Medical Education最新文献

{"title":"Lessons on applying a trauma-informed research approach in health professions education scholarship.","authors":"Helen Anne Nolan","doi":"10.1111/medu.15745","DOIUrl":"https://doi.org/10.1111/medu.15745","url":null,"abstract":"<p><strong>Background: </strong>Health professions education (HPE) research routinely explores trauma-related subjects, yet trauma impacts may remain overlooked. Trauma-informed approaches and guiding principles provide a framework for interactions with those affected by trauma and advocate for accommodation of trauma impacts to promote recovery and inclusion. My own reflections on experiences of trauma-related research in medical education led to consideration of how trauma-informed approaches may be applied in qualitative research. This paper identifies and discusses strategies that may be implemented in HPE research.</p><p><strong>Approach: </strong>The paper begins by exploring the rationale for trauma-informed approaches and how these relate to contemporary HPE research. Examples of emergent approaches from published literature in various disciplines, and how these can accommodate the needs of groups and individuals impacted by trauma and promote inclusion to enhance research outcomes, are identified and discussed. Approaches are situated in key aspects of the research process.</p><p><strong>Findings: </strong>Trauma-informed research has been recently adopted in various disciplines and may act as an effective adjunct to established ethics protocols, although no published accounts in HPE research were identified. Application of trauma-informed approaches and reflexivity in research design may pre-emptively identify trauma-related needs. Trauma-informed approaches can be applied to create safety, trust and empowerment during data collection interactions. Measures to manage participant distress are discussed. Principles for community engagement and participation and their role in in HPE research are considered, exploring how these overcome trauma impacts (e.g. by sharing power and supporting inclusion), and enhance research outputs. Implications of trauma for researcher wellbeing and research culture are also acknowledged, and trauma-informed approaches may systematically support these needs. Approaches to research dissemination should acknowledge existing oppressive structures and consider alternatives, in partnership with affected communities.</p><p><strong>Conclusions: </strong>This paper considers an emergent area of research practice, highlighting strategies that are currently under-explored and may enhance HPE research by addressing trauma impacts, and supporting stakeholder collaboration in research. Approaches may be readily implemented and adapted to the research context. Adoption of these approaches should be supported by trauma-informed research training to enhance research culture, and institutions more widely.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We should nudge clinicians and trainees to participate in health professions education programmes.","authors":"Lea Harper, Sylvain Coderre, Kirstie Lithgow, Kenna Kelly-Turner, Melinda Davis, Kevin McLaughlin","doi":"10.1111/medu.15749","DOIUrl":"https://doi.org/10.1111/medu.15749","url":null,"abstract":"<p><p>Health Professional Education (HPE) programmes, such as mentorship, are widely regarded as being advantageous to the personal and professional development of clinicians and trainees. Involvement in a mentoring relationship is associated with positive outcomes for both mentees and mentors, including improved career preparation, increased career success, higher job satisfaction and reduced risk of burnout. Despite these data, a minority of trainees report having a mentor. In this Cross-Cutting Edge article, the authors focus on an impediment to participation in HPE programmes that they feel are both highly prevalent and modifiable: habit. Taking the example of mentorship, they use dual processing as their theoretical framework and describe how we use both System 1 and System 2 processing to make decisions that, in turn, promote habitual and goal-directed actions, respectively. The authors discuss the relationship between habitual and goal-directed actions and suggest that habits can both facilitate and hinder our goals. Drawing on the clinical literature on adherence to clinical practice guidelines, they describe how habits and contextual factors can interfere with clinical goals and how manipulating the clinical environment can move behaviour in the desired direction. They then branch into behavioural economics to describe the features of a nudge (and a sludge) and review the literature on the effectiveness of this type of intervention - including potential ethical concerns around the use of nudges as behavioural interventions. Using the MINDSPACE mnemonic/framework they suggest different types of transparent and non-transparent nudges that could be used to increase participation in mentorship. Recognizing that mentorship is complex and the impact of a single nudge on behaviour may be ineffective or wane over time, the authors propose a process of ongoing programme evaluation and quality improvement that could help create and maintain a culture of mentorship and that can also be applied to other HPE programmes.