Medical Education最新文献

{"title":"First aid for first years: A comprehensive pre-matriculation approach to medical student readiness.","authors":"Christopher P Robinson, Donna Parker","doi":"10.1111/medu.70036","DOIUrl":"https://doi.org/10.1111/medu.70036","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960335","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":"Breaking down binaries: The imperative of change","authors":"Rola Ajjawi","doi":"10.1111/medu.70001","DOIUrl":"10.1111/medu.70001","url":null,"abstract":"<p>For International Women's Day (IWD) 2025, Wiley created a multi-journal special issue titled Gender Equity in Health Care. <i>Medical Education</i> was invited to participate resulting in a collection of papers, in this issue, that deal with gender equity in health professions education.<span><sup>1-5</sup></span> Unsurprisingly, these papers show persistent, and in some cases increasing, unequal power distributions and gender-based discrimination within medicine. My aim in this editorial is not to repeat all the ways in which we are failing—you can read the papers. Instead, building on this year's IWD 2025 theme of <i>Accelerate Action</i>, I wish to call for action in the form of more critical and participatory research that seeks change and upends binaries and binary thinking.</p><p>In 2010, Regehr<span><sup>6</sup></span> published an influential paper called ‘It's not rocket science’, arguing that health professions education research is more complex than rocket science that relies on structured, linear systems and identifiable factors. He suggested that the metaphor of the natural sciences—and associated ideas such as objectivity and simplicity—was no longer serving the field, as it legitimised what constituted <i>good</i> research in health professions education in unhelpful ways. He urged researchers to shift from an imperative of proof (a narrowly defined search for ‘evidence’) to an imperative of understanding where researchers explore education-related phenomena in their natural setting.<span><sup>6</sup></span> He also argued that we needed to become more comfortable with complexity.</p><p>Regehr's paper was influential. It is still a key paper for graduate students who come to our field particularly from the health professions and the natural sciences where evidence, proof and objectivity are the common research frames. Given the persistence of hierarchical gendered systems demonstrated in the collection of papers in this issue, I have increasingly been contemplating the need for another shift in how we conceptualise research—towards an <i>imperative of change</i>. This demands that the goal of our research is not only to understand and reframe phenomena but to change practice and avoid binary oppositions. Binary thinking can reinforce inequities in its oversimplification of identities, marginalising those who do not fit into those categories and upholding power structures that benefit dominant groups.</p><p>Rather than viewing knowledge as representative of a natural world <i>out there</i>, we might instead see it as a set of relations. It is not only that we as researchers are always in relation (to the topic, the methods, the participants, etc.), but also knowledge itself is relational. It does not exist solely in the minds of individuals to be filled, acquired and critiqued, but knowledge emerges through interconnections and is shaped by relationships. Respect, reciprocity and responsibility are crucial to relationships (resea","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 10","pages":"1022-1023"},"PeriodicalIF":5.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960327","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":"Taking a definitional stance in health professions education scholarship","authors":"Catherine Patocka,&nbsp;Rachel Ellaway","doi":"10.1111/medu.70023","DOIUrl":"10.1111/medu.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Problem</h3>\u0000 \u0000 <p>Definitions are fundamental to the work of scholarship. Indeed, all scholarship has a definitional stance, even if that stance is not to use definitions. A definitional stance is the position scholars take regarding the use, interpretation or treatment of definitions within their work. In this paper, the authors explore definitional stances that shape inquiry in health professions education (HPE), from the formulation of research questions to the interpretation and dissemination of findings. Despite their ambient presence, definitional stances are rarely acknowledged in scholarly work, nor are they explicitly and consistently examined in peer review processes, critical appraisal, the methodological literature or in graduate education. As a result, definitional ambiguity and misalignment often goes unnoticed, and the coherence of scholarly discourse is undermined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Definitional stances</h3>\u0000 \u0000 <p>The authors describe eight distinct types of definitional stances