Medical Teacher最新文献

{"title":"Beyond resilience: Strengths-based narratives require psychologically safe systems.","authors":"Kenneth Ian Talosig Batac, Ronilo Palle Antonio","doi":"10.1080/0142159X.2026.2663865","DOIUrl":"10.1080/0142159X.2026.2663865","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1614-1615"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147776160","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 advocacy training in undergraduate medical education over 20 years: A scoping review.","authors":"Kalli Spencer, Kerry Uebel, Devi Mohan, Nalini Pather","doi":"10.1080/0142159X.2026.2649963","DOIUrl":"10.1080/0142159X.2026.2649963","url":null,"abstract":"<p><strong>Introduction: </strong>Health advocacy is recognised globally as a core physician competency yet remains one of the most challenging domains to teach, assess, and evaluate. Despite regulatory emphasis, integration into undergraduate medical curricula is inconsistent and poorly aligned with professional frameworks. This review maps and critically analyses how health advocacy has been conceptualised, implemented, and assessed in undergraduate medical education over the past two decades.</p><p><strong>Methods: </strong>A scoping review following Arksey and O'Malley's framework and PRISMA-ScR guidelines was undertaken, incorporating critical interpretive synthesis to move beyond description towards theory development. Thirty-two studies (2003-2025) were identified from EMBASE, PubMed, Scopus, and Web of Science. Carlisle's advocacy domains, CanMEDS competencies, Van Melle's implementation components, and Kirkpatrick's evaluation levels were applied as complementary lenses.</p><p><strong>Results: </strong>Advocacy education was most frequently framed as representation or community development, with limited engagement in community activism or policy reform. Programs were variably integrated, often elective or episodic rather than longitudinal. Implementation gaps were evident: only 56% articulated measurable advocacy competencies, 16% demonstrated sequenced progression, and 22% showed programmatic assessment alignment. Assessment was predominantly faculty-driven, with minimal community feedback and rare measurement of system-level impact. Evaluation focused largely on learner knowledge (Kirkpatrick level 2), with little evidence of behaviour change or structural outcomes.</p><p><strong>Discussion: </strong>Advocacy education has advanced in visibility but remains conceptually under-specified, structurally fragmented, and weakly evaluated. By integrating complementary frameworks, this review identifies where breakdowns occur at the levels of meaning, design, and enactment. Educators should embed advocacy longitudinally, integrate community co-creation, and use assessment approaches that measure behavioural change and social impact. These findings are synthesised into five evidence-informed design principles presented as practice points to guide advocacy curriculum development and evaluation.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1592-1605"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674577","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":"Augmented reality enhances competency-based training in simulated vaginal birth: A multicenter randomized controlled trial.","authors":"María Teresa Valenzuela, José A Poblete, Milena Zamboni, Rocío Astudillo, Cristóbal A Carvajal, Nicolás Moreno, Luis A Sarmiento, Sandra X Jaramillo, Luis C Franco, Fernando Ayala, Jorge A Carvajal","doi":"10.1080/0142159X.2026.2630982","DOIUrl":"10.1080/0142159X.2026.2630982","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation is essential for teaching procedural skills in obstetrics, yet access to high-fidelity simulators remains limited. Augmented reality (AR) offers an innovative and scalable way to enhance pre-simulation learning. This study evaluated whether AR-based training improves student performance in simulated vaginal births compared with traditional text- and video-based preparation.</p><p><strong>Methods: </strong>We conducted a multicenter, prospective, randomized controlled trial with blinded evaluators involving 401 undergraduate medical and midwifery students from two universities (Chile and Colombia). Participants were assigned to AR-based training (experimental group) or conventional preparation (control group). All students completed high-fidelity childbirth simulations assessed using a validated Direct Observation of Procedural Skills (DOPS) checklist. The primary outcome was achievement of the minimum competency threshold; secondary outcomes included mean DOPS scores, critical task performance, and student satisfaction.</p><p><strong>Results: </strong>Students trained with AR achieved significantly higher DOPS scores (11.9 ± 0.14 vs 10.6 ± 0.15; <i>p</i> < .001) and greater critical task completion (3.6 ± 0.07 vs 3.3 ± 0.07; <i>p</i> < .001) than controls. The proportion reaching the competency threshold doubled in the AR group (12.8% vs 6.2%; RR 2.23; 95% CI 1.07-4.01; <i>p</i> < .05). Both groups reported high satisfaction, though AR users noted opportunities to improve realism.</p><p><strong>Discussion: </strong>AR-based pre-simulation training enhances performance and competency attainment in simulated vaginal birth care. This scalable and cost-effective approach complements traditional simulation, supporting competency-based medical education while broadening access to high-quality procedural training in obstetrics.