Medical Education最新文献

{"title":"Assessment fairness at the nexus of validity: Linking fairness threats to score meaning.","authors":"Christina St-Onge, Mélanie Marceau, Bruno D Zumbo","doi":"10.1111/medu.70311","DOIUrl":"https://doi.org/10.1111/medu.70311","url":null,"abstract":"<p><strong>Introduction: </strong>Nearly a century after Kelley's seminal work Interpretation of educational measurements, we revisit the concept of validity to argue that fairness is not a downstream equity add-on but a core requirement throughout the assessment lifecycle. In health professions education, where assessment decisions shape learner progression and patient care, validity arguments must justify the meaning and use of scores for all examinees in equity-relevant contexts.</p><p><strong>Methods: </strong>We advance a fairness-as-validity position: Fairness consists of validity claims about whether scores carry comparable meaning and support defensible decisions across groups. In this framing, fairness threats are validity threats when construct underrepresentation or construct-irrelevant variance systematically alters what scores represent. We distinguish these threats from test misuse and situate fairness evaluation within argument-based validation and the Standards for Educational and Psychological Testing.</p><p><strong>Results: </strong>Using examples from Objective Structured Clinical Examinations, Multiple Mini Interviews and standardised tests, we show how culturally narrow norms, rater expectations and access barriers introduce avoidable variance that undermines validity. We propose a lifecycle approach that integrates fairness evidence into design, administration, scoring, interpretation and decision-making, drawing on multiple sources of validity evidence and mixed methods. We highlight system levers (e.g. barrier-aware blueprinting, principled accommodations and programmatic assessment) that support defensible interpretation. Finally, we introduce intersectional psychometric approaches to model compounded bias and detect validity threats that are missed when groups are examined in isolation.</p><p><strong>Discussion: </strong>Together, these arguments position fairness as central to validity theory and validation practice in socially accountable assessment.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920321","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":"Podcasting to build confidence in climate and health advocacy.","authors":"Augusta A Williams, Nadine Simprevil","doi":"10.1111/medu.70317","DOIUrl":"https://doi.org/10.1111/medu.70317","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930265","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":"Now you see me, now you don't: A critical narrative review of educator identity in health professions education.","authors":"Farah Ennab, Mersiha Kovacevic, Shaista Salman Guraya","doi":"10.1111/medu.70307","DOIUrl":"https://doi.org/10.1111/medu.70307","url":null,"abstract":"<p><strong>Introduction: </strong>Health professions educators occupy a unique position at the intersection of clinical practice, education and service. Despite their central role, educator identity remains under-recognised and insufficiently theorised within academic medicine, where clinical expertise and research dominate traditional hierarchies of value. This review offers an integrated understanding of educator identity by foregrounding the interplay among the self, institutional structures and the broader sociocultural milieu of health professions education (HPE).</p><p><strong>Methods: </strong>We conducted a critical narrative review using an interpretive approach. A multidisciplinary Scopus search identified empirical and non-empirical English-language studies published between 2000 and 2025 that engaged conceptually with educator identity in HPE. Selected studies were analysed through a layered interpretive lens drawing on sociological, psychological, psychosocial and sociocultural perspectives to examine how educator identity is conceptualised, negotiated and sustained within sociocultural context of the field.</p><p><strong>Results: </strong>Sixteen studies informed three interconnected interpretive perspectives synthesised through the metaphor of a disciplinary 'home'. Our synthesis suggests that HPE remains a partially constructed discipline that is fragmented, under-formalised and unevenly institutionalised. Within this home, two heuristic identity trajectories were identified: full inhabitants, who orient their primary professional identities towards HPE, and dual citizens, whose educator identity coexists alongside their disciplinary (clinical) identities. Rather than representing hierarchical categories, these trajectories reflect different identity orientations asking for personalised forms of institutional support. Across both trajectories, educator identity is shaped by individual agency, institutional structures and the hidden curriculum that governs legitimacy and recognition.