Medical Education最新文献

{"title":"From mechanisms to systems: Reconceptualising supervised workplace learning in postgraduate medical education","authors":"Anél Wiese, Deirdre Bennett","doi":"10.1111/medu.70208","DOIUrl":"10.1111/medu.70208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Why do the same supervisory mechanisms (feedback, observation, entrustment) produce different learning experiences across clinical settings? Current research treats them as discrete behaviours rather than examining how they interact within local contexts. This study uses realist theory to reframe supervised workplace learning as contextually configured systems, examining how key mechanisms (the processes through which attending physicians and residents interact) couple differently across postgraduate clinical settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a realist-informed multiple case study across four clinical departments in Ireland (Geriatric Medicine, Surgery, Paediatrics and Infectious Diseases). Semi-structured interviews with residents and attending physicians explored everyday clinical work, learning and supervisory dynamics. Analysis proceeded in two phases: (1) within-case, theory-informed inductive analysis using a realist theory on supervised workplace learning as a sensitising concept; (2) cross-case configurational analysis tracing how six mechanisms (entrustment, support seeking, monitoring, modelling, meaning making and feedback) patterned differently by context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty participants (38 residents, 12 attending physicians) were interviewed. All six mechanisms appeared in every setting but were organised into distinct patterns shaped by local conditions. Geriatric medicine: continuous monitoring and narrow entrustment produced high oversight with limited autonomy progression (shaped by patient frailty, strong continuity, containment culture). Surgery: tightly coupled entrustment-monitoring-feedback drove staged procedural progression (shaped by observable performance, resource scarcity, competitive selection). Paediatrics: fluid, overlapping mechanisms enabled relational negotiation (shaped by family-facing work, small teams and psychological safety). Infectious diseases: fragmented, reactive mechanisms produced discontinuous supervision (shaped by severe discontinuity, high workload, frequent roster changes). What distinguished settings was not mechanism presence but mechanism coupling (how mechanisms reinforced or constrained one another), producing systematically different outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Supervision operates as a contextually adapted configuration of interdependent mechanisms, not a set of discrete behaviours. The same mechanisms organise into different patterns depending on local ","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1143-1153"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616285","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":"Validity for whom? Unpacking assessment validity from an inclusion perspective","authors":"Laura Gray, Sue A. Sharpe","doi":"10.1111/medu.70279","DOIUrl":"10.1111/medu.70279","url":null,"abstract":"<p>Weiner et al., in their recent paper ‘The myth that slow test-takers are worse students: Implications for time-limited testing”’,<span><sup>1</sup></span> interrogate the myth that those who can complete time-limited assessments rapidly are better students or clinicians. They point to the lack of evidence supporting this myth and the likelihood that time pressure selects for a set of attributes not necessarily aligned with professional competence.</p><p>The myth paper illustrates one way that some groups of learners (those who may find time-limited examinations more challenging) encounter barriers within assessment systems despite possessing the underlying capability being assessed. This is a critical example of the validity issues woven into assessment systems, highlighting two questions we should be asking:</p><p>The first question points directly to issues of <b>construct validity</b>, the ability of an assessment to evaluate the intended capability or learning outcome (the construct).<span><sup>2</sup></span> However, when observation of construct-relevant factors is obscured by extraneous (construct-irrelevant) factors, the validity and therefore defensibility of assessments fall. Often assessments are designed with a clear outcome in mind, with less consideration of construct-irrelevant factors which might get in the way.</p><p>The experiences of learners who diverge from dominant norms of learning, communication and performance provide an important lens through which to explore construct-irrelevant factors which compromise assessment validity. Weiner et al. point to learners who possess the requisite knowledge and skills but perform poorly on time-limited assessments. This might include learners who use English as an additional language or dialect, those with slower language processing, those whose voices do not conform to masculine standards,<span><sup>3</sup></span> those who find prolonged eye contact distracting or those with limited manual writing/typing endurance. If otherwise capable students perform differently because of factors unrelated to the intended construct, then assessment outcomes may reflect conformity to norms of performance rather than competence itself.