Medical Education最新文献

{"title":"Teaching intervision: Overcoming student resistance by using e-learning","authors":"Richta C. IJntema, Nicole J. J. M. Mastenbroek","doi":"10.1111/medu.15502","DOIUrl":"10.1111/medu.15502","url":null,"abstract":"<p>Intervision, a peer-led group reflection method, is regarded as an important instrument for continuing professional development.<span><sup>1</sup></span> Therefore, students in all master programmes of the Faculty of Veterinary Medicine (FVM) at Utrecht University (UU) are taught how to conduct intervision in four 2-hour sessions during their outpatient clinic work. In teaching this method to students, we encountered two main problems: (1) students showing resistance to share personal issues with each other, and (2) some veterinary medicine staff being underqualified to teach intervision.</p><p>To address both problems at once, we decided to flip the classroom and develop an e-learning on the ULearning platform, made possible by an UU Education Innovation Grant. This e-learning consists of five modules explaining the why, what and how of intervision, and illustrating how to apply three different intervision models. Powerful learning activities in the e-learning are the many short videos in which veterinary medicine alumni explain why they participate in intervision, what they share and learn, and which pitfalls to avoid. Their testimonials clarify to students that intervision is a relevant and ordinary method for expertise development. Powerful are also the comprehensive examples of how to structure an intervision meeting and the actual practice with a virtual coach (DialogueTrainer tool). Due to this e-learning, students became less dependent of their teacher. They all received the same comprehensive explanation about the intervision method and knew what to do during meetings because they could immediately apply what they had learned online. Student resistance decreased as shown by teacher observations and student evaluations, and teachers felt more equipped for the job. Hence, the e-learning had the intended effect.</p><p>Although the e-learning was successful and can be used for years, even in master programmes outside FVM, it did not happen overnight. We started off enthusiastically, but soon discovered that we had been overly optimistic about the time and effort it would take to build the e-learning and naive about the skills required to successfully complete the project. An e-learning is like an interactive book. It not only requires good writing skills, but also software skills to design interactive content and multimedia skills, such as video production and infographic design. We learned that it is no unnecessary luxury to have such expertise in the design team. Thanks to student feedback, we also learned that less is more. Rather than providing the complete guide to intervision, we limited ourselves to information beginners need to start with intervision and added further reading tips for anyone interested. Although the e-learning turned-out to be concise and appealing, we still needed a student tracking system to motivate students to complete the e-learning in time. Apart from the e-learning, we learned that circumstances matter to r","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1404-1405"},"PeriodicalIF":4.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109219","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 ABCs of competence development in physiotherapy education","authors":"Tonderai Washington Shumba, Ara Tekian","doi":"10.1111/medu.15519","DOIUrl":"10.1111/medu.15519","url":null,"abstract":"<p>The undergraduate physiotherapy programme at the University of Namibia is in its infancy, with the first cohort graduating in 2022. The programme lacked a defined set of competencies for undergraduate students and entry level physiotherapists developed and agreed upon by all relevant stakeholders including professional associations and regulatory bodies. Most of the regulations and guidelines were developed prior to the implementation of the physiotherapy programme and have not yet been reviewed. The current system has resulted in producing graduates who lack clear-cut competencies that are responsive to the Namibian and international rehabilitation standards.</p><p>This project offered an opportunity to identify and supplement specific competencies to add clarity, strength and content to the current competencies for undergraduate students and entry level physiotherapists in Namibia. The project involved four steps from June 2022 to May 2024. First, the scoping review yielded a set of competencies from global physiotherapy frameworks and their accompanying specific knowledge and skill activities required to achieve each competence. Second, the key informant interviews explored the experiences and perceptions of faculty, clinicians, students and external examiners on the existing competencies of the physiotherapy programme. This culminated in proposals of contextually relevant competencies the programme can revise and strengthen and those that could be added. Based on the first two steps, a draft competence framework was developed.