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1524-1532"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147307666","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 plurality of good teaching.","authors":"Dan Pratt","doi":"10.1080/0142159X.2025.2555360","DOIUrl":"10.1080/0142159X.2025.2555360","url":null,"abstract":"","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1421-1422"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000941","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":"A national investigation on the impact of rurality on standardised clinical aptitude test performance.","authors":"Sam Biki, Jordan Fox, Doogie Whitcombe, Edward Bliss, Riitta Partanen, Eliza Whiteside, Sonia Saluja, Matthew McGrail","doi":"10.1080/0142159X.2026.2628083","DOIUrl":"10.1080/0142159X.2026.2628083","url":null,"abstract":"<p><strong>Introduction: </strong>Rural applicants to medical school are known to be disadvantaged, given their observed poorer performance on most selection measures. This study aims to examine performance differences of rural and metropolitan applicants on all UCAT-ANZ (University Clinical Aptitude Test in Australia and New Zealand) subtests and overall, as well as explore whether increasing rurality is associated with poorer performance.</p><p><strong>Methods: </strong>Retrospective repeated cross-sectional study of all UCAT-ANZ applicants between 2019 and 2023, stratified by rurality according to the Modified Monash Model. Six performance scores of the UCAT-ANZ were assessed: verbal reasoning, abstract reasoning, decision making, quantitative reasoning, situational judgement and aggregate cognitive score.</p><p><strong>Results: </strong>Rural origin applicants consistently achieved lower scores compared with the metropolitan origin applicants across all five years and most test components, with quantitative reasoning and abstract reasoning having the largest differences. Most test scores consistently decreased with each rurality level, even after accounting for key socio-economic and demographic differences. Additionally, the gap between metropolitan and rural applicants increased for decision making, quantitative reasoning, abstract reasoning and overall. The largest decrease in scores between rurality categories occurred for metropolitan and large regional centre applicants, with scores generally decreasing with each subsequent rurality category.</p><p><strong>Discussion: </strong>There remains a substantial disadvantage for rural applicants completing standardised tests for selection into medical school, and this worsens with increasing rurality. The performance gap between rural and metropolitan applicants has somewhat widened in the last five years, emphasising the need for immediate action to help address rural disadvantage within medical school selection. Failure to address this risks selection not aligning with social justice principles. Key actions include increased efforts from an earlier age to better support rural applicants, decreased reliance on these tests for selection decisions, or decreased direct competition between rural and metropolitan applicants through the use of quotas or separate tiers.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1476-1487"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258626","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":"Drawing the ARC: How medical students shape their professional selves.","authors":"Maya G Sardesai, Jessica M Lewis, Brian E Mavis, David Hatem, Meg G Keeley, Thuy L Ngo, Silvia Lizett Olivares Olivares, Jennifer L Quaintance, Marjorie D Wenrich, Robert B Shochet","doi":"10.1080/0142159X.2026.2630977","DOIUrl":"10.1080/0142159X.2026.2630977","url":null,"abstract":"<p><strong>Introduction: </strong>Challenges with developing a strong professional identity can have adverse consequences like burnout and misconduct. While conceptual models describe how medical students internalize the attitudes, behaviors and norms ascribed to physicianhood, a comprehensive catalog of the processes students employ to drive PIF is lacking. This study aimed to use qualitative evidence to deconstruct and codify so-called 'mechanisms' for professional identity formation (PIF) and generate a practical construct for educators.</p><p><strong>Methods: </strong>We undertook a cross-sectional qualitative multi-institutional study of 52 graduating medical students from four U.S. medical schools to explore their experiences during medical school. Pairs of investigators coded semi-structured interview transcripts identifying passages relevant to PIF with audit by a third coder for additional validation. Excerpts were reviewed to identify mechanisms and characterize patterns.</p><p><strong>Results: </strong>Analysis of 52 transcripts identified 20 discrete mechanisms that despite overlap, could primarily be categorized into one of three domains: action (experiencing/role enactment, observing, learning from role models, experimenting, acting with agency, isolating oneself, and stepping back), reflection (metacognition/reflection, self-evaluation, evaluation/feedback from others, turning negatives into learning, compartmentalization, and imagining/visualizing) and connection (having support, talking, attachments to others, being trusted, trusting others, teaching, and asking). Students used multiple mechanisms to develop their professional identities with interplay across domains.