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing the intruder paradox: \"It's not the imposter syndrome, it's you don't want me in the field\".","authors":"Kori A LaDonna, Lindsay Cowley, Emily Field, Shiphra Ginsburg, Christopher Watling, Rachael Pack","doi":"10.1111/medu.15741","DOIUrl":"https://doi.org/10.1111/medu.15741","url":null,"abstract":"<p><strong>Introduction: </strong>Imposter phenomenon (IP) or syndrome is typically framed as a personal problem rooted in low self-esteem or anxiety that an individual must overcome to succeed. Critics argue that this framing overlooks external forces, such as discrimination, that engender feelings of inadequacy. Since women in medicine disproportionately experience both IP and workplace harms, our purpose was to examine the link between gender-based discrimination and IP from their point of view.</p><p><strong>Methods: </strong>Women training and practicing across Canada were invited to participate via Twitter/X. Forty consented (n = 13 Faculty Physicians; 27 Trainees). During semi-structured interviews, participants discussed their imposter experiences, including how discrimination influenced perceptions of their competence. Data were analysed using constructivist grounded theory, with constant comparative analysis employed across three coding stages.</p><p><strong>Results: </strong>The link between workplace discrimination and IP is complex. Some perceived no link whereas others described IP as a trauma response to repeated instances of gender-based harms. Most participants experienced discrimination, although subtle instances led some to question whether they were overreacting. Others suggested that perceptions of incompetence were externally imposed rather than internally generated. Some also wondered if they were being \"gaslighted\" or manipulated by others into questioning their competence. Although some participants endorsed experiencing IP, others pushed back, rejecting the imposter label altogether: \"it's not the imposter syndrome, it's you don't want me in the field.\" Based on participants' experiences, we developed a theoretical model called the Intruder Paradox (IPx) to nuance understanding about IP in medicine.</p><p><strong>Discussion: </strong>We define IPx as a form of gaslighting used against those who do not fit sociocultural norms. Although it may co-exist with IP, IPx appears to be a distinct, overlooked barrier to personal well-being and professional advancement in medicine. Addressing IP and IPx, and achieving equity, depends on acknowledging the complex sociocultural factors that can trigger imposter feelings and be weaponized against intruders.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconciling the tension between the 'global' and the 'local' in medical education.","authors":"Birgit H Fruhstorfer, Colin F Macdougall","doi":"10.1111/medu.15740","DOIUrl":"https://doi.org/10.1111/medu.15740","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing e-portfolio with Microsoft teams in preclinical medical years.","authors":"Nourhan F Wasfy, Fatma Mohamed, Mai Mahmoud, Ranya Hassan","doi":"10.1111/medu.15734","DOIUrl":"https://doi.org/10.1111/medu.15734","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging the norm: Length of exams determined by classification accuracy or reliability.","authors":"Stefan K Schauber, Matt Homer","doi":"10.1111/medu.15742","DOIUrl":"https://doi.org/10.1111/medu.15742","url":null,"abstract":"<p><strong>Purpose: </strong>This paper challenges the notion that reliability indices are appropriate for informing test length in exams in medical education, where the focus is on ensuring defensible pass-fail decisions. Instead, we argue that using classification accuracy instead better suited to the purpose of exams in these cases. We show empirically, using resampled test data from a range of undergraduate knowledge exams, that this is indeed the case. More specifically, we address the hypothesis that the use of classification accuracy results in recommending shorter test lengths as compared to when using reliability.</p><p><strong>Method: </strong>We analysed data from previous exams from both pre-clinical and clinical phases of undergraduate medical education. We used a re-sampling procedure in which both the cut-score and test length of repeatedly generated synthetic exams were varied systematically. N = 52 500 datasets were generated from the original exams. For each of these both reliability and classification accuracy indices were estimated.