</p><p>Third, the Delphi consensus study allowed physiotherapy stakeholders (students, interns, junior, senior, faculty, external examiners) to reach a 97.7% consensus on the set of competencies that are contextual and relevant to Namibia. Last, content validation was conducted with five experts and two final year students on each competence and its accompanying knowledge and skill learning objectives for the following: I-CVI (item-level content validity index; Universal agreement (UA); S-CVI/Ave (scale-level content validity index based on the average method); and S-CVI/UA (scale-level content validity index based on the universal agreement method). Interestingly there was a high (>0.9) S-CVI/UA in terms of patient treatment, clinical reasoning, health promotion, community physiotherapy and ethics and low (<0.70) S-CVI/UA in terms of diagnostic reasoning, research capacity building, quality improvement and collaboration.</p><p>Despite a wealth of literature on developing competencies in health care, there seem to be limited and inconsistent methods for developing competencies in physiotherapy. Recent literature has associated development of competencies with several methodological steps.<span><sup>1</sup></span> An important outcome was the implementation of this project following a multi-stepped methodology.</p><p>Initially the project envisioned including training on the validated competency framework. This c","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1387-1388"},"PeriodicalIF":4.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15519","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109220","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":"What happened to my patient? Automated patient follow-up","authors":"Susan Croft, Joseph Harding, Tom Bircher, Rebecca Hartshorn","doi":"10.1111/medu.15504","DOIUrl":"10.1111/medu.15504","url":null,"abstract":"<p>Reflection is the process where ‘an individual thinks analytically about … their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements when possible’.<span><sup>1</sup></span></p><p>It can be challenging and time consuming to access the information required to reflect upon your clinical practice by reviewing the outcomes of individual patients (referred to as patient follow-up). This is particularly the case for acute specialties such as emergency medicine (EM) where the patient is either discharged or moves on to be cared for by another specialty; and for specialties where (perhaps due to shift patterns) there is disjointed continuity of care.</p><p>Information regarding individual patient's ongoing care is commonly recorded in electronic health records (EHR), providing valuable information on their ongoing management, treatment, final diagnosis and outcome.</p><p>This study aimed to automate the process of patient follow up, so rather than individual EM clinician's keeping patient details and manually searching files to find out what happened next/the final diagnosis, this process was automated.</p><p>A novel automated system was developed that provided EM clinicians working at the Northern General Hospital (NGH), Sheffield with patient follow-up information. This collected information from two EHRs in use: ‘Lorenzo’ and ‘ICE’ to generate a list of patients reviewed by each individual clinician and relevant patient outcome data.</p><p>This information was sent by weekly email to EM clinicians of all grades.</p><p>Detailed patient information was presented in separate tables (‘Admissions’, ‘Re-attendances’, ‘Deaths’, ‘Handovers’ and ‘Senior Reviews’).</p><p>For each patient information collected included ‘ED diagnosis’, ‘Destination’ (admitting specialty), ‘Inpatient final diagnosis’ and ‘Length of admission’ (nights).</p><p>This process was implemented in December 2020 and is ongoing. Clinicians experience and opinions on this system was collected via surveys in February 2021 and February 2023. Surveys were opt-in, anonymous, carried out online using Google Forms, available for a two-week period, and distributed by email. They contained single-answer, multiple-choice, and open free text questions.</p><p>Clinicians used the information for workplace-based assessments, supervisor meetings, discussion with peers and to facilitate collection of patient feedback.</p><p>The qualitative feedback was also positive ‘It's brilliant, informative and helpful for me as an established consultant to reflect on the cases I see and advise on’.</p><p>Routine Electronic Health Care record data can be used innovatively to provide feedback on individual patients to healthcare staff to support their reflection, learning and improve patient care.</p><p><b>Susan Croft:</b> Formal analysis; supervision; writing – original draft; writing – review and editing; data curation. <b>Joseph H","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1379-1380"},"PeriodicalIF":4.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109222","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":"Role-playing computer games in disaster medicine education","authors":"Hai Hu, Yaning Lai, Chuan Zuo","doi":"10.1111/medu.15515","DOIUrl":"10.1111/medu.15515","url":null,"abstract":"<p>The COVID-19 pandemic has forced a transition from traditional in-person teaching to virtual learning in disaster medicine education, posing significant challenges. The lack of dedicated teaching platforms, especially those offering immersive experiences in critical decision-making under austere conditions, created a challenging environment for medical students transitioning to disaster settings. The scarcity of resources and complex disaster site management situations, coupled with limited prior experience, further exacerbated the difficulties.