Medical Teacher最新文献

{"title":"Competence, mattering and belonging: An evidence-based and practical approach to understanding and fostering medical student professional identity formation.","authors":"Jennifer L Quaintance, Thuy L Ngo, Marjorie D Wenrich, David Hatem, Meg G Keeley, Jessica M Lewis, Brian E Mavis, Silvia L Olivares, Robert B Shochet, Maya G Sardesai","doi":"10.1080/0142159X.2025.2500568","DOIUrl":"https://doi.org/10.1080/0142159X.2025.2500568","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding professional identity formation (PIF) in medical education is essential for preparing future physicians to navigate their profession and integrate communities' of practice (CoP) values, norms, and expertise to meet patients' needs. Despite robust PIF literature, gaps persist due to greater focus on internal psychological processes than social-contextual influences. Empirically describing PIF within medical training's cultural context will enhance understanding and inform learning environment interventions.</p><p><strong>Methods: </strong>We employed a constructivist qualitative approach to examine social-contextual factors influencing students' PIF. In one-on-one interviews, 52 graduating students from 4 geographically diverse U.S. medical schools described their PIF from pre-medical school through graduation. We used an iterative, multi-stage, constant-comparison approach to data analysis, employing reflexive methods throughout.</p><p><strong>Results: </strong>Social-contextual cues defining PIF were identified in three domains: competence, mattering, belonging. As students received cues, their professional identity evolved. They described a gradual integration of personal and professional values, with growing confidence and a shifting position within the physician CoP.</p><p><strong>Conclusions: </strong>This study provides a conceptual framework that describes how CoP members' interactions with medical students positively influence and at times undermine students' sense of competence, belonging, and mattering. Understanding these cues can help educators create a supportive environment that enhances students' PIF.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-12"},"PeriodicalIF":3.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curriculum mapping: Visualizing curricular alignment in a competency-based interprofessional fellowship program.","authors":"Ashlyne P Elliott, Travis Croom, Bradley V Watts, Molly J Horstman, Kyler M Godwin","doi":"10.1080/0142159X.2025.2497892","DOIUrl":"https://doi.org/10.1080/0142159X.2025.2497892","url":null,"abstract":"<p><p><b>Introduction:</b> This short report introduces an application of curriculum mapping in a postgraduate health professions continuing education setting. Our focus is on the Health Professions Education Evaluation and Research (HPEER) Advanced Fellowship Program, a national interprofessional 2-year program offered through the Department of Veterans Affairs. <b>Methods:</b> We designed an Excel-based tool to align HPEER domains and competencies with curricular elements. An interprofessional team conducted an independent review of the curricula, ensuring consistency and accuracy in the mapping. Discrepancies were reconciled to maintain consistency. <b>Results:</b> The pilot use of the curriculum mapping tool showed that all planned competencies appeared in at least two sessions per year, with each competency appearing a median of six times. The curriculum featured a balance of didactic and interactive sessions, ensuring diverse learning experiences. <b>Discussion:</b> Our curriculum mapping tool demonstrates a program-wide approach, enabling program leaders to oversee the comprehensive alignment of educational content with fellowship goals. This approach enhances transparency and stakeholder engagement, offering a fresh perspective on curriculum mapping in postgraduate interprofessional education. Our method demonstrates significant potential for quality enhancement in various continuing education settings and demonstrates that CM need not rely on complex digital platforms to be effective.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-5"},"PeriodicalIF":3.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of introducing planetary health topics to medical school curricula: A meta-ethnography.","authors":"Eleanor Nash, Zakia Arfeen, Carol Chan, Samantha Gallivan, Ahmed Rashid","doi":"10.1080/0142159X.2025.2497898","DOIUrl":"https://doi.org/10.1080/0142159X.2025.2497898","url":null,"abstract":"<p><strong>Introduction: </strong>Future doctors will need to adapt to the impact on health caused by the changing climate, whilst developing more sustainable practices to decrease the burden of healthcare on the environment. Planetary Health (PH) is emerging as a crucial subject area in medical education. This systematic review synthesises evidence on integrating PH into medical school curricula globally, focusing on experiences of medical students and educators.</p><p><strong>Methods: </strong>MEDLINE, ERIC, and EMBASE were systematically searched to identify qualitative research studies focusing on experiences of medical students and staff in PH integration into medical school curricula. We included articles published in English and in peer-reviewed journals, from 2010 onwards. Articles were assessed for quality using the CASP checklist for qualitative research. Fourteen studies were identified and synthesised using meta-ethnography.