</p><p><strong>Result: </strong>Results indicate that only classification accuracy, not reliability, varies in relation to the cut-score for pass-fail decisions. Furthermore, reliability and classification accuracy are differently related to test length. The optimal test length for using reliability was around 100 items, independent of pass-rates. For classification accuracy, recommendations are less generic. For exams with a small percentage of failed decisions (i.e., 5% or less), an item size of 50 did, on average, achieve an accuracy of 95% correct classifications.</p><p><strong>Conclusions: </strong>We suggest a move towards the employment of classification accuracy using existing tools, whilst still using reliability as a complement. The benefits of re-thinking current test design practice include minimizing the burden of assessment on candidates and test developers. Item writers could focus on developing fewer, but higher quality, items. Finally, we stress the need to consider the effects of the balance false positive and false negative decisions in pass/fail classifications.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first national disability medical student affinity organisation in the United States.","authors":"Zainub Dhanani, Melissa C Leeolou, Ifeoma Ikedionwu, Nora Newcomb","doi":"10.1111/medu.15733","DOIUrl":"https://doi.org/10.1111/medu.15733","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconceptualising interprofessional learning: A cross-cultural and religious perspective on physician development.","authors":"Muhammad Taufiqurrahman, Zelvia Liska Afriani, Ixsir Eliya, Muhammad Yusrizal","doi":"10.1111/medu.15736","DOIUrl":"https://doi.org/10.1111/medu.15736","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A signature pedagogy for speech-language pathology education.","authors":"Frances Cochrane","doi":"10.1111/medu.15739","DOIUrl":"https://doi.org/10.1111/medu.15739","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of nurses in moderating the emotional dynamics in the clinical learning environments: Implications for medical students' experience.","authors":"Shalini Gupta, Stella Howden, Mandy Moffat, Lindsey Pope, Cate Kennedy","doi":"10.1111/medu.15728","DOIUrl":"https://doi.org/10.1111/medu.15728","url":null,"abstract":"<p><strong>Introduction: </strong>Existing literature recognises that health professionals' socialisation in the workplace involves an emotional component, including management of feelings as per professional expectations and demands. However, there is limited understanding of the emotions-related processes involved in the interprofessional educational space of the clinical learning environment (CLE) and the role of nurses in moderating the emotional dynamics. This paper explores ways in which emotions operate in the interprofessional encounters of the CLE, utilising Hochschild's theory on emotional work.</p><p><strong>Methods: </strong>An ethnographic approach was adopted that included 120 hours of observations conducted in two hospital wards hosting clinical placements for medical students and 36 individual interviews with staff and students populating these clinical sites. Key themes were derived using the circular process of ethnographic data analysis utilising the sensitising concepts of emotional labour, emotional gifts and feeling rules, together with the relational dimensions of interprofessional interactions in the CLE.</p><p><strong>Results: </strong>The following key themes were identified: emotional gifts from nurses to medical students and junior doctors, interprofessional interactions suggesting a breach in feeling rules and suspension of interprofessional hierarchies that engendered goodwill and appreciation among health care teams in the CLE. Interconnected subthemes highlight the nurses' efforts to maintain the sentimental order in the CLE through generously gifting emotional support to students and doctors in a variety of situations, impacting their professional socialisation and well-being. However, workplace stresses such as time pressures and staff shortages created interprofessional tensions, generating negative emotions. Blurred professional boundaries and professional humility positively impacted interprofessional dynamics and student experience in the CLE.</p><p><strong>Discussion: </strong>This ethnographic exploration of the CLE revealed the emotions-related processes nested within the interprofessional space of health care practice. In their work towards emotional housekeeping of the CLE, the nurses offer emotional gifts to medical staff and students populating the ward. Workload issues and inadequate staffing influence both cognition and behaviour adversely, impacting interprofessional dynamics. Our findings support fostering professional humility as a pedagogical tool so that we collectively move away from current structures that keep us siloed.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}