Medical Education最新文献

{"title":"From optimization to wisdom: Fostering a patient-centered professional identity","authors":"Diego Lima Ribeiro","doi":"10.1111/medu.15767","DOIUrl":"10.1111/medu.15767","url":null,"abstract":"<p>The recently published realist review on teaching person-centred care through Medicines Optimization (MO)<span><sup>1</sup></span> offers a timely and welcome contribution to the field. It explores how medical educators can teach medication-related decisions (including prescribing and deprescribing) as both technical skills and patient-centred practices. The authors advocate for an approach that prioritizes thoughtful clinical reasoning rooted in person-centred care, rather than procedural competence alone.</p><p>This commentary extends that perspective by arguing that prescribing is not just a routine, automated task. It is a critical point where clinical reasoning, moral judgement and emotional regulation converge, challenging students to integrate these dimensions in real-time decisions. Prescribing compels learners to navigate uncertainty, conflicting values and the responsibilities of patient-centred care and in doing so, serves as an entry point into their professional identity formation. To foster this development, we must go beyond teaching pharmacology or prescribing guidelines. As medical educators, we must cultivate pedagogies that support students as cognitive, moral and emotional agents.</p><p>To begin, consider the cognitive dimension of prescribing. Before a prescription is written, students must engage in clinical reasoning and reach a diagnosis. Clinical reasoning is not just memorizing guidelines or following a diagnostic checklist.<span><sup>2</sup></span> Rather, it is a dynamic process of pattern recognition and analytical thinking that enables physicians to navigate clinical uncertainty toward a reasoned diagnosis. Students soon realize that foundational knowledge—while necessary—is insufficient. They must interpret the signs and symptoms in complex, real-world contexts, often while trying to avoid cognitive bias. Clinical reasoning demands the constant integration of prior knowledge with new evidence, as well as the ability to revisit and reassess assumptions. For example, imagine John, a 60-year-old man presenting with acute chest pain. The student must distinguish among a myocardial infarction, aortic dissection or a panic attack. After arriving at a diagnosis, the complexity deepens: Treatment decisions must balance clinical evidence with contextual factors. If thrombolytics are indicated, the risks must be weighed in light of John's specific case. At this point, a second dimension, which runs parallel to and transcends the clinical aspects of care arises—moral judgement.</p><p>From cognitive complexity emerges the question: What is the right thing to do for this person? Moral judgement begins with intuitive responses—gut feelings about what seems right or wrong—can shift into deliberate moral reasoning when emotionally charged situations expose value conflicts.<span><sup>3</sup></span> In the case of John, diagnosed with ST-elevation myocardial infarction (STEMI) in a setting without percutaneous coronary interventio","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 11","pages":"1145-1147"},"PeriodicalIF":5.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591600","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":"Near peers help prepare medical students to navigate hierarchy in medicine.","authors":"Noreen Mansuri, Kelsi D Camacho, Noelle Boctor","doi":"10.1111/medu.15768","DOIUrl":"https://doi.org/10.1111/medu.15768","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584309","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":"Transforming procedural skills through direct observation in medical parasitology","authors":"Marmar Ahmed Hanafy, Hala S. Elwakil, Doaa Ashraf Nassar","doi":"10.1111/medu.15766","DOIUrl":"10.1111/medu.15766","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 11","pages":"1248-1249"},"PeriodicalIF":5.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591601","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":"Integrating asynchronous trauma-informed care into preclinical education.","authors":"Sidney Ezenwugo, Jessa Culver, Corina L Iacopetti, Denise M Connor","doi":"10.1111/medu.15770","DOIUrl":"https://doi.org/10.1111/medu.15770","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584308","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":"From the ground up: Building an educator-led community for AI in medical education.","authors":"Olivia Ng, Jessica Ang","doi":"10.1111/medu.15769","DOIUrl":"https://doi.org/10.1111/medu.15769","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575774","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 cannot measure what we have not yet attempted to measure: Steps towards reconceptualising team-based assessments in the health professions","authors":"Stefanie S. Sebok-Syer,&nbsp;Daniel Tawfik","doi":"10.1111/medu.15762","DOIUrl":"10.1111/medu.15762","url":null,"abstract":"<p>There is more to teamwork than what can be observed. Focusing on uncovering the latent constructs of teamwork can help pave the way to efficient, accurate, and comprehensive measurement of teamwork within healthcare and HPE.