</p><p><strong>Results: </strong>This review identified a strong consensus on the necessity to incorporate PH into medical school curricula. Three inter-related third-order constructs shaped our synthesis. The first was challenging existing norms, as PH represented atypical scenarios with flattened medical hierarchies and reliance on student and faculty enthusiasm and advocacy. The second was a recognition of a moral dimension, with an ethical obligation to teach PH and a responsibility to manage 'climate anxiety' that can emerge in students. The third was an enthusiasm to innovate and influence, reflecting the importance of embedding PH longitudinally in teaching and assessment.</p><p><strong>Discussion: </strong>Whilst some factors that shape PH implementation into medical curricula are consistent with other new subject areas, PH integration also raises unique considerations and dynamics. These include a power and knowledge shift away from staff, and a central notion of ethical justice linked to PH education. Medical education leaders should be mindful of these when embedding and growing PH as a core topic in the medical curriculum.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The answer may vary: large language model response patterns challenge their use in test item analysis.","authors":"Lauren K Buhl","doi":"10.1080/0142159X.2025.2497891","DOIUrl":"https://doi.org/10.1080/0142159X.2025.2497891","url":null,"abstract":"<p><strong>Introduction: </strong>The validation of multiple-choice question (MCQ)-based assessments typically requires administration to a test population, which is resource-intensive and practically demanding. Large language models (LLMs) are a promising tool to aid in many aspects of assessment development, including the challenge of determining the psychometric properties of test items. This study investigated whether LLMs could predict the difficulty and point biserial indices of MCQs, potentially alleviating the need for preliminary analysis in a test population.</p><p><strong>Methods: </strong>Sixty MCQs developed by subject matter experts in anesthesiology were presented one hundred times each to five different LLMs (ChatGPT-4o, o1-preview, Claude 3.5 Sonnet, Grok-2, and Llama 3.2) and to clinical fellows. Response patterns were analyzed, and difficulty indices (proportion of correct responses) and point biserial indices (item-test score correlation) were calculated. Spearman correlation coefficients were used to compare difficulty and point biserial indices between the LLMs and fellows.</p><p><strong>Results: </strong>Marked differences in response patterns were observed among LLMs: ChatGPT-4o, o1-preview, and Grok-2 showed variable responses across trials, while Claude 3.5 Sonnet and Llama 3.2 gave consistent responses. The LLMs outperformed fellows with mean scores of 58% to 85% compared to 57% for the fellows. Three LLMs showed a weak correlation with fellow difficulty indices (r = 0.28-0.29), while the two highest scoring models showed no correlation. No LLM predicted the point biserial indices.</p><p><strong>Discussion: </strong>These findings suggest LLMs have limited utility in predicting MCQ performance metrics. Notably, higher-scoring models showed less correlation with human performance, suggesting that as models become more powerful, their ability to predict human performance may decrease. Understanding the consistency of an LLM's response pattern is critical for both research methodology and practical applications in test development. Future work should focus on leveraging the language-processing capabilities of LLMs for overall assessment optimization (e.g., inter-item correlation) rather than predicting item characteristics.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discursive (mis)alignments in internationalization: The case of International Medical Programmes.","authors":"Emmaline E Brouwer, Janneke M Frambach, Erik W Driessen, Maria Athina Tina Martimianakis","doi":"10.1080/0142159X.2024.2382852","DOIUrl":"10.1080/0142159X.2024.2382852","url":null,"abstract":"<p><strong>Purpose: </strong>International Medical Programmes (IMPs) form a distinctive modality in medical education, with diverse student populations, English as a language of instruction and 'globalized' curricula. A lack of common understanding of IMPs' purposes and role in the medical education landscape triggers critiques. This study aims to document the effects of different discourses used to justify the purpose of IMPs.</p><p><strong>Methods: </strong>We use a discourse analysis approach to explore the different ways in which the purposes of IMPs are constructed at the regulatory, institutional, and individual level, and how these discourses interact. The research situates in two IMPs, in the Netherlands and in Hungary. Key-informant interviews, policy documents, and scholarly literature form the archive.</p><p><strong>Results: </strong>The purpose of IMPs is constructed discursively around three distinct narratives and associated practices: around serving the institutions that host them, around serving the (global) public interest, and around serving individual students. Co-existence and misalignments of these three discourses cause conflicting practices and confusion among stakeholders.