Medical Education最新文献

{"title":"Professional identity struggles in healthcare professions education: A theoretical review","authors":"Adam P. Sawatsky,&nbsp;Lynn V. Monrouxe,&nbsp;Caroline L. Matchett,&nbsp;Lara Varpio,&nbsp;Pim W. Teunissen,&nbsp;Ellen L. Usher","doi":"10.1111/medu.70235","DOIUrl":"10.1111/medu.70235","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Professional identity formation in healthcare professions education (HPE) is a complex and often fraught process. Physicians and trainees experience identity struggles as they navigate their personal and professional development, along with the conflicting expectations, cultural norms and systemic pressures within the healthcare environment. Despite growing attention to these challenges, conceptual clarity around identity struggle remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>To advance theoretical understanding of identity struggle, we conducted a critical narrative review of identity theories from developmental psychology, social psychology and sociology. We selected three major theoretical traditions—Neo-Eriksonian, symbolic interactionist and social identity theories—and analysed their conceptualizations of identity, identity development and identity struggle. We examined these diverse perspectives to inform research and educational practice on professional identity formation in HPE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Each theoretical tradition offers distinct insights into identity struggle. Neo-Eriksonian theories emphasize exploration and commitment as central processes, framing struggle as developmental and potentially productive. Symbolic Interactionist theories highlight the role of socialization and identity dissonance, viewing struggle as emerging from tensions between personal agency and societal norms. Social Identity theories focus on group belonging and intergroup dynamics, conceptualizing struggle at both individual and socio-contextual levels. We provide common critiques and limitations of each theoretical tradition. These perspectives illuminate varied mechanisms through which identity struggle manifests and evolves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This review underscores the multifaceted nature of identity struggle and the value of theoretical pluralism in understanding professional identity formation. Struggle is not inherently negative; rather, it can be a catalyst for growth when appropriately framed and supported. We propose how educators and researchers might use these theoretical lenses to design interventions that foster productive identity development and address systemic contributors to identity struggles. We invite scholars drawing on critical perspectives of power and structure to challenge and deepen the conversation on identity struggle in HPE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 11","pages":"1201-1215"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816830","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":"Graduate attributes as expressions of mastersness in HPE master's programmes: An international Delphi study.","authors":"Mariette Volschenk, Susan Van Schalkwyk, Heinri Zaayman, Elize Archer, Ara Tekian","doi":"10.1111/medu.70333","DOIUrl":"https://doi.org/10.1111/medu.70333","url":null,"abstract":"<p><strong>Introduction: </strong>Master of Health Professions Education (MHPE) programmes develop clinician-educators, educational scholars and academic leaders. Despite the global growth of these programmes, no internationally shared articulation of the graduate attributes that express master's-level development (mastersness) currently exists. This absence constrains curriculum coherence, comparability across programmes and alignment with expected graduate roles. This study aimed to establish international consensus on the essential attributes of MHPE graduates.</p><p><strong>Methods: </strong>We conducted a three-round electronic Delphi study. In Round 1, we invited 62 established health professions education (HPE) scholars to propose candidate attributes, and 21 participated. Round 2 expanded the panel to include MHPE programme leads, lecturers, researchers and HPE scholarship unit directors (168 were invited and 35 participated), who rated attributes for inclusion. We predefined consensus as ≥70% agreement. In Round 3, 23 of 35 eligible panellists ranked the agreed attributes. We analysed quantitative data descriptively and iteratively synthesised qualitative comments. Surveys were administered anonymously using REDCap.</p><p><strong>Results: </strong>Round 1 generated 100 items that were synthesised into 18 attributes. In Round 2, 14 attributes met the predefined consensus threshold and two additional attributes were retained for further exploration because of their conceptual relevance to mastersness. Sixteen attributes therefore progressed to ranking. Attributes ranked in Round 3 were grouped into three interrelated categories: core, enabling and aspirational attributes. Qualitative comments highlighted conceptual overlap among attributes, resistance to hierarchical ranking and differing views on foundational and developmental expressions of mastersness.</p><p><strong>Discussion: </strong>This study provides an empirically grounded articulation of mastersness in MHPE programmes through a consensus-derived attribute set. Master's-level development appears to extend beyond discrete competencies to encompass integrated scholarly, critical, collaborative and context-responsive ways of knowing, being and acting. The resulting attribute set offers a shared reference point for curriculum design, assessment, programme evaluation and international dialogue while remaining adaptable to diverse educational contexts.