</p><p>This is fundamentally a construct validity problem. Examining the performance of learners who differ from the ‘ideal student’ reveals what assessments are unintentionally measuring. Neurodivergent students and other minoritised learners report feeling constrained by norms of professionalism, forced to mask, conform and perform.<span><sup>4</sup></span> As Weiner et al. point out that time-limited testing presumes that rapid cognitive processing is valued in healthcare professionals, do our assessments also presume that standardised forms of social fluency and tolerance to sensory stimuli are normal, necessary and valued?</p><p>Features such as strict timing, particular communication formats or performance under observation are often defended on the grounds tha","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1063-1065"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471691","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":"Exciting changes ahead","authors":"Rola Ajjawi","doi":"10.1111/medu.70296","DOIUrl":"10.1111/medu.70296","url":null,"abstract":"<p>In 2013, <i>Medical Education</i> launched its remarkable Editorial Internship Programme.<span>¹</span> I do not use the word <i>remarkable</i> lightly. Over the past 13 years, 39 interns from countries around the world have completed the programme. Many have gone on to hold editorial roles across a wide range of journals, including several who are now Editors-in-Chief.</p><p>To mark the journal's 60th anniversary, we are delighted to expand the programme to accommodate up to 10 interns each year. The internship is designed to provide participants with an inside view of scholarly publishing by exposing them to the full breadth of editorial work. Interns will work closely with the editorial team, participate in all aspects of the editorial process, review submitted manuscripts, make recommendations and engage in discussions about emerging technologies and innovations shaping the future of the journal.</p><p>Applications will open on <b>1 October 2026</b> and close on <b>20 November 2026</b>. The programme will begin in <b>February 2027</b> and will involve a monthly commitment. Please see the journal's website—mededuc.com—for further details and application information.</p><p>In further news, I would like to express my sincere thanks to Dr Shiphra Ginsburg for her outstanding contributions to <i>Medical Education</i> and to the field more broadly over her 17 years as an editor with the journal. Throughout her tenure, Shiphra has brought wisdom and both methodological and conceptual rigour to our decision-making processes.</p><p>More joyfully, the journal welcomes three new Deputy Editors. Dr Karen Stegers-Jager joins us from the Netherlands, bringing additional expertise in quantitative and experimental research. Dr Neera Jain and Dr Francisco Olmos Vega are also taking up Deputy Editor roles, transitioning from their previous positions as Triage Editors.</p><p>Finally, I encourage you to keep an eye on this space as many new authors can be expected to contribute commentaries as I extend invitations to scholars from adjacent fields, such as higher education and implementation science, in an effort to broaden the research conversation and connect with a wider body of literature. The wicked problems (e.g., workforce development, equity, selection and assessment) with which we struggle, after all, are sure to benefit from interdisciplinary thinking.</p><p><b>Rola Ajjawi:</b> Conceptualization; writing—original draft; writing—review and editing.</p><p>The author has nothing to report.</p><p>Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766652","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 systems set the limits of supervision","authors":"Sayra M. Cristancho","doi":"10.1111/medu.70255","DOIUrl":"10.1111/medu.70255","url":null,"abstract":"&lt;p&gt;Supervision in postgraduate medical education is often described through its component parts: feedback, observation and entrustment.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; These are the practices we return to when we think about improving training. They are visible. They can be named, taught and assessed. Across the literature, they are also consistent. And yet, the learning that emerges from them is not.&lt;/p&gt;&lt;p&gt;Wiese and Bennett offer a way to make sense of this.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Their study shows that these practices are present across clinical settings, but they do not come together in the same way. What differs is how they connect within the conditions of everyday work. Continuity, workload, team structure and local culture shape how supervision unfolds. Over time, these elements settle into patterns. Those patterns, more than any single practice, shape what learning becomes.&lt;/p&gt;&lt;p&gt;Seen through a systems lens, that variability stops looking like a problem to be fixed and starts looking like evidence. Different conditions produce different configurations. Different configurations produce different learning. The variation is the system showing you how it works—and what it makes possible and what it does not. Those differences across training environments are not only variations in how supervision is enacted. They also reflect the limits that systems place on what supervision can achieve.