Medical Education最新文献

{"title":"Beyond the tip of the iceberg: Mental health, disclosure and the medical education ecosystem","authors":"Lauren E. Cox, Neera Jain, Christy Noble","doi":"10.1111/medu.70280","DOIUrl":"10.1111/medu.70280","url":null,"abstract":"<p>Disclosing mental health disorders should pave the way to support, yet, in medical education it seems to be a calculated risk.<span><sup>1</sup></span> In this issue, Aljuwaiser and Roberts'<span><sup>2</sup></span> meta-synthesis helps conceptualise why. When exploring how medical students approach mental health disclosure, they found that students must negotiate a relational process shaped by socio-cultural and institutional power dynamics. And so, the challenges students experience in disclosing mental health disorders are neither psychological nor interpersonal problems (i.e., individual stigma, personal reluctance, communication skills) rather they are structural and political problems. Yet, student disclosure, we argue, is merely the tip of the iceberg with a broader ecosystem of challenges sitting below the surface.</p><p>As a group of educators, feeling the pressure of endless productivity whilst aching for our students as they navigate the system, we could not help but wonder: If ableism is producing conditions for non-disclosure amongst students, what about others (e.g., clinicians, educators and leaders) also trying to function within this ecosystem? What is hidden below the surface that allows these conditions to persist and replicate? In this commentary, we wrestle with these questions and argue that any meaningful response to mental health (including disclosure) must attend to the whole ecosystem.</p><p>Student disclosure is the tip of the iceberg. As we dove below the surface, a complex ecosystem was uncovered including: a population of educators alongside students; an ecosystem deeply organised around the assumed norm of the invulnerable, all-knowing and all-doing highly productive physician-to-be, which continues to drive distress and non-disclosure; a continuum of mental health (not just mental illness) that rarely meets visibility; and environments with high psychosocial risks that increase stress-mediated harm.</p><p>The complex socio-cultural and institutional factors not only shape the student experience but also educators working within it. The underlying ideology in medical education—the perpetual capability imperative—demands selfless superhumans.<span><sup>3</sup></span> This imperative applies as much to medical educators as it does to medical students. Academic ableism privileges an ‘able mind’ in university contexts<span><sup>4</sup></span> and self-sacrificing altruism functions within health professions.<span><sup>5</sup></span> This ecosystem taxes educators with lived expertise traditionally excluded from the academy.<span><sup>6</sup></span> Educators also weigh up the risk and benefit of disclosure due to fear of negative professional outcomes in academia<span><sup>7</sup></span> and potential limitations to medical practice. Thus, academic medicine's oppressive ableism shapes an ecosystem whereby mental health is recognised only when exposed as a diagnosable illness (the visible tip of the iceberg). This thr","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1170-1172"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the theoretic discourse: Upanishadic perspectives on identity struggle in medical education","authors":"Subha Ramani,&nbsp;Vishna Devi Nadarajah,&nbsp;Sarada Ramani,&nbsp;Balakrishnan R. Nair","doi":"10.1111/medu.70276","DOIUrl":"10.1111/medu.70276","url":null,"abstract":"<p>Upanishadic principles of Dharma and Brahman highlight ethical service and the role of the self in the larger universe, expanding and enriching perspectives on professional identity formation. #MedEd</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1173-1175"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471714","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":"There is no way back home: A phenomenological study of the fears and future uncertainty of Afghan female medical students in Iran","authors":"Nadia Rehman,&nbsp;Xiao Huang,&nbsp;Chaocheng Zhou,&nbsp;Amir Mahmood","doi":"10.1111/medu.70248","DOIUrl":"10.1111/medu.70248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Taliban's 2022 ban on women's higher education represented one of the most extensive gender-based restrictions in recent history. Little was known about how this ban shaped the educational experiences, professional identities and future expectations of Afghan female medical students studying abroad. This study examined how Afghan women enrolled in medical programmes in Iran understood their training, fears and imagined futures under the shadow of the ban.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative study employed Interpretative Phenomenological Analysis. In-depth online interviews were conducted with 25 Afghan female medical students enrolled in MBBS programmes across Iranian universities. Snowball sampling was used due to the sensitivity of the topic and the dispersed nature of the student population. Interviews were transcribed and analysed through iterative phenomenological coding to understand how participants interpreted their educational journeys and future possibilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Participants reported that the Taliban's restrictions created persistent feelings of fear, guilt and emotional burden. Many believed their medical degrees might lose value and described returning to Afghanistan as unsafe or impossible due to gendered limitations and escalating risks for women professionals. Despite these constraints, students actively reconstructed hope by exploring migration pathways, international licensing options and