<span><sup>1</sup></span></p><p>To address the challenges in disaster medicine education, we developed Disaster Medicine Game (DMG), a role-playing computer game tailored for pre-clinical medical students. DMG offers immersive disaster scenarios, where players assume the role of a cartoon character engaged in on-site medical rescue. Players navigate through disaster scenes, interact with computer-controlled non-player characters (NPCs), triage and treat casualties using limited medical supplies, and make strategic decisions. Three two-dimensional disaster scenarios—earthquake, chemical incident, and infectious disease outbreak—were created to cultivate clinical decision-making and situational awareness.</p><p>To assess the effectiveness of DMG, we implemented a comprehensive evaluation process. This included pre- and post-course online tests to measure students' knowledge gains. Additionally, we administered questionnaires using a 6-point Likert scale to assess students' motivation before and after the course. We also conducted a post-course questionnaire to assess cognitive load and acceptance of the game's technology. This multifaceted evaluation allowed us to gain insights into the impact of DMG on students' learning outcomes and their perceptions of the game.</p><p>Following the implementation of DMG, students demonstrated significant improvement in test scores, with the post-test average reaching 83.6%, compared to 70.7% pre-test (<i>p</i> < 0.001). All participants expressed interest in future game-based courses, reporting enhanced understanding and confidence in disaster medicine. Motivation increased significantly (from 3.9 to 5.7 on a 6-point Likert scale, <i>p</i> < 0.001), while the average score for technical acceptance was 5.6, indicating students' positive reception of the game's operation. However, high cognitive load was observed, with an average score of 5.1, highlighting the need for improved balance between complexity and educational goals in future game iterations. Students also expressed a desire for more scenarios, underscoring the relevance and value of this learning approach. This study underscores the potential of role-playing computer games as a valuable educational tool in disaster medicine education, especially in the current hybrid learning environment.</p><p>In summary, the DMG, a role-playing computer game designed for pre-clinical medical students provides immersive","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1408-1409"},"PeriodicalIF":4.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15515","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109216","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":"Fireside chats: Using recorded case-based discussions with medical experts to teach clinical reasoning","authors":"Ghaniah Hassan-Smith, Zaki Hassan-Smith","doi":"10.1111/medu.15497","DOIUrl":"10.1111/medu.15497","url":null,"abstract":"<p>Consensus opinion suggests that students and trainees receive insufficient teaching on clinical reasoning.<span><sup>1</sup></span> Following the COVID-19 pandemic, students had reduced access to some specialist clinics, which impacted on their educational opportunities within clinical reasoning, including discussions around choice and interpretation of diagnostic tests, problem identification and management approach. Feedback from students and clinicians, confirmed that this remains a challenge in some medical specialities with increasing clinical pressures, use of remote consultations and reductions in educational time in clinical job plans.</p><p>To address this, we devised an efficient process whereby a bank of video resources, called ‘Fireside Chats’ was created and made available to students to support the development of clinical reasoning abilities. This was piloted for students rotating through clinical rotations in Endocrinology and Neurology, within our teaching hospital. Topics were selected and mapped to the learning outcomes of the Clinical Curriculum in each specialty. We prepared Powerpoint presentations of example clinical cases, including details of clinical presentation and history, examination findings, initial investigations and ongoing management, under each sub-specialty area. We identified clinical experts, who were consultant physicians with relevant sub-specialty interests (e.g. for endocrinology these included metabolic bone, adrenal, pituitary and thyroid disease etc.). The clinical experts were given guidance on learning objectives, and format considerations and were invited to an MS Teams meeting with us, where the ‘Fireside Chat’ was recorded. The clinical expert was given an online briefing ahead of the recording where queries were addressed. We acted as case presenters and posed questions to facilitate a discussion with the clinical expert, with the aim of sharing insights into the clinical reasoning process, for a range of cases. The chats finished with summary learning points and links to further reading. The ‘Fireside Chat’ recordings were made available on the virtual learning environments for the associated medical schools. The full recordings were presented as long-form discussions on a sub-specialty topic, covering several cases lasting up to 1 hour in total. Students were directed to these as part of placement induction and were encouraged to use these as the basis for further learning and discussion during clinical placements.