Perspectives on Medical Education最新文献

{"title":"Principles for Developing a Large-Scale Point-of-Care Ultrasound Education Program: Insights from a Tertiary University Medical Center in Israel.","authors":"Roy Rafael Dayan, Ofri Karni, Itamar Ben Shitrit, Rachel Gaufberg, Karny Ilan, Lior Fuchs","doi":"10.5334/pme.1613","DOIUrl":"10.5334/pme.1613","url":null,"abstract":"<p><strong>Background & need for innovation: </strong>Point-of-care ultrasound (POCUS) has transformed bedside diagnostics, yet its operator-dependent nature and lack of structured training remain significant barriers. To address these challenges, Ben Gurion University (BGU) developed a longitudinal six-year POCUS curriculum, emphasizing early integration, competency-based training, and scalable educational strategies to enhance medical education and patient care.</p><p><strong>Goal of innovation: </strong>To implement a structured and scalable POCUS curriculum that progressively builds technical proficiency, clinical judgment, and diagnostic accuracy, ensuring medical students effectively integrate POCUS into clinical practice.</p><p><strong>Steps taken for development and implementation: </strong>The curriculum incorporates hands-on training, self-directed learning, a structured spiral approach, and peer-led instruction. Early exposure in physics and anatomy courses establishes a foundation, progressing to bedside applications in clinical years. Advanced technologies, including AI-driven feedback and telemedicine, enhance skill retention and address faculty shortages by providing scalable solutions for ongoing assessment and feedback.</p><p><strong>Evaluation of innovation: </strong>Since its implementation in 2014, the program has trained hundreds of students, with longitudinal proficiency data from over 700 students. Internal studies have demonstrated that self-directed learning modules match or exceed in-person instruction for ultrasound skill acquisition, AI-driven feedback enhances image acquisition, and early clinical integration of POCUS positively influences patient care. Preliminary findings suggest that telemedicine-based instructor feedback improves cardiac ultrasound proficiency over time, and AI-assisted probe manipulation and self-learning with ultrasound simulators may further optimize training without requiring in-person instruction.</p><p><strong>Critical reflection: </strong>A structured longitudinal approach ensures progressive skill acquisition while addressing faculty shortages and training limitations. Cost-effective strategies, such as peer-led instruction, AI feedback, and telemedicine, support skill development and sustainability. Emphasizing clinical integration ensures students learn to use POCUS as a targeted diagnostic adjunct rather than a broad screening tool, reinforcing its role as an essential skill in modern medical education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"319-327"},"PeriodicalIF":4.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making as Method in Teaching: Do-It-Yourself (DIY) Objects and Hands-on Learning with Materials.","authors":"Anna Harris, Martina Bardelli, Giuliana Brancaleone, Nyah Costa, Lia Hruby, Remco Poeliejoe","doi":"10.5334/pme.1575","DOIUrl":"10.5334/pme.1575","url":null,"abstract":"<p><p>In medical education, technological innovation often focuses on the digital and virtual. In the analogue space, physical learning tools seem to come readymade - pre-programmed mannequins, printed textbooks or the ubiquitous articulated plastic skeletons. The market for mass-produced objects in medical education is vast, however we concern ourselves here with important but overlooked learning materials that fall outside this digital-industrial complex: handmade objects, crafted using (often) simple, low-cost, locally sourced materials, also known as <i>DIY objects</i>. Educational materials have long been hand-crafted, yet this topic receives little attention in the healthcare professions education literature. In this Eye Opener article, we aim to bring DIY objects out of the shadows and in doing so, introduce to the healthcare professions community some of the main theories, movements and approaches behind making as a teaching method. To further our understanding of the role of DIY objects in medical teaching we adopted an ethnographic method that involved making the objects ourselves. Our Eye Opener suggests a greater emphasis can be placed on making one's own teaching materials and on making as a learning activity. We discuss how making facilitates active and multisensory modes of learning including enhancing spatial awareness, helps students to challenge the status quo in medicine and encourages environmental sustainability in the classroom. We propose some applications of making in the classroom, such as exploring more diverse representations of bodies and studying the environmental impact of medical education materials.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"309-318"},"PeriodicalIF":4.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Programs of Active Arts Engagement in International Medical Curricula.","authors":"Zoe Moula, Stephanie Bull, Naa Okantey, Megan Brown, Victoria Edleston, Maisie Crawford, Sandra Sawchuk, Tracy Moniz","doi":"10.5334/pme.1506","DOIUrl":"10.5334/pme.1506","url":null,"abstract":"<p><strong>Introduction: </strong>Arts and humanities are often positioned as 'additive' to medical education, rather than 'intrinsic'. They are also used to teach skills and perspective-taking more than utilising their transformative potential to propel personal insight and social advocacy. There is, therefore, a need for more meaningful and strategic integration of the arts in medical curricula. Existing reviews combine <i>active</i> and <i>receptive arts</i> engagement, although these methods represent different magnitudes of engagement.</p><p><strong>Methods: </strong>This review aimed to synthesise the use of <i>active</i> arts engagement in undergraduate medical curricula internationally. We searched seven databases for articles published between 1991-2024.