transnational strategies to support Afghan women. Becoming a doctor emerged as a symbol of purpose and resistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The findings demonstrated that Afghanistan's education ban functioned as an enduring emotional, professional and identity-based disruption for Afghan women abroad. However, students also showed resilience by re-imagining attainable futures beyond Afghanistan. These findings highlight the need for trauma-informed support, structured academic advising and international mechanisms to protect educational and professional continuity for Afghan female medical students. In addition, this study contributes to international health professions education highlighting how educational disruption is experienced not only as interrupted access but also as a destabilisation of identity, belonging and professional futurity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1265-1275"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218348","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're Kind of in This Weird Space”: How Asian Americans physicians navigate perspectives towards race-conscious admissions","authors":"Candace J. Chow,&nbsp;Gavin Truong,&nbsp;Heeyoung Han,&nbsp;Tiffany Ho,&nbsp;Madeline Rogers,&nbsp;Zareen Zaidi","doi":"10.1111/medu.70247","DOIUrl":"10.1111/medu.70247","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;(In)equity in admissions is a global conversation. Approaches to addressing these inequities include affirmative action, holistic admissions and race-conscious admissions. Different countries vary in their usage of these approaches: while some have nationwide policies to implement affirmative action through quota systems, others utilise more holistic approaches, which are determined by individual institutions. This study explored the perspectives of Asian American physicians regarding race-conscious admissions in medical education, using Poon and colleagues' multidimensional model of race class frames to understand how individuals navigate tensions between private and public interests.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Using an interpretive qualitative approach, we employed an inductive-deductive qualitative research methodology using purposeful, snowball sampling to identify participants. One-hour interviews were conducted with 25 Asian American physicians across the Northeastern, Southern, Midwestern and Western regions of the United States. Interview transcriptions were analysed using inductive and deductive thematic analysis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The majority of participants supported race-conscious admissions, but both groups (supporters and non-supporters) had fundamentally different interpretations of educational equity. We constructed five themes. (1) &lt;i&gt;Understandings of Race-conscious Admissions&lt;/i&gt; examines whether participants held accurate understandings of race-conscious admissions policies; (2) &lt;i&gt;Intersectional Realities&lt;/i&gt; versus &lt;i&gt;Individual Merit&lt;/i&gt; explores how supportive participants viewed race and socioeconomic status as inextricably intertwined whereas unsupportive participants treated them as separate variables; (3) &lt;i&gt;Public&lt;/i&gt; versus &lt;i&gt;Private Interests&lt;/i&gt; demonstrates how supportive participants wanted to expand educational opportunities whereas unsupportive participants emphasised individual interests; (4) &lt;i&gt;Evolution of Consciousness&lt;/i&gt; documents transformative experiences that facilitated movement from individualistic merit-based frameworks toward systemic understanding; and (5) &lt;i&gt;Coalition&lt;/i&gt; versus &lt;i&gt;Competition&lt;/i&gt; illustrates divergent visions for Asian American physicians. Critically, widespread misunderstanding of race-conscious admissions practices was identified, particularly among unsupportive participants.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study challenges monolithic representations of Asian American","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1235-1247"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When I say … listening","authors":"Brian Tuohy","doi":"10.1111/medu.70226","DOIUrl":"10.1111/medu.70226","url":null,"abstract":"<p>When we say “listening” in medical education, what do we mean — and who gets to decide what counts as worth hearing? New “When I say…” piece on interpretive listening and the meaning that gets filtered. #MedEd</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1180-1181"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675055","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":"When I say … glocalization","authors":"Ming-Jung Ho","doi":"10.1111/medu.70294","DOIUrl":"10.1111/medu.70294","url":null,"abstract":"<p>Medical education is increasingly global—but always local in practice. This paper on glocalization examines how globally circulating ideas are interpreted and reshaped in local contexts. #MedEd</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1182-1183"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678483","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":"Disclosing mental health in medical education: A global qualitative meta-synthesis","authors":"Sameera Aljuwaiser,&nbsp;Gwyndaf Roberts","doi":"10.1111/medu.70240","DOIUrl":"10.1111/medu.70240","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Mental health disorders among medical students represent a persistent global challenge. Disclosure, defined as the act of revealing a mental health disorder to peers, educators or institutions, is shaped by cultural norms, institutional structures and professional expectations. Despite growing awareness of well-being, disclosure remains complex and fraught with stigma, confidentiality concerns and fears of professional repercussions. This international qualitative meta-synthesis explores how medical students experience and navigate mental health disclosure, aiming to clarify the social, cultural and institutional forces that shape disclosure decisions. It further seeks to inform policies that create psychologically safe learning environments.