</p><p>The bank of resources was well-received by students, with positive evaluation feedback. Students suggested potential future topics for the chats. The process was efficient, with a relatively short preparation time. Clinical experts enjoyed the process, and appreciated the time-efficient way in which they were able to share their insights. This offers a solution, whereby clinical teams can be guided in using this simple process, to develop high quality video resources, to sup","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1377-1378"},"PeriodicalIF":4.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109206","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":"Giving recorded video lectures new life","authors":"Nu Cindy Chai","doi":"10.1111/medu.15513","DOIUrl":"10.1111/medu.15513","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1412"},"PeriodicalIF":4.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109209","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":"Constructive dialogue: Strengthening our knowledge by exploring cross-cultural differences.","authors":"Jennifer Cleland, Rola Ajjawi, Kevin Eva","doi":"10.1111/medu.15494","DOIUrl":"https://doi.org/10.1111/medu.15494","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142086174","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":"Medical Education and artificial intelligence: Responsible and effective practice requires human oversight","authors":"Kevin W. Eva","doi":"10.1111/medu.15495","DOIUrl":"10.1111/medu.15495","url":null,"abstract":"<p>I have a confession to make. I have been slow to generate an official policy statement for <i>Medical Education</i> about artificial intelligence (AI) because I find the discussion terribly boring. Don't confuse that statement with lack of interest—I consider the technology exhilarating, use it routinely, and marvel at its potential.<span><sup>1</sup></span> Don't confuse it either with being dismissive—I recognise, appreciate, and wish to help guard against the ethical harms that could be done from, among other things, loss of intellectual property and reinforcement of systemic bias.<span><sup>2</sup></span> However, I find most discussion about the use of AI in publishing (be it about writing, enabling better and faster peer review, or the need to guard against unscrupulous practices) to boil down to the same basic sentiment: Responsible and effective practice requires human oversight.</p><p>With over 14 500 seemingly viable AI resources readily available,<span><sup>3</sup></span> there is great risk of overgeneralization and I will not profess to having deep knowledge of the means through which each has been generated. I do, however, believe this class of technologies, as a whole, to best be conceived of as tools (that happen to be proliferating at unprecedented speed and with little empirical testing).<span><sup>4, 5</sup></span> Some of the panic the rate of development creates amounts to worry that we ourselves will become tools, used by the computers, but that is not the reality we are dealing with at the moment and there are very good reasons to not believe the futurists in that regard.<span><sup>6</sup></span> As such, we must focus on what all tools require for responsible and effective practice: Human, or at least biological,<span><sup>7</sup></span> oversight. So let's consider the role each group involved in journal publication has to play in that regard.</p><p>We encourage authors to use AI <span>if and when</span> it helps strengthen their capacity to improve awareness of pre-existing literature,<span><sup>8</sup></span> to formulate stronger research questions or to bolster research designs and analyses (i.e. any time it helps to make their scholarship better). We are not going to force disclosure of every way in which AI influenced their submissions because it would be impossible to craft a sufficiently detailed guideline (especially given that people are often unaware of how AI has been embedded in common software packages). Further, a dominant theme in our International Editorial Advisory Board's debate about this issue was that requiring such disclosure is likely to be increasingly nonsensical, tantamount to needing to disclose the use of Google, spell-check, a keyboard, or any other tool that is similarly omnipresent in academic work. If using AI was of fundamental importance to your project, then what made it so should be disclosed in the body of your paper. That standard, however, is the same as has always been applied t","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1260-1261"},"PeriodicalIF":4.