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 9","pages":"895-897"},"PeriodicalIF":5.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575775","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":"Who are the intruders in medical education?","authors":"Marco Antonio de Carvalho Filho,&nbsp;Megan Milota,&nbsp;Frederic William Hafferty,&nbsp;Ligia Cayres Ribeiro","doi":"10.1111/medu.15771","DOIUrl":"10.1111/medu.15771","url":null,"abstract":"&lt;p&gt;We felt deeply intrigued and inspired by the manuscript that introduces the concept of the &lt;i&gt;intruder paradox&lt;/i&gt; as a critical counterpoint to the widely discussed &lt;i&gt;impostor phenomenon&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; One of the most compelling contributions of this new concept is that it shifts the locus of the ‘problem’ from the individual psyche (impostor phenomenon) to the social structure within which this psyche is alleged to exist and communicate with both self and others (intruder paradox). Where the impostor phenomenon frames the experience of not belonging as a mistakenly internalised sense of fraudulence, the intruder paradox reframes it as an externally imposed experience of exclusion—especially for those who are seen to deviate from the historically dominant norms of medicine. In doing so, the concept invites us to interrogate the social architecture of medicine itself. Although conceptualised by the authors around the dimension of gender, the intruder paradox concept may inform intersecting processes of &lt;i&gt;othering&lt;/i&gt; in medical education.&lt;/p&gt;&lt;p&gt;So, inspired by this reframing, we offer a provocation: Who, exactly, are the &lt;i&gt;intruders&lt;/i&gt; in medical education and practice? And what are the cultural blueprints that ‘culturally clone’ certain kinds of professionals while simultaneously signalling other individuals or groups as outsiders?&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; We hope this reflection encourages further research into the structural dimensions of non-belonging and exclusion in the medical profession.&lt;/p&gt;&lt;p&gt;Our central argument is that modern medical education is designed—perhaps unintentionally but nevertheless, structurally—for the success of white, wealthy, subservient, men. This design is not neutral; it is encoded in the rituals, expectations and rhythms of medical training. Let us explore these four dimensions more deeply:&lt;/p&gt;&lt;p&gt;Medicine, as institutionalised in the West, is a colonial construct. It evolved in parallel with European expansionism, often replacing or suppressing traditional healing practices across the Global South. This coloniality is embedded in and enacted by modern medical professionalism, which continues to privilege Eurocentric values: objectivity, neutrality, emotional detachment and rationality.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; These culturally specific values often act as gatekeepers to belonging. Trainees from non-European backgrounds may experience their identities and epistemologies as incompatible with the ‘whiteness’ of medicine—leading not to &lt;i&gt;impostorism&lt;/i&gt; in the psychological sense, but to an enforced outsider status, as in the suggested intruder paradox.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For instance, I, the first author of this commentary, a great-great-child of a traditional healer, vividly remember the first time I was exposed to a conversation about medical professionalism in a North-American conference. Several practices I understood as normal in my cultural context, such as crying during co","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 10","pages":"1026-1028"},"PeriodicalIF":5.2,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567630","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":"Can educators distinguish between medical student and generative AI-authored reflections?","authors":"Constance Wraith,&nbsp;Alasdair Carnegy,&nbsp;Celia Brown,&nbsp;Ana Baptista,&nbsp;Amir H. Sam","doi":"10.1111/medu.15750","DOIUrl":"10.1111/medu.15750","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reflection is integral to the modern doctor's practice and, whilst it can take many forms, written reflection is commonly found on medical school curricula. Generative artificial intelligence (GenAI) is increasingly being used, including in the completion of written assignments in medical curricula. We sought to explore if educators can distinguish between GenAI- and student-authored reflections and what features they use to do so.