taken in health professions education. These range from adefinitional (avoiding any definitions) and rhetorical (adopting definitions as tools of persuasion) positions that resist fixed meanings, to realist, construct and pattern-based stances that embrace definitional coherence while allowing for ongoing inquiry and conceptual evolution. The authors illustrate the utility of this framework through a worked example (using the construct of professionalism), showing how different stances yield different understandings and scholarly pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> What this paper adds</h3>\u0000 \u0000 <p>There is no one ‘right’ definitional stance, but rather to promote thoughtfulness, reflexivity and transparency in how definition stances are taken and the implications thereof. The paper offers practical guidance to help scholars identify, articulate and justify their definitional stances in ways that are aligned with their epistemological commitments and research purposes. By making definitional stances more deliberate, transparent and open to discussion, HPE scholarship can make stronger knowledge claims based on a richer understanding of the kinds of knowledge that different stances afford, which has the potential to advance HPE in both principled and pragmatic ways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 11","pages":"1189-1195"},"PeriodicalIF":5.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960401","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":"Interprofessional identity.","authors":"Jan-Jaap Reinders","doi":"10.1111/medu.70027","DOIUrl":"https://doi.org/10.1111/medu.70027","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960353","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":"Serious safety events as a window into clinical learning environment dynamics: A qualitative situational analysis.","authors":"Paula Rowland, Maria Athina Tina Martimianakis, Glen Bandiera, Walter Tavares","doi":"10.1111/medu.70026","DOIUrl":"https://doi.org/10.1111/medu.70026","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical learning environments (CLE) are complex and have not been thoroughly explored from the perspective of advancing conceptual understanding of their unique dynamics. An opportunity to advance this understanding rests in examining specific situations, such as what happens when a student/trainee has been involved in a serious patient safety event.</p><p><strong>Methods: </strong>Shaped by concepts of negotiated orders and discourses, we conducted a qualitative, interpretive study in a large urban university and affiliated health science centre in Canada using document analysis and semi-structured interviews. Documents and interview transcripts were analysed using concepts and tools from Adele Clarke's situational analysis.</p><p><strong>Results: </strong>Between March 2022 and April 2023, we conducted 17 interviews with staff physicians (n = 6), medical residents (n = 2), safety leaders and/or university administrators (n = 9). Analysis revealed counter-vailing forces that must be constantly interpreted, negotiated and re-negotiated by participants attempting to deliver on the aspirations of the CLE. Furthermore, analysis revealed potentially competing discourses about the nature of learning in the CLE, animating long-standing tensions about the role of the CLE in developing clinical expertise and professional identity.</p><p><strong>Discussion: </strong>Our study reveals counter-vailing forces, interacting policies and potential disagreements about the learning imperatives and priorities of the CLE. These counter-vailing pressures shape learning about patient safety. More than learning content or process, invested groups must also learn to negotiate risks and responsibilities distributed across multiple social arenas. These distributions are changing. Understanding these dynamics is essential for educators and researchers seeking to positively influence the CLE. Future CLE research should account for the various pressures acting on health service organizations and the possible implications for educational mandates in these spaces.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960370","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":"Situational judgement testing at different stages of undergraduate medical training and the risk of professionalism lapses: A cohort study.","authors":"Gurvinder Sahota, Paul A Tiffin, Daniel Smith, Edward Tyrrell, Mandy Hampshire, Jaspal Taggar","doi":"10.1111/medu.70020","DOIUrl":"https://doi.org/10.1111/medu.70020","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying medical students at risk of professionalism lapses is critical for future patient safety. Situational Judgement Tests (SJTs) are commonly used to assess procedural knowledge of professionalism. Evidence suggests SJT scores can predict professionalism lapses, though longitudinal data across different stages of medical training are lacking. This study investigates the relationship between SJT performance at three points in pre-qualification medical education and professionalism lapses.