</p><p><strong>Conclusion: </strong>Discrete mechanisms actively employed by medical students to develop their professional identities can be categorized within domains of action, reflection, and connection (ARC). The ARC construct helps validate existing theories and could be used by educators and advisors to systematize and optimize interventions for PIF.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1533-1544"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290617","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":"From similar starting point to divergent academic trajectories: Evidence from rural order-oriented medical students in China.","authors":"Yanqing Xiong, Chenglong Zhang, Xinxin Han","doi":"10.1080/0142159X.2026.2628091","DOIUrl":"10.1080/0142159X.2026.2628091","url":null,"abstract":"<p><strong>Introduction: </strong>The training program for Rural Order-Oriented Medical Students (ROMS) in China is an important policy instrument designed to address the shortage of healthcare professionals in primary-level institutions. It plays a critical role in promoting educational equity and optimizing the allocation of health resources. However, challenges remain regarding the quality of training. Previous studies have primarily focused on the overall characteristics of ROMS, overlooking a subgroup whose entry-level academic ability are comparable to those of students who are not order-oriented (hereafter referred to as Non-Rural Order-Oriented Medical Students, non-ROMS). This oversight may obscure the underlying mechanisms that affect training quality.</p><p><strong>Methods: </strong>This cross-sectional study compared 250 ROMS and 985 non-ROMS in western China. Guided by the Input-Environment-Outcome (IEO), we analyzed inputs (demographics, socioeconomic status, and cultural backgrounds), environment (cognitive, emotional and behavioral engagement), and outcomes (academic performance) to examine divergent academic trajectories between the two groups, despite their comparable academic ability at enrollment.</p><p><strong>Results and discussion: </strong>ROMS were more likely to come from socioeconomically and culturally disadvantaged backgrounds, with higher proportions of female and ethnic minority students. Although emotional engagement did not differ significantly between groups, ROMS displayed lower cognitive and behavioral engagement, setting less ambitious goals, using self-regulated learning strategies less often, and spending less time on extracurricular study. Consequently, ROMS achieved significantly lower academic performance. Even when ROMS demonstrate comparable entry-level academic ability, as reflected by National College Entrance Examination (NCEE) scores, gaps in engagement and academic performance persist. We argue that expanding access alone is insufficient; substantive equity requires targeted, process-level interventions to ensure that policy-driven recruitment translates into high-quality, sustainable rural healthcare workforce development.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1467-1475"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271279","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":"Using neurocognitive profiles and common personality traits to predict academic success in written examination and growth trajectory in undergraduate medical education.","authors":"Ryan R Landoll, Madison F Clark, Layne D Bennion, Kade Thornton, Richard Iwuagwu, Dario Torre, Steven J Durning","doi":"10.1080/0142159X.2026.2628960","DOIUrl":"10.1080/0142159X.2026.2628960","url":null,"abstract":"<p><strong>Introduction: </strong>A central challenge in academic remediation is identifying struggling learners prior to a major academic failure. Standardized assessments may fail to capture contributions to score more aligned with humanistic theories of learning such as motivation, psychological needs, and response to prior failure. Thus, the current study sought to understand how neurocognitive and social/personality data predict academic success and academic trajectory during the pre-clerkship period of medical school. Specifically, this study utilized non-academic individual data along with cognitive assessments to help identify or predict at risk learners.</p><p><strong>Method: </strong>Sixty learners at an allopathic medical school were recruited during pre-clerkship and completed an abbreviated neurocognitive battery (problem solving, memory, attention, and processing speed) and measures of normative personality traits, grit, and test anxiety. Scores were analyzed in comparison to both their exam performance as well as their exam performance trajectory over time.</p><p><strong>Results: </strong>A stepwise multiple linear regression model was found to be significant, <i>F</i> (13, 46) = 1.98, <i>p</i> < .05 with cognitive, personality, and social measures as predictors of exam average. Working memory was the only significant individual predictor in the model, β = 0.30, <i>p</i> = .03. Learners whose trajectory of academic performance on written exams declined compared to those with improving trajectories had higher openness to experience as measured by the NEO-FFI-3^™, <i>t</i>(58) = 2.06, <i>p</i> = .02.</p><p><strong>Discussion: </strong>Results suggest that identification of at-risk learners can be enhanced by including additional non-academic data, e.g. lower openness to experience. However, at-risk learner performance is difficult to identify solely on individual factors; thus, interventions should be sensitive to situational variation and systemic in nature.