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a mixed-methods study. Twenty-eight educators attended a ‘think aloud’ interview and were presented with a set of four reflections, either all authored by students, all by GenAI or a mixture. They were asked to identify who they thought had written the reflection, speaking aloud whilst they did so. Sensitivity (AI reflections correctly identified) and specificity (student reflections correctly identified) were then calculated, and the interview transcripts were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Educators were unable to reliably distinguish between student and GenAI-authored reflections. Sensitivity across the four reflections ranged from 0.36 (95% CI: 0.16–0.61) to 0.64 (95% CI: 0.39–0.84). Specificity ranged from 0.64 (95% CI: 0.39–0.84) to 0.86 (95% CI: 0.60–0.96). Thematic analysis revealed three main themes when considering what features of the reflection educators used to make judgements about authorship: features of writing, features of reflection and educators' preconceptions and experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study demonstrates the challenges in differentiating between student- and GenAI-authored reflections, as well as highlighting the range of factors that influence this decision. Rather than developing ways to more accurately make this distinction or trying to stop students using GenAI, we suggest it could instead be harnessed to teach students reflective practice skills, and help students for whom written reflection in particular may be challenging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 11","pages":"1214-1221"},"PeriodicalIF":5.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15750","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540803","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":"Enhancing deliberate practice in knot-tying with a novel task trainer measuring performance metrics.","authors":"Meng-Yu Wu","doi":"10.1111/medu.15765","DOIUrl":"https://doi.org/10.1111/medu.15765","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540804","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":"New horizons: Evolving approaches to uncertainty tolerance scale development","authors":"Michelle D. Lazarus,&nbsp;Melanie Farlie,&nbsp;Md Nazmul Karim","doi":"10.1111/medu.15732","DOIUrl":"10.1111/medu.15732","url":null,"abstract":"&lt;p&gt;The paper titled “Tolerance for uncertainty and medical students' specialty choices: A myth revisited” by Wegwarth and colleagues&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; provides additional evidence that the existing approaches for uncertainty tolerance scale development and evaluation in health professional learners&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and professionals&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; may not be the optimal approach for measuring this complex construct. In this commentary, we discuss the predominant approaches currently taken in developing and evaluating uncertainty tolerance using scales and suggest ways to evolve these strategies to optimise measurement validity of this construct.&lt;/p&gt;&lt;p&gt;Uncertainty tolerance is defined as individuals' perceptions and responses to sources of uncertainty (such as ambiguity, probability or complexity).&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; An individuals' response to uncertainty is expressed by how they think, feel and act. Uncertainty tolerance construct modelling by Hillen and colleagues (2017)&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; describes a multi-component construct comprised of (1) the source of uncertainty, (2) how this source is perceived by an individual and (3) each subsequent response (emotions, thoughts and behaviours).&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; However, the degree to which these elements contribute to the overall measurement of this construct remains (ironically) uncertain.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Further complicating this is the question as to the changeability of one's uncertainty tolerance, which influences measurement approaches. In the mid-20th Century, uncertainty tolerance was conceptualised as a static personality trait.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Mounting contemporary evidence, however, suggests that uncertainty tolerance is a dynamic and changeable state-based construct influenced by contextual and personal factors such as prior experiences, geographic location and reflective capacity.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;There is evidence that uncertainty tolerance is, at least in part, state-based in learners. Learners can feel negatively about an experience of uncertainty but can act adaptively (e.g. with uncertainty tolerance) in response through their cognition and behaviour.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; For example, a medical student evaluating a patient with fatigue, fever and joint pain may initially feel anxious, due to the broad range of potential differential diagnoses (stimulus). However, by relying on their training and prior experiences (e.g. moderators) they can adaptively respond—despite their feelings of anxiety (emotional response)—by gathering a history, recommending appropriate tests and consulting with peers and colleagues about the next step to take (behavioural responses) and feeling confident about these next steps in supporting the patient (cognitive response). If this students' uncertainty tolerance was being measured, would they be evaluated as intolerant of uncertainty because of their anxiety or tolerant of un","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 8","pages":"787-791"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540806","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}