</p><p><strong>Conclusions: </strong>This study illustrates how diverging perspectives on internationalization in medical education create tensions for learners and staff. Articulating a clear and explicit meaning to internationalization may reduce uncertainties, and may reinforce realistic expectations of what constitutes a good outcome.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"865-871"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedagogy and generative artificial intelligence: Applying the PICRAT model to Google NotebookLM.","authors":"Neil Mehta, Anoop Agrawal, Jennifer Benjamin, Seysha Mehta, Heather MacNeill, Ken Masters","doi":"10.1080/0142159X.2024.2418937","DOIUrl":"10.1080/0142159X.2024.2418937","url":null,"abstract":"<p><p>Healthcare educators (HPE) are challenged by rapid developments in Generative Artificial Intelligence (GenAI) tools. They need a standardized model to evaluate these new tools and to guide them in pedagogically-sound integration in the curriculum. PICRAT is an educational model designed specifically to help teachers meet this challenge. NotebookLM is a new multi-featured GenAI tool to help teachers and learners in education and research. Its newest feature allows automatic generation of an engaging podcast (called audio overview) from uploaded education or research content. Using the example of NotebookLM and, specifically, the auto-podcast feature, we illustrate how HPE can use the PICRAT model to evaluate GenAI tools for technology integration. We discuss how this model can be utilized as a standardized approach for evaluation and implementation of GenAI tools in health professions education.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"788-790"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is vMMI effective in fairly assessing interpersonal skills?","authors":"","doi":"10.1080/0142159X.2024.2431135","DOIUrl":"10.1080/0142159X.2024.2431135","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"907"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health worker education, employment and equity: Aligning markets and strategies.","authors":"Jim Campbell, Jennifer Cleland, Janusz Janczukowicz, Siobhan Fitzpatrick","doi":"10.1080/0142159X.2025.2469604","DOIUrl":"10.1080/0142159X.2025.2469604","url":null,"abstract":"<p><p>A fit for purpose health workforce is essential for achieving universal health coverage and delivering on the 2030 Agenda for Sustainable Development. However, virtually all countries face challenges either in educating, employing or in retaining the health workforce they require to address population needs. The WHO estimates a global shortage of 11.1 million health workers by 2030. Some low- and middle-income countries have successfully expanded health workforce education and employment in recent years, leading to significant growth in workforce numbers. However, many graduates face job market absorption issues. Many high-income countries rely on international recruitment, with impacts on health systems in both sending and receiving countries. A comprehensive approach to health workforce strengthening must integrate education within health labour markets and health systems, to ensure effective returns on investment. The cost of health professions education remains poorly understood, with estimates ranging from USD $110 billion to $300 billion annually. Workforce retention strategies - such as decent employment, career development, and workplace safety - are critical. With five years remaining in the SDGs era, there is an opportunity - and an emerging consensus among countries at WHO's Executive Board in February 2025 - to accelerate action on the health and care workforce by 2030. Health workers must be prepared for the contexts in which they will practice, including a greater shift towards education and practice in primary and community care settings and contributions to public health functions, including emergency preparedness and response. Fundamental questions need to be asked, and gaps in the evidence must be addressed, to deepen understanding on what to teach, how to teach, whom to teach, how many to teach, and the underpinning science to guide cost, value and impact in health professions education.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"763-765"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing culturally competent physicians: Empathy, inclusivity, moral distress training and ethical reflections during the Medicine Clerkship.","authors":"Amalia Landa-Galindez, Melissa L Armas, Gloria Coronel-Couto","doi":"10.1080/0142159X.2024.2374943","DOIUrl":"10.1080/0142159X.2024.2374943","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship.</p><p><strong>Materials and methods: </strong>A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress.</p><p><strong>Results: </strong>357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress.</p><p><strong>Conclusion: </strong>Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"835-841"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewing the authenticity of the OSCE: Challenges and opportunities.","authors":"Supianto","doi":"10.1080/0142159X.2024.2425041","DOIUrl":"10.1080/0142159X.2024.2425041","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"904"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}