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1506-1514"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195089","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":"Determining the influence of video-based benchmarking (VBB) on examiner variability in objective structured clinical exams (OSCE): The Align study.","authors":"Peter Yeates, Rebecca Jane Edwards, Aditya Narain, Robert McKinley, Janet Lefroy, Gareth McCray, Giles Roberts, Ellie Hammond, Stu McBain, Andrew Blythe, Kathy Cullen, Craig Napier, Laura Sims, Harish Thampy, Tushar Vince, Sue Ensaff, Rhian Goodfellow, Christopher Harrison, Ching-Wa Chung, Steven Capey, Chris Roberts, Rebecca Vallender","doi":"10.1080/0142159X.2026.2631743","DOIUrl":"10.1080/0142159X.2026.2631743","url":null,"abstract":"<p><strong>Introduction: </strong>Reducing examiner variability in Objective Structured Clinical Exams (OSCEs) is a priority within clinical performance assessment. In contrast to typical OSCE examiner training, video-based benchmarking (VBB) involves examiners scoring videos a/from their specific station b/shortly before the OSCE and then reflecting on and discussing scores/justifications agreed by an expert panel. Whilst realist evaluation has described mechanisms and contexts by which VBB may operate, VBB's overall efficacy is unknown.</p><p><strong>Methods: </strong>We performed a multi-centre (12 UK medical schools) stratified randomised controlled trial of VBB versus control to determine the influence of VBB on examiners' score variability and other score characteristics. Secondarily, we compared the average scores allocated by examiners from different schools.</p><p><strong>Results: </strong>171 medically qualified, trained OSCE examiners participated in the study. VBB showed no significant effect on overall examiner variability. In pre-specified analyses, VBB reduced variability from group mean of initially 'outlying' examiners on the borderline performance (VBB mean variability 3.02 out of 27 (IQR1.98-4.98), control 4.70 (3.91-5.70), <i>p</i> < 0.016) and made examiners more likely to correctly fail a minimally failing performance (<i>p</i> < 0.03, OR = 2.133[95% CI 1.081-4.208]). VBB caused a small increase in confidence. There were no significant differences in average scores by school.</p><p><strong>Discussion: </strong>VBB may enhance trust in OSCEs through more accurate classification of borderline performances and aligning outlying examiners scoring.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1561-1575"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326545","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":"Clinical placements beyond numbers: A guide to understanding and enhancing clinical learning capacity: AMEE Guide No. 195.","authors":"R B Hays, T J Wilkinson, S Ramani, D D Samarasekera, L Green-Thompson, K Baatjes, E Amaral","doi":"10.1080/0142159X.2026.2718313","DOIUrl":"https://doi.org/10.1080/0142159X.2026.2718313","url":null,"abstract":"<p><p>Clinical learning is the cornerstone of medical education, providing opportunities for learners to integrate knowledge, develop clinical skills, form professional identities and prepare for independent practice. However, increasing learner numbers, changing models of healthcare delivery, workforce pressures and growing expectations of healthcare systems have intensified concerns about clinical placement capacity. While discussions of capacity have often focused on placement numbers, patient availability and supervisory resources, such approaches provide only a partial understanding of how clinical learning opportunities are created and sustained. This AMEE Guide presents a systems-based framework for understanding clinical learning capacity in medicine. We argue that clinical learning capacity is not simply a function of available resources but an emergent property arising from formal and informal interactions among learners, patients, supervisors, healthcare organisations and educational institutions within specific healthcare contexts. Drawing on literature and international perspectives, we examine the conceptual foundations of clinical learning, the determinants of clinical learning capacity, markers of quality in clinical placements and practical approaches to planning, monitoring and enhancing clinical learning systems. We propose that clinical learning capacity should be considered across the whole healthcare system and that efforts to strengthen capacity should focus on quality as well as quantity recognising the importance of factors including the clinical learning environment. Finally, we identify priorities for future research, including the development of systems-based approaches to evaluation and a better understanding of the relationships between clinical learning, healthcare outcomes and workforce development. By reframing clinical learning capacity as a systems issue rather than simply a placement issue, this guide provides educators, healthcare organisations and policy makers with a framework for planning, evaluating and strengthening clinical learning in contemporary healthcare systems.</p>","PeriodicalId":18643,"journal":{"name":"Medical Teacher","volume":" ","pages":"1-18"},"PeriodicalIF":4.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830195","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}