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046880","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":"Formed in context: A mixed-methods study of medical students' mindsets in an Eastern culture.","authors":"Jiaxi Tan, Honghe Li, Pingmei Zhang, David A Hirsh","doi":"10.1111/medu.15491","DOIUrl":"https://doi.org/10.1111/medu.15491","url":null,"abstract":"<p><strong>Introduction: </strong>Mindsets have become an important focus in the fields of social and cognitive psychology. When holding a growth mindset, people appear more likely to engage in hard work and effort to foster success, seeing setbacks as necessary for learning. When holding a fixed mindset, in contrast, people tend to believe success comes from innate ability, seeing setbacks as evidence of inability. As such, mindsets affect students' learning, resilience and personal development. There is little empirical evidence, however, regarding how medical students perceive mindsets and the fundamental determinants of mindset formation, especially in non-Western contexts. This study investigated medical students' mindsets and perceptions of mindset formation with the aim of broadening the cross-cultural understanding of self-theories.</p><p><strong>Methods: </strong>Using a convergent mixed-methods approach at a medical school in China, the authors conducted a survey and four focus groups with medical students in first to third years. Quantitatively, we used the Dweck Mindset Scale to describe medical students' mindsets in the domains of intelligence and talent. Qualitatively, we analysed focus group data using a grounded theory approach to develop a descriptive model.</p><p><strong>Results: </strong>Survey results included 464 responses for quantitative analysis. Multivariable regression found that Year 3 students had more fixed mindsets for intelligence and talent (p < 0.05) compared with Year 1 students. Rural students reported a more mixed mindset for intelligence compared to urban students (p < 0.05). Qualitative analysis of focus group data yielded four major categories: beliefs about mindsets, conceptualization of mindsets, achievement motivation and source of mindset formation. We developed a Mindset Basis Model to depict connections among the factors students perceived to influence mindset formation-intra- and interindividual factors; contextual factors; and micro-, meso- and macro-system factors-and students' motivation regarding achievement.</p><p><strong>Conclusion: </strong>The study describes medical students' mindsets for the domains of intelligence and talent and explores how they conceptualised these mindsets. The findings indicate that factors influencing mindsets do not operate in isolation but through intricate interactions among multilevel factors embedded within a context.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017933","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":"Stoking the fires of professional resistance: Trainees' efforts across time.","authors":"Tasha R Wyatt, Emily Scarlett, Vinayak Jain, Ting Lan Ma","doi":"10.1111/medu.15489","DOIUrl":"https://doi.org/10.1111/medu.15489","url":null,"abstract":"<p><strong>Introduction: </strong>Researchers who study acts of resistance largely focus on efforts when they are at their peak, giving the impression that those who resist are in a constant state of arousal. What is missing in such studies is the variable of time, which is theorised to be intimately connected to power and resistance. To explore this aspect, we followed a group of trainees engaged in professional resistance against social injustice over the period of 1 year to understand how their efforts shifted across time. This longitudinal approach was meant to capture the temporality of resistance, specifically how time affects resistance efforts.</p><p><strong>Methods: </strong>Using a constructivist grounded theory approach for data collection and analysis, we conducted follow-up interviews with 13 trainees approximately 10 months apart. Interviews were analysed using holistic narrative analysis, in which we analysed contexts, subjectivities and interactions across the two time points. We then conducted a cross-case analysis and restoried the data to develop an understanding of how resistance shifts across time. Finally, we contextualised the data using the metaphor of open and zombie wildfires.</p><p><strong>Results: </strong>The findings demonstrate that when trainees transition to new institutions or professional positions, their access to power and interactions with colleagues shift, thus making it challenging for them to resist in ways they had done so earlier. In transitions where trainees were given power, the flames of resistance continued to blaze visibly. In other cases, without an appreciable change in power, resistance resembled more of a 'zombie fire', smouldering quietly underfoot.</p><p><strong>Discussion: </strong>Examining trainees' acts of resistance across time demonstrates that the work of advocacy and resistance is extremely taxing for trainees. Therefore, when they experience shifts in their context or subjectivity, they conserve energy and strategise their next move. This study provides new insight on the relationship between time and resistance.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004580","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}