&lt;/p&gt;&lt;p&gt;That ‘systems’ framing changes how familiar challenges appear.&lt;/p&gt;&lt;p&gt;When trainees struggle to progress, attention often turns to strengthening individual practices. Feedback can be made more specific. Expectations can be clarified. Observation can be increased. These are important responses. They reflect a genuine commitment to improving training.&lt;/p&gt;&lt;p&gt;At the same time, research has shown that practices such as feedback are shaped by relationships, credibility and the broader environment in which they occur.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Decisions about entrustment unfold within uncertainty and are responsive to contextual cues as much as to trainee performance.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; Supervisory practices do not operate on their own. Their effects depend on how they connect to other elements of the system.&lt;/p&gt;&lt;p&gt;Feedback carries weight when learners have an opportunity to act on it.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Observation becomes more meaningful when it occurs within relationships that provide enough continuity to make sense of what is observed.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Support seeking contributes to learning when it opens space for dialogue and shared problem solving.&lt;/p&gt;&lt;p&gt;When these connections are in place, learning can move forward. When they are not, the same practices remain present, but their impact is diminished.&lt;/p&gt;&lt;p&gt;Context has long been recognised as important in workplace learning. A systems perspective takes a further step. It helps explain how context shapes what supervision can actually accomplish. It brings into view not only variation, b","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1071-1073"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317907","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":"Arts informed indigenous research: Listening to Indigenous Peoples' knowledges in health professions education","authors":"Karen Adams,&nbsp;Lynne Stuart,&nbsp;Ali Drummond,&nbsp;Linda Deravin,&nbsp;Olivia Bonanno,&nbsp;Vicki Saunders","doi":"10.1111/medu.70259","DOIUrl":"10.1111/medu.70259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>The 2007 United Nations Declaration on the Rights of Indigenous Peoples affirms Indigenous Peoples' right to maintain, control, protect and develop their knowledge systems, including knowledges of sciences and technologies of medicine and health. It could, however, be argued that this right is typically not upheld in health professions education (HPE), as the broader HPE community perceives dominant colonial ideologies as supreme. Yet, Indigenous Peoples' knowledges promote futurity. They can protect communities and promote healing for everyone from colonising harms. However, engaging with Indigenous Peoples' knowledges in HPE is not straightforward, as a contested cultural interface exists between knowledge systems. This article shares how Arts Informed Indigenous Research (AIIR) can illuminate ways to grow Indigenous knowledges into HPE. We outline the context and problem, describe AIIR's conceptual frame and praxis and share a praxis example.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Informed by arts-based research paradigms, AIIR embeds and embodies an Indigenist research agenda. AIIR also incorporates storywork drawing attention to storying complexity. Indigenous Peoples engage AIIR to deeply investigate research questions and solve complex issues often caused by colonisation. Importantly, AIIR is Indigenous Peoples led and engages knowledge holder diversity through sensory and symbolic forms that create reflection. For many research methods, researchers perform data analysis. However, in AIIR knowledge holders make meaning through creativity, searching for ideas and interrelated understanding. Researchers revere created knowledges with honour and show reciprocity by strengthening story impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Incorporating Indigenous knowledge within HPE is not straightforward, as colonial ideologies continue to dominate the field. However, AIIR can support engagement between divergent western and Indigenous knowledge systems by creating ethical, critically reflective and relational spaces that promote anti-colonial listening. Additionally, AIIR offers methods to generate insights into ways the broader HPE community can relinquish colonial power to make space in HPE for Indigenous Peoples' knowledges of futurity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1092-1101"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422234","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 … pragmatism","authors":"Ghaith Alfakhry,&nbsp;Danica Sims,&nbsp;Ariel Lindorff","doi":"10.1111/medu.70204","DOIUrl":"10.1111/medu.70204","url":null,"abstract":"&lt;p&gt;While designing a research project (G.A.) on self-assessment of communication skills, I found myself navigating a deep ideological divide between two scholarly camps—each with starkly different views on reality (ontology), systems of knowledge (epistemology) and how research should be conducted (methodology).