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A systematic search of nine databases (updated December 2025) identified peer-reviewed qualitative and mixed-methods studies published between 2013 and 2025. Data were synthesised using Thomas and Harden's thematic synthesis method within an interpretivist paradigm. Reporting followed the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodological quality was assessed using the critical appraisal skills programme (CASP) checklist. Confidence in the review findings was evaluated using confidence in the evidence from reviews of qualitative research (GRADE-CERQual). The review protocol was registered with the international prospective register of systematic reviews (PROSPERO; CRD42024521037).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Eighteen studies from seven countries (&lt;i&gt;n&lt;/i&gt; = 379 participants) met the inclusion criteria. Six overarching themes and 16 subthemes were identified. Key barriers to disclosure included stigma, professional anxiety, confidentiality concerns, institutional rigidity and uncertainty about support services. Peer influence emerged as the only consistent facilitator of disclosure. The findings illustrate how medical culture, systemic structures and social expectations intersect to sustain nondisclosure and limit access to support.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Disclosure of mental health disorders in medical education is a negotiated, relational process embedded within socio-cultural and institutional power dynamics. This synthesis advances understanding by situating disclosure within disability and critical theory frameworks, highlighting how ab","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1184-1194"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70240","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living between stereotype and erasure: A study of the model minority myth in medical education","authors":"Keegan D'Mello,&nbsp;George Kim,&nbsp;Robin Mackin,&nbsp;Amrit Kirpalani","doi":"10.1111/medu.70278","DOIUrl":"10.1111/medu.70278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Asian sub-ethnic trainees and physician educators constitute a substantial proportion of the medical workforce across Western countries yet remain systematically excluded from diversity and inclusion discourse. The model minority myth (MMM)—the construct that positions Asians as uniformly high-achieving, non-confrontational and culturally assimilated—operates as a structural force that simultaneously confers partial privilege and constrains identity, advancement and help-seeking. Despite its harms, the mechanisms by which the MMM operates across medical training remain understudied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fourteen semi-structured interviews were conducted with Asian sub-ethnic medical students, residents and physician educators across medical training institutions. A hermeneutic phenomenological approach was used, guided by an Asian Critical Theory (AsianCrit) framework. Interviews were audio-recorded, transcribed and analysed using deductive and inductive thematic analysis to ensure rigour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six themes were identified: (1) internalised exceptionalism and family-mediated career pressure; (2) everyday racial misrecognition and erasure, including name mispronunciation and physical interchangeability; (3) structural barriers to leadership, including the bamboo ceiling, voluntold labour and social exclusion; (4) homogenisation and the use of the MMM as a wedge against Black and Indigenous peers; (5) performative equity, diversity and inclusion (EDI) initiatives, curriculum gaps and tokenistic institutional participation; and (6) mentorship patterns shaped by shared ethnic and cultural experience. Cross-cutting findings included the MMM's suppression of help-seeking, the differential operation of the myth across Arab/Middle Eastern sub-ethnic identities and the influence of geopolitical events on identity expression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MMM shapes lived experience across the full arc of medical training, from admissions through senior leadership. Its harms are not uniform: They vary by sub-ethnic group, generation, gender and institutional context. Medical education must move beyond performative EDI to structurally address the MMM's manifestations in curriculum, selection processes and mentorship. Disaggregating ‘Asian’ into its constituent sub-ethnic identities is essential to equitable policy and practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1248-1255"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Haunted curriculum’ and neurodivergence: A quality improvement initiative","authors":"Sarah Bernard,&nbsp;Rae Shim,&nbsp;Heather Lane","doi":"10.1111/medu.70254","DOIUrl":"10.1111/medu.70254","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1283-1284"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272153","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":"Participatory learning in home health care for complex care","authors":"Elaine Lin,&nbsp;Florence Gagne,&nbsp;Karen Fitton,&nbsp;Kathleen Huth","doi":"10.1111/medu.70186","DOIUrl":"10.1111/medu.70186","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1276-1277"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119466","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}