</p><p><strong>Conclusion: </strong>Educator identity in HPE is shaped by the interaction between individual aspirations and the structural conditions within which educational work is recognised and valued. Strengthening HPE requires institutional structures that provide identity scaffolding, value diverse educator identities and sustain HPE both as a scholarly discipline and a professional home to support those who seek to build a primary identity within it, while also enabling flexible and meaningful participation for those who enter from adjacent professional domains.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920269","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 validity arguments for artificial intelligence-based assessment: Balancing affordances and threats.","authors":"Martin G Tolsgaard, Lawrence Grierson, Martin V Pusic, Laurah Turner","doi":"10.1111/medu.70309","DOIUrl":"https://doi.org/10.1111/medu.70309","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is increasingly used to generate, score and interpret educational assessment, yet these applications are being adopted in a largely unregulated environment. This creates a paradox: Whereas AI systems used in clinical care are subject to formal scrutiny for safety, performance and monitoring, AI systems used to inform consequential decisions about learner progression and future clinical practice are not. Existing validity frameworks remain useful but may not fully account for AI-specific threats.</p><p><strong>Methods: </strong>We conducted a state-of-the-science conceptual review examining validity for AI-based assessment through Kane's four inferences: scoring, generalisation, extrapolation and implications. We integrated conceptual and empirical literature from medical education and adjacent AI evaluation fields to identify major threats, evidence needs and practical implications for defensible AI-based assessment use.</p><p><strong>Results: </strong>AI introduces distinct validity threats across the inferential chain. For scoring, key risks include construct contamination, prompt instability and limited explainability. For generalisation, domain shift, rater culture differences and temporal drift threaten reproducibility across settings and time. For extrapolation, AI may alter the construct being assessed, making explicit construct definition essential to defensible interpretation. For implications, risks include subgroup inequities, automation bias, deskilling, weak accountability and erosion of academic integrity. Across these inferences, we identified seven cross-cutting mechanisms that can operate as either threats or affordances depending on design and governance.</p><p><strong>Conclusions: </strong>Validity for AI-based assessment should be approached as ongoing governance of a sociotechnical system rather than one-time validation of a static instrument or assessment process. Defensible adoption requires explicit validity arguments, auditability, multi-site evaluation and continuous consequence monitoring that is aware of the specific AI affordances and threats.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906783","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":"Teaching structural inequality through experiential learning.","authors":"Heitor Bernardes Pereira Delfino, Phelipe Elias Silva, Flávia do Bonsucesso Teixeira","doi":"10.1111/medu.70300","DOIUrl":"https://doi.org/10.1111/medu.70300","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887564","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":"Growing in confidence on call: What supervisors may not see.","authors":"Saskia Millard, Benjamin H L Harris, Louis J Koizia","doi":"10.1111/medu.70310","DOIUrl":"https://doi.org/10.1111/medu.70310","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874348","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":"Unravelling student engagement orientations within peer assessment in team-based learning: A constructivist grounded theory study.","authors":"Elda Maria Stafuzza Gonçalves Pires, Hans H C M Savelberg, Stephanie N E Meeuwissen","doi":"10.1111/medu.70304","DOIUrl":"https://doi.org/10.1111/medu.70304","url":null,"abstract":"<p><strong>Introduction: </strong>While peer assessment in Team-Based Learning is intended to foster students' academic skills and core competencies, implementation often falls short of meeting these goals. Because students' engagement is shaped by their beliefs and motivation, this research explored how they perceive and engage with peer assessment.</p><p><strong>Methods: </strong>We conducted a constructivist grounded theory study at a Brazilian medical school with a 6-year curriculum centred on collaborative Team-Based Learning in rotating teams. Fifteen students were purposefully sampled and interviewed. Data were analysed inductively in an iterative way, using focused coding and constant comparison.