&lt;/p&gt;&lt;p&gt;The postpositivist camp believed in a &lt;i&gt;single&lt;/i&gt; observer-independent reality &lt;i&gt;measured objectively&lt;/i&gt; using reliable &lt;i&gt;scientific&lt;/i&gt; methods that put numbers (quantitative methods) on a pedestal. This all seemed too Pythagorean to me. Believing that an observer's reality can be captured entirely by a number struck me as a reductionist view of our complex value-laden social reality. On the other hand, the interpretivist camp sounded too metaphysical to me. Interpretivists believed in &lt;i&gt;multiple&lt;/i&gt; socially co-constructed realities, s&lt;i&gt;ubjective&lt;/i&gt; to the observer, who reflexively interprets the world using language, discourse and dialogue (qualitative methods).&lt;/p&gt;&lt;p&gt;These two camps often operated independently and justified their approaches in stark comparison with the other's worldview and research practices. Choosing one or the other of these paradigms when designing my research felt artificial and unnecessarily limiting. Quantitative research offered empirical validity, statistical generalisability and hypothesis testing. These are features valued by decision-makers and suited to large samples. In comparison, qualitative research provided rich, contextual insights, captured participants' lived experiences and was flexible to changing study settings.&lt;/p&gt;&lt;p&gt;I struggled with this ‘either/or’ decision, as I was drawn to the strengths of both approaches and frustrated by the pressure to align philosophically and methodologically with one paradigm. Fortunately, there was a third camp which sought to integrate &lt;i&gt;both&lt;/i&gt; qualitative and quantitative methodological and philosophical perspectives. It did not make itself as pronounced as the previous two. But when the qualitative/quantitative dualism was put under scrutiny, one could discern those scholars in the third camp. A particularly popular philosophical stance taken up by those in that third camp was &lt;i&gt;pragmatism&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;This piece provides arguments for &lt;i&gt;methodological&lt;/i&gt; pragmatism in the practice of medical education research, to transcend the qualitative/quantitative &lt;i&gt;dualism&lt;/i&gt; while also giving the reader some context for some of the existing philosophical debates and stances surrounding it.&lt;/p&gt;&lt;p&gt;Pragmatists highlight purists' ‘false dualism’ as described by Pring.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Instead, they tend to be &lt;i&gt;methodological pluralists&lt;/i&gt;. In so doing, the pragmatists reject the incommensurability thesis that argues that different paradigms and their associated methodologies/methods cannot be reconciled and cannot and should not be mixed in a single research project. Pragmatists integrate different methodologies and epistemologies in the sense","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1074-1075"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434191","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":"Validity considerations in programmatic assessment of clinical reasoning.","authors":"Christopher Runyon, Laura Zwaan, Monica M Cuddy, Andrew P J Olson, Verity Schaye","doi":"10.1111/medu.70308","DOIUrl":"https://doi.org/10.1111/medu.70308","url":null,"abstract":"<p><strong>Problem: </strong>Clinical reasoning is a core competency in health professions education, but its assessment is challenging. Clinical reasoning is multifaceted, content- and context-dependent, and largely unobservable, and no single assessment can support a robust characterisation of a learner's clinical reasoning. Programmatic assessment has gained traction as a response to these challenges, but a validity argument explaining why a programmatic approach addresses the specific vulnerabilities of clinical reasoning assessment has received limited attention.</p><p><strong>Approach: </strong>We examine validity issues in the programmatic assessment of clinical reasoning using Kane's argument-based framework, organised around five inferences: performance, scoring, generalisation, extrapolation and consequences. For each inference, we identify the central validity question, describe issues specific to clinical reasoning at the level of the individual assessment and the programme, discuss how a programmatic approach mitigates weaknesses of single assessments and describe residual or new validity threats. A fictional learner followed across undergraduate medical education makes these issues concrete. We then consider generative artificial intelligence (GAI) as a cross-cutting validity challenge affecting each inference.</p><p><strong>Key points: </strong>Programmatic assessment strengthens each inference in the validity chain, but it does not resolve every weakness and introduces new assumptions of its own, particularly around how conflicting evidence is synthesised. GAI compounds these challenges: it can shift what is actually being measured, complicate scoring and generalisation, and blur the line between assessment and target performance, while also offering new opportunities to make clinical reasoning more observable when incorporated deliberately.