</p><p><strong>Results: </strong>We reviewed 134 studies conducted in 27 countries (total n = 10,700). Most programs were medium-intensity (e.g., standalone modules), used visual and performing arts, and aimed to foster skills mastery, perspective-taking, and personal insight. Studies on artmaking for social advocacy were lacking, as was data about program evaluation and learner assessment. Almost all survey instruments used were unvalidated.</p><p><strong>Discussion: </strong>Studies of active arts engagement are disproportionately low compared to receptive engagement, signaling missed opportunities to leverage the benefits of the arts. Most studies were conducted in high-income countries, illuminating that lower-income countries do not have a strong voice in the knowledge exchange. To avoid devaluing the arts in medical curricula, we suggest that medical educators: a) direct attention to creative opportunities to engage students with social advocacy; b) collaborate with arts/humanities professionals and international medical educators; c) consider more meaningful and strategic integrations of active arts engagement into medical curricula, approaching them with the same rigor as other medical education programs to maximise their pedagogical potential.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"296-308"},"PeriodicalIF":4.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Traditional: Clearing the Roadblocks to Advancement in Academic Medicine.","authors":"Pilar Ortega, Mara L Becker, Teresa M Chan, Kimberly D Manning","doi":"10.5334/pme.1681","DOIUrl":"10.5334/pme.1681","url":null,"abstract":"<p><p>In academic medicine, the label of nontraditional is often used to refer to scholars whose outputs or journeys differ from what is considered normative. Those who do not sufficiently align with traditional expectations may be at risk of being excluded from fully participating or achieving advancement in academic medicine, an experience that disproportionately affects groups who have been historically marginalized and underrepresented in medicine. In this eye opener, the authors use the lenses of their own stories in academic medicine to illustrate some of the traditional roadblocks experienced by these scholars, such as the lack of mentorship, the tendency to overlook or discourage work on nontraditional topics, and difficulty fitting innovative scholarship formats into curricula vitae or promotion packets. To clear the roadblocks, the authors call upon institutional leaders to enhance their processes, support systems, and criteria for learner and faculty academic advancement. Secondly, the authors call upon individuals to consider how they might engage in and frame their scholarly pursuits in a way that their merit can be readily ascertained.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"286-295"},"PeriodicalIF":4.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Burnout in Croatian Medical Students: The roles of Lifelong Learning and Loneliness.","authors":"Ivan P Gradiski, Ana Borovecki, Marko Curkovic, Esperanza García-Gómez, Roberto C Delgado Bolton, Luis Vivanco","doi":"10.5334/pme.1468","DOIUrl":"10.5334/pme.1468","url":null,"abstract":"<p><strong>Background: </strong>Burnout and engagement are seen as opposite ends of a continuum. In medical education, engagement reflects motivation and social belonging, while burnout signifies a lack of interest in learning and social detachment. This study aimed to investigate the influence of lifelong learning and loneliness on these dynamics.</p><p><strong>Methods: </strong>A cross-sectional study involving a culture back-translation procedure was performed. Participants were medical students enrolled in a Croatian medical school. The Maslach Burnout Inventory (MBI-GS), Jefferson Scale of Physician lifelong learning (JeffSPLL-MS), and the Scale of Social and Emotional Loneliness Scale for Adults (SELSA-S), were used as main measures. Sex, age, grade point average, and year of study, were collected in a complementary form. Confirmatory Factor Analyses (CFAs), followed by correlation, comparative and multiple linear regression analyses were performed to assess the above-mentioned variables.</p><p><strong>Results: </strong>The sample consisted of 1,371 medical students (872 women), all native Croatian speakers. A model including lifelong learning, loneliness and sex variables accounted for 17% of the variance in the global MBI-GS score. This model showed a medium-to-large effect size and fulfilled conditions required for statistical inference. Additionally, differences by sex appeared in loneliness (p < 0.001), but not in lifelong learning abilities. Furthermore, the Croatian versions of the JeffSPLL-MS and the SELSA-S exhibited good psychometric properties, as confirmed by CFAs.</p><p><strong>Conclusions: </strong>These findings highlight the influence of lifelong learning abilities and loneliness on the burnout-engagement continuum. Additionally, findings indicate that female medical students are at heightened risk of experiencing burnout.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"274-285"},"PeriodicalIF":4.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residents' Experiences of Learning, Working, and Developing in Entrustable Professional Activity-Based Training.","authors":"Maaike P Smit, Janiëlle A E M van der Velden, Reinoud J B J Gemke, Karsten A van Loon, Matthijs de Hoog","doi":"10.5334/pme.1464","DOIUrl":"https://doi.org/10.5334/pme.1464","url":null,"abstract":"<p><strong>Introduction: </strong>Entrustable Professional Activity (EPA)-based residency programmes are designed to offer structure, flexibility, and a gradual increase in autonomy. While residents are expected to take an active role in their learning, little is known about how they actually experience learning and working within the EPA framework. This study explores paediatric residents' experiences of learning, working, and developing within an EPA-based training programme.</p><p><strong>Methods: </strong>We conducted a