</p><p><strong>Methods: </strong>A longitudinal study was conducted using linked data from the UK Medical Education Database (UKMED) and the University of Nottingham. Data were available for 705 students who sat a professionalism-focused SJT in their second year (2016 to 2018). Professionalism lapses were identified using concern forms. The study used scores from three SJTs administered at different stages: the University Clinical Aptitude Test (UCAT) at application; a Nottingham Medical School (NMS) test mid-training, and the UK Foundation Programme (UKFP) SJT, at the end of medical school. The relationship between SJT scores and the odds of a professionalism lapse was modelled using logistic regression.</p><p><strong>Results: </strong>Performance on the NMS SJT was statistically significantly associated with the odds of professionalism lapses (Odds Ratio [OR] 0.64, p = 0.001) even after adjusting for educational and cognitive performance (OR 0.68, p = 0.005). The UKFP SJT scores showed a univariable (0.66, p = 0.006) but not an independent relationship with the outcome (OR 0.77, p = 0.14). The UCAT SJT scores were not statistically significantly predictive of professional lapses, on univariable (OR 0.85, p = 0.34) or multivariable analysis (OR 0.92, p = 0.66).</p><p><strong>Conclusions: </strong>SJTs can support medical professionalism in students. They are likely to be most effective in this context when they are administered during training, rather than as a selection measure for entry to medical school. Moreover, SJTs designed to have specific, professionalism-focused content and a limited cognitive load are most likely to add unique value in this respect.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960380","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 influence of narrative medicine on medical students' readiness for holistic care practice: A realist synthesis.","authors":"Chien-Da Huang, Rahma Novita Asdary, Yosika Septi Mauludina, Yufrica Huang, Lynn Monrouxe","doi":"10.1111/medu.70024","DOIUrl":"https://doi.org/10.1111/medu.70024","url":null,"abstract":"<p><strong>Background: </strong>The increasing focus on technical skills and efficiency in medical education often overshadows humanistic aspects, creating gaps in preparing clinicians for holistic patient care. Narrative Medicine, integrating storytelling and reflective practices, offers a promising approach to addressing these challenges.</p><p><strong>Objective: </strong>This study explores how Narrative Medicine interventions influence medical students' readiness for holistic care by examining the mechanisms, contexts and outcomes that underpin its effectiveness.</p><p><strong>Methods: </strong>A realist synthesis was conducted following Pawson's five-stage methodology with a two-phase search strategy across four databases and grey literature. Phase 1 (2008-2018) yielded 10 studies; Phase 2 (2018-2025) added 3, totalling 13. Studies were included if they focused on Narrative Medicine interventions, involved medical students and examined holistic care outcomes. Studies were assessed for credibility, theoretical depth and trustworthiness. Context-Mechanism-Outcome (CMO) configurations were iteratively synthesised using ATLAS.ti, ensuring rigour and consistency in accordance with RAMESES standards.</p><p><strong>Results: </strong>A total of 13 studies, predominantly from U.S. medical schools and hospitals and one from the Netherlands, involving 1158 participants, were analysed. Nine CMO configurations were identified across three contexts: Storytelling Activities, Storytelling Skills and Engaging with Stories. These contexts activated mechanisms such as Deep Observation, Reflection, and Peer Learning, which contributed to outcomes including Enhanced Holistic Patient Connection, Improved Patient Care and Enhanced Self-Perspective. Notably, Peer Learning showed a weaker linkage to these outcomes, reflecting variability in the effectiveness of Narrative Medicine interventions. Emotional resistance, including avoidance and disengagement, highlighted challenges in implementing Narrative Medicine effectively.</p><p><strong>Conclusion: </strong>Narrative Medicine enhances relational competence, empathy and reflective practice, aligning with the principles of holistic care. Addressing barriers such as emotional discomfort and variability in outcomes requires adaptable formats and supportive environments. This study underscores Narrative Medicine's transformative potential in medical education and offers actionable insights for its integration into diverse learning contexts.