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137263","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":"Evolving from where? On the origins of validity in health professions education.","authors":"Ugo Caramori","doi":"10.1111/medu.70338","DOIUrl":"https://doi.org/10.1111/medu.70338","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128098","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 sociomateriality of prescribing feedback interventions: A scoping review.","authors":"Karen Mattick, Ana Gomez Corrales, Daniele Carrieri, Christy Noble, Richard Conn, Rola Ajjawi","doi":"10.1111/medu.70335","DOIUrl":"https://doi.org/10.1111/medu.70335","url":null,"abstract":"<p><strong>Objectives: </strong>Prescribing errors frequently threaten patient safety, with early career doctors writing most prescriptions. Prescribing feedback interventions can improve the prescribing capabilities of early career doctors. These typically involve interactions between people and materials; however, these relations tend to be under-researched due to a general focus on human behaviours. This study aimed to trace the sociomaterial relations that produce and sustain prescribing feedback interventions for early career doctors in hospital settings.</p><p><strong>Methods: </strong>We conducted a scoping review of eight databases (PubMed Central, CINAHL [EBSCOhost], Embase, Web of Science, Scopus, ProQuest Education Database, ERIC and Cochrane) from 2013 to 2024, following Arksey and O'Malley's five-step framework. Key data were extracted and reflexive thematic analysis generated themes across included papers.</p><p><strong>Results: </strong>Nineteen studies were included. None took an explicit sociomaterial perspective. The main social actors were hospital pharmacists, other doctors, nurses and advanced practice professionals. The main material actors were paper-based and electronic medication charts, medical guidelines and policies, prescribing error summaries, feedback tools, physical spaces and other material artefacts. We generated four themes: (1) sociomaterial relations of feedback information, (2) sociomaterial relations of feedback interaction, (3) sociomaterial relations of goal setting and planning and (4) sociomaterial relations that shape division of labour.</p><p><strong>Discussion: </strong>Prescribing feedback interventions are assembled and sustained in busy clinical environments through sociomaterial relations. Materials are active in producing the work of prescribing feedback interventions and the move to electronic records and e-prescribing changes the sociomaterial affordances. Sociomaterial approaches show strong potential to improve prescribing feedback interventions and ultimately benefit patients but more research is needed.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111717","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":"Developing agency through experiences of misalignment: A path to becoming a physician.","authors":"Robert Sternszus, Nissim Maxim Frija-Gruman, Monica Molinaro, Javeed Sukhera, Maimouna Mbengue, Elizabeth Anne Kinsella, Yvonne Steinert","doi":"10.1111/medu.70334","DOIUrl":"https://doi.org/10.1111/medu.70334","url":null,"abstract":"<p><strong>Introduction: </strong>How medical students respond to the dissonance that can result from misalignments between personal values and the norms and values of the profession informs their evolving professional identities. But to what extent do medical students have agency to respond intentionally to these experiences? While current literature focuses primarily on agentic constraints (e.g., hierarchy), how medical students enact agency when they perceive the expectations of the clinical environment to be negatively aligned with their own values remains underexplored. This study examines the following research questions: (1) How do medical students perceive their agency when experiencing misalignment between their personal values and the norms and values of the clinical setting? and (2) How do medical students perceive their experiences of agency in the face of misalignment as contributing to their professional identity formation (PIF)?</p><p><strong>Methods: </strong>This study used interpretive description methodology, with social cognitive theory as a primary theoretical framework. Semi-structured interviews (n = 16) were conducted with third- and fourth-year medical students at McGill University, using rich pictures as an elicitation technique. Interpretive themes were generated iteratively and inductively.</p><p><strong>Results: </strong>Participants reported that agency evolved over time and was shaped by experiences of misalignment. In situations of negative misalignment, the enactment of agency was described as shaped by emotional responses, involving dynamic, often deliberate judgements that weighed internal and external factors. Participants' accounts further suggested that enacting agency in these moments may have informed their future capacity for agency and their PIF.</p><p><strong>Discussion: </strong>This study highlighted how developing and enacting agency in response to misalignment contributes to PIF. By implementing strategies to foster agency, such as guiding reflection on the emotions associated with misalignment, medical educators may be better positioned to help students engage more meaningfully in becoming the physicians they hope to become.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111801","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 … sponsorship.","authors":"Charlotte E Rees, Juman Al-Dujaili","doi":"10.1111/medu.70337","DOIUrl":"https://doi.org/10.1111/medu.70337","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111767","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 whole is greater than the sum of its parts: Evaluating systems of assessment as complex adaptive systems.","authors":"Phil Hider, Dario Torre, Sylvia Heeneman, Tim J Wilkinson","doi":"10.1111/medu.70329","DOIUrl":"https://doi.org/10.1111/medu.70329","url":null,"abstract":"<p><strong>Background: </strong>Assessment in health professions education has evolved from individual assessment instruments towards integrated systems of assessment that support learning and high-stakes decision-making. While considerable attention has been devoted to the design, validity and reliability of individual assessment methods, far less attention has been paid to evaluating assessment systems themselves. This is an important gap, as assessment systems may contain multiple high-quality assessment tools yet still fail to function as coherent and effective wholes.