</p><p><strong>Implications: </strong>We conclude with a three-stage developmental framework-coherence and coverage, intentional depth, and multimodal longitudinal integration-to help institutions integrate existing assessments into a programme of clinical reasoning assessment. This framework reflects validity as an ongoing institutional commitment to evidence building for better learning, decisions and patient care.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956145","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":"Exploring the use of gender-inclusive language amongst health care students and staff in obstetrics and gynaecology","authors":"Debbie Aitken,&nbsp;Georgia Lin,&nbsp;Bhabesh San San Wal,&nbsp;Merryn Rhodes,&nbsp;Mariam Aly,&nbsp;Jack Amiry","doi":"10.1111/medu.70232","DOIUrl":"10.1111/medu.70232","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;Gender-inclusive language is increasingly recognised as essential in health care to ensure respectful and equitable care for transgender and gender-diverse individuals. However, the adoption of gender-inclusive language in Obstetrics and Gynaecology (O&amp;G) may vary across generations and hierarchical levels, and the perspectives of students and staff on its use remain underexamined. This study aimed to explore how O&amp;G learners and clinicians understand and use gender-inclusive language.&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;An exploratory qualitative study was conducted in a UK teaching hospital's O&amp;G department. Data were gathered via an online survey (27 respondents) and follow-up semi-structured interviews (12 participants: 7 students and 5 clinical staff). The study design was guided by queer and generational theory, applied via a constructivist lens. Reflexive thematic analysis was used to identify key themes.&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;Four themes were generated, reflecting generational, educational and power dynamics in gender-inclusive language usage. Students generally reported greater familiarity and commitment to gender-inclusive language, whereas some senior staff, but also a minority of students, voiced reservations or confusion. Hierarchical barriers were noted, with students hesitant to challenge non-inclusive language used by superiors. Participants highlighted perceived curricular gaps and limited explicit teaching on caring for sexual and gender minority patients, recommending longitudinal, practical training, supportive correction of mistakes and visible role-modelling. Structural obstacles, such as electronic record systems lacking non-binary options, further constrained inclusive practice. Despite varied enthusiasm, participants universally emphasised respectful communication as a common professional value, converging on the importance of inclusive language for patient dignity.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Gender-inclusive language uptake in O&amp;G is shaped by generational, hierarchical, educational and structural factors; however, a shared commitment to respectful care provides common ground. Fostering supportive intergenerational dialogue and addressing structural barriers can enable consistent, respectful practice. Senior role-modelling and structured opportunities for juniors to teach upwards may further shift clinical culture without overburdening minority staff, ultimately improving care for gender-diverse patients.&lt;/p&gt;\u0000","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1110-1120"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775692","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":"The stories the data can tell: The tenuous link between evidence and theory","authors":"Geoff Norman","doi":"10.1111/medu.70298","DOIUrl":"10.1111/medu.70298","url":null,"abstract":"&lt;p&gt;Premature closure is generally viewed as a cognitive bias that leads the clinician to terminate an encounter before gathering the critical data needed to arrive at the correct diagnosis. Their results neatly confirm this hypothesis. The experimental intervention is the salient distracting feature (SDF)—a feature of an alternative diagnosis that is also related to the correct diagnosis. In the study, the SDF was introduced into the case description early, late or not at all. Students working up the case with no SDF had an accuracy of 27%. When the SDF appeared late in the protocol, it dropped to 17%, and when it appeared early, overall accuracy was only 11%. Not surprisingly, percent selecting the distracting diagnosis were almost the inverse—13% when there was no SDF, 30% when it was at the end and 33% when it was at the beginning. Additional data showed that the presence of the SDF resulted in decreased processing time and decreased time per word.&lt;/p&gt;&lt;p&gt;The SDF was persuasive. Students who saw protocols with the SDF were almost twice as likely to conclude for the alternative diagnosis as the correct diagnosis. Moreover, the earlier the SDF was presented the more likely the judgement in favour of the alternative and, perhaps critically, the less time was needed to arrive at this incorrect conclusion.