</p><p><strong>Results: </strong>Students differed in how they valued, provided and responded to peer assessment and in how peer assessment was influenced by contextual factors. We identified three distinct engagement orientations: requirement-, team- and peer-oriented. Requirement-oriented students treated peer assessment as a formal obligation and offered generic feedback. Team-oriented students focused on improving team functioning. Peer-oriented students engaged deeply with peer assessment as a tool for both team and personal development, offering specific and constructive feedback. These orientations were shaped by contextual influences, including fear of interpersonal conflict, proximity to peers, workload and exposure to strong feedback exemplars.</p><p><strong>Discussion: </strong>These findings suggest that variation in peer assessment engagement reflects distinct context-sensitive orientations rather than uniform behaviour. Rather than a procedural activity, peer assessment is shaped by an interaction between context and students' motivational stance, which influences whether feedback is generic, team-focused or developmental. Recognising these patterns could inform strategies to reduce social risk, strengthen feedback literacy and support more meaningful engagement with peer assessment.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874542","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 warnings: Leveraging AI disagreement as a catalyst for reflective clinical reasoning.","authors":"Yu Xiao, Yuan-Xin Guo, Liang Liu, Zhong-Rui Ma","doi":"10.1111/medu.70203","DOIUrl":"10.1111/medu.70203","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":"1058-1059"},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390371","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":"Asynchronous learning pearls: Building a learning community.","authors":"Fa'iz Bayo-Awoyemi","doi":"10.1111/medu.70312","DOIUrl":"https://doi.org/10.1111/medu.70312","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874338","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":"'I've been here before, but never looked at the ceiling': Narratives of medical trainees who took illness-based leaves.","authors":"Daniela Keren, Martina Kelly, Lorelei Lingard, Pim Teunissen, Taryn Taylor","doi":"10.1111/medu.70302","DOIUrl":"https://doi.org/10.1111/medu.70302","url":null,"abstract":"<p><strong>Introduction: </strong>Medical training is commonly imagined as a linear, uninterrupted progression, yet many trainees experience illness that necessitates a leave of absence (LOA). Illness-based leaves may be especially fraught given stigma, opaque processes and training cultures that prioritise endurance. Little is known about how trainees experience illness and illness-based leaves.</p><p><strong>Methods: </strong>We conducted a narrative inquiry using Riessman's narrative analysis framework. Canadian physicians who had taken an illness-based LOA during medical school or residency were recruited nationwide. Semi-structured, in-depth interviews were completed between December 2022 and July 2023, audio-recorded, and transcribed verbatim. Analysis was inductive and iterative, examining narrative content and structure to understand participants' meaning-making and shifting positioning within their stories. Rigour was supported through reflexive practice, collaborative team analysis and Criteria for Reporting Qualitative Research (COREQ)-informed reporting.</p><p><strong>Results: </strong>Seven participants shared the stories of their illness-based leaves because of diverse conditions (including rheumatologic disease, malignancy, mental illness, traumatic brain injury and a movement disorder). Narratives followed common threads: (1) identity disruption, as illness fractured self-concepts built on competence and grit and shifted trainee identities from clinician to patient; (2) loss of narrative control with shifting protagonists, as administrative and service demands shaped decisions and timelines, often intensifying vulnerability; (3) isolation and perceived illegitimacy, compounded by cohort separation, stigma and the need to justify both 'visible' and 'invisible' illness; (4) misalignment between individual needs and structural expectations, marked by unclear processes, limited accommodations, and reliance on informal workarounds or external advocacy; and (5) meaning-making and purpose-greater humanism and advocacy-coexisting with residual disillusionment when systems remained unchanged.</p><p><strong>Conclusion: </strong>Illness-based leaves in medical training are narrated as profound identity disruptions, shaped by structural rigidity and cultural expectations of uninterrupted productivity. Training programmes should develop transparent, compassionate leave and accommodation processes, normalise vulnerability within professional identity formation and incorporate trainees' voices into policy to better support learners who become ill. This will retain the perspectives they bring to patient care and teaching.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840588","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}