</p><p><strong>Purpose: </strong>This paper proposes a conceptual framework for evaluating systems of assessment in health professions education. Drawing on systems thinking and complexity theory, we argue that contemporary assessment systems, such as programmatic assessment, can be understood as complex adaptive systems and therefore require evaluation approaches that extend beyond the evaluation of individual assessment components.</p><p><strong>Approach: </strong>We trace the evolution of assessment thinking-from individual assessments to systems of assessment-and consider these systems through the lens of complex adaptive systems. We then combine the Logic Model and the Context-Input-Process-Product (CIPP) evaluation framework to connect programme theory with evaluation and examine both intended and unintended consequences.</p><p><strong>Framework: </strong>The integrated framework comprises six components: Planning, Resource Design, Implementation, Short-term Results, Outcomes and Long-term Impact. Together, these components provide a structure for evaluating how assessment systems are designed, implemented, experienced and improved over time. A worked example illustrates how system-level evaluation identifies issues that are not apparent when individual assessment tools are evaluated in isolation.</p><p><strong>Conclusions: </strong>Evaluating assessment systems requires approaches that examine interactions, implementation processes, educational impact and broader consequences. The proposed framework offers a structured theory-informed approach to support continuous improvement, quality assurance and the development of validity arguments for contemporary systems of assessment. Future research should explore the framework's feasibility, utility and impact across diverse health professions education contexts.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111723","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":"Rethinking validity in medical education: A Māori-centred framework 100 years on.","authors":"Fran Kewene, Rochelle Ellison-Lupena, Gloria Fraser, Vicky Shaw, Aliitasi Su'a-Tavila","doi":"10.1111/medu.70330","DOIUrl":"https://doi.org/10.1111/medu.70330","url":null,"abstract":"<p><strong>Background: </strong>Truman Lee Kelley helped reorient educational assessment towards validity, with contemporary validity theories positioning validity in the interpretations and decisions made from assessment scores. Despite these advances, Indigenous principles remain largely absent from contemporary validity theory in health professions education.</p><p><strong>Objective: </strong>We propose a new approach to assessment validation relevant to a Māori-centred conceptualisation of validity that integrates measurement theory with tika (appropriateness), pono (integrity) and mana (consequences), underpinned by whanaungatanga (relationship), whakapapa (contextual history) and mātauranga Māori (Māori knowledge).</p><p><strong>Methods: </strong>Using a Māori-centred qualitative narrative inquiry grounded in wānanga (collective discussion), Māori and Pacific health professions educators met to discuss how cultural identity shaped our teaching practice and approaches to assessment. These kōrero (discussions) were guided by tikanga-based (Māori cultural practices) protocols, recorded, transcribed and thematically organised under the principles that emerged through these discussions: tika, pono and mana.</p><p><strong>Results: </strong>Three interconnected principles emerged. Tika was concerned with the appropriateness of assessment tasks and criteria in relation to their purpose and context; pono emphasised authentic and trustworthy interpretation through collective judgement, culturally safe moderation and equitable assessment practices, and mana highlighted the dignity, authority and relational responsibility of assessment decisions for learners, whānau (family) and communities, including tensions with institutional policy.</p><p><strong>Framework: </strong>We extend Kane's argument-based model by embedding Māori-centred Pou (pillars grounded in Māori values) as warrants (justifications) and incorporating relational accountability and community legitimacy as additional lenses through which validity claims are scrutinised. This conceptual framework proposes that assessment design should define constructs through Māori values and priorities, interpretation should include evidence of cultural safety and equity and governance should support Māori authority through Te Tiriti o Waitangi-aligned co-leadership and data sovereignty.</p><p><strong>Conclusion: </strong>A Māori-centred conceptualisation of validity reframes defensibility as relational, ethical and technical, recognising Māori authority, community legitimacy and accountability to learners, whānau and communities in assessment validation while aligning assessment with Te Tiriti o Waitangi and Indigenous aspirations.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111740","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":"Using structured video review guidance to surface interprofessional participation patterns during ward rounds.","authors":"Sze-Yuen Yau, Ching-Yi Lee, Szu-Han Wang","doi":"10.1111/medu.70233","DOIUrl":"10.1111/medu.70233","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":"1162-1163"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775783","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":"Beyond imposter syndrome: Deconstructing the hidden architecture of belonging in medical schools.","authors":"Xiaoshuai Li, Rui Wang","doi":"10.1111/medu.70202","DOIUrl":"10.1111/medu.70202","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":"1164-1165"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390439","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}