&lt;/p&gt;&lt;p&gt;The authors'&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; explanation for the results is that ‘One plausible interpretation is that participants accepted an initially plausible but incorrect diagnostic hypothesis and invested less effort in processing subsequently presented information, a pattern consistent with premature closure’. However, as the discussion ensues, it becomes less clear exactly what is going on. The normative view espoused by researchers working in the ‘heuristics and biases’ paradigm would be that the student clinician has a predilection to closing prematurely. An extreme position, taken by Kahneman,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; is that such biases are a central aspect of human information processing. We are uniquely vulnerable to various distortions (biases) in thinking as a consequence of our use of cognitive heuristics or shortcuts, which, in turn, are a consequence of our limited working memory. Moreover, these biases cannot be reduced or eliminated by education or experience. As Kahneman&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; states in his popular book, &lt;i&gt;Thinking Fast and Slow&lt;/i&gt;:&lt;/p&gt;&lt;p&gt;Then a third explanation is offered. It may be a consequence of ‘confirmation bias’ where participants seek data to confirm the initial wrong diagnosis.&lt;/p&gt;&lt;p&gt;The authors then reject the ‘cognitive bias’ interpretation altogether:&lt;/p&gt;&lt;p&gt;Imagine, for a moment, that we feed the written cases into a Bayesian diagnostic system. We ask it to use the data to compute the conditional probabilities of diagnoses A and B under three conditions—no SDF, SDF early and SDF late, with all the data. It is not thinking; it is simply doing straightforward Bayesian analysis using base rate","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1066-1067"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795223","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":"Have researchers in health professions education pathologised medical training?","authors":"Dorene F. Balmer,&nbsp;May Shum,&nbsp;A. Emiko Blalock","doi":"10.1111/medu.70243","DOIUrl":"10.1111/medu.70243","url":null,"abstract":"&lt;p&gt;Researchers in the field of health professions education typically approach scientific inquiry with a pragmatic lens, seeking to elucidate shared problems and, in turn, their solutions.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In this issues of &lt;i&gt;Medical Education&lt;/i&gt;, Pattinson, Savelberg and Atherley use longitudinal audio diaries to explore the ‘problem’ of transitioning from medical student to junior doctor.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; While that transition was indeed stressful, the authors note, ‘Challenges can be seen as opportunities for valuable personal and professional development where transformational experiences are lived and reflected on’. They call for a conceptual shift away from seeing transitions as discrete events, which health professions education almost invariably frames as problematic, and toward seeing them as ongoing, complex processes.&lt;/p&gt;&lt;p&gt;We endorse this frameshift. As longitudinal qualitative researchers, we are uniquely positioned to follow the trajectory of these ‘problems’ as they evolve over time. One of us interviewed 15 women throughout their 4 years of medical school to understand their process of becoming doctors within a gendered organisation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Another interviewed six medical students as they became residents, fellows and ultimately practicing physicians over the course of 12 years, exploring the challenges they faced when constructing a career in medicine or surgery.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Having the privilege of sustained engagement with participants in these studies, both of us found ourselves asking, has health professions education pathologised medical training? Have we made training a condition that needs to be treated, if not cured?&lt;/p&gt;&lt;p&gt;Clearly, there are problems. For instance, suicide was the most prevalent cause of death for US medical residents and fellows from 2015 to 2021, a statistic that is wholly unacceptable.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Moreover, the very structure of medical training is one rooted in exclusion and still struggles to recruit and support a diverse student body.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; In health profession education, researchers' problem-based focus may suggest that the long arc of training inevitably bends toward depletion. In our experience, however, when trainees narrated their own growth as aspiring doctors, they viewed their paths in a much less pathological manner.&lt;/p&gt;&lt;p&gt;Take empathy, for example. Research reporting a decline in empathy with clinical training may be interpreted as an inevitability for medical students.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Aspiring doctors believed the research that foreshadowed an inevitable decline in empathy as training progressed; they worried that they would become &lt;i&gt;jaded&lt;/i&gt;. But, to their own surprise, they did not. Rather, how they conceptualised empathy changed through time, in response to the challenges of medical training. When asked about earlier warnings that empathy would decline, one newly minted neonatologist pushed back:","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"60 10","pages":"1068-1070"},"PeriodicalIF":6.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.70243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948449","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}