15407.