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959135","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":"Designing effective clinical education spaces: A scoping review.","authors":"Megan Phelps, Pippa Yeoman, Lynn V Monrouxe","doi":"10.1111/medu.70002","DOIUrl":"https://doi.org/10.1111/medu.70002","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical education in health facilities is critical for health professional student learning. However, consideration of health professional students' learning when designing and building hospitals appears to be neglected. Evidence-based health facility design may encourage student learning and add value to the investment in facilities. We ask, 'What does the literature say about the consideration of health professional students' education when designing health facilities?'</p><p><strong>Methods: </strong>We developed a scoping review protocol following Arksey and O'Malley's Guidelines. Our search strategy employed the following concepts: Health Facilities, Facility design, Health professional students, Learning and teaching and health professional education. Forty articles were identified for inclusion. Databases comprised Medline, Art and Architecture Archive, Avery Index to Architecture and Periodicals (EBSCO), CINAHL, ERIC, Scopus, Proquest Central and Web of Science.</p><p><strong>Results: </strong>Articles were published between 1963 and 2023. There was a range of publication types originating mostly from North America and the United Kingdom (UK). Only four articles describe original research. Medical students are the most reported individual student group. Links are made between principles of learning and the built environment (45% of articles). Recognised features supporting learning include floor space, various building elements and their attributes, environmental features and furniture, fittings and equipment. Evaluation is lacking, and building codes and standards are noted in only three publications.</p><p><strong>Discussion: </strong>The review reveals a scarcity of published evidence documenting how health professional student learning is considered in health facility design. While design professionals may address these needs in practice, the lack of accessible literature limits evidence-based approaches. Opportunities exist for educators and administrators to advocate for the inclusion of students and their learning needs in collaboration with colleagues from other disciplines such as architecture and design. Documenting and publishing these collaborations will strengthen the evidence base, ensuring learning is more intentionally integrated in clinical settings.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960322","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 Fellow-Led Orientation to Mitigate Microaggressions in the Intensive Care Unit.","authors":"David E Rink, Rosemary Adamson, Laura Granados, Kristine L Cueva, Tyler J Albert","doi":"10.1111/medu.70014","DOIUrl":"https://doi.org/10.1111/medu.70014","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960398","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":"Visual-spatial abilities enhancement and spatial anatomy learning: A systematic review.","authors":"Lara Nokovitch, Houssein El Hajj, Sophie Deneuve, Vincent De Andrade, Rémi Gagnayre, Aurore Margat","doi":"10.1111/medu.70022","DOIUrl":"10.1111/medu.70022","url":null,"abstract":"<p><strong>Introduction: </strong>Student's visual-spatial abilities appear to be an important predictor of learning time, performance and knowledge in anatomy. The objective of this systematic review was to assess the relationship between spatial abilities enhancement and spatial learning of anatomy.</p><p><strong>Materials and methods: </strong>A systematic literature search of databases (MEDLINE, Embase, ERIC, Scopus and Web of Science) was undertaken using relevant keywords. The search included citations published from inception to December 31st, 2024. The transferability of spatial abilities enhancement to spatial learning of anatomy was assessed using a 2 × 2 classification of spatial skills, in which each visual-spatial task was coded in terms of both intrinsic-extrinsic and static-dynamic dimensions. A qualitative analysis of the results was performed.</p><p><strong>Results: </strong>The search yielded 2135 results, which narrowed down to 8 articles after application of exclusion criteria. Significant relationships between spatial abilities and the spatial learning of anatomy were observed in five studies. Among studies reporting a positive correlation between spatial abilities and spatial learning of anatomy, within-cell transfer was observed for four studies, and across-cell transfer for one study.</p><p><strong>Conclusions: </strong>Enhanced spatial abilities seem to transfer mainly to similar tasks related to spatial learning of anatomy. However, the spatial abilities tests used to evaluate spatial abilities were all intrinsic × dynamic. A future study using different spatial abilities tests could evaluate if spatial abilities engaging different dimensions of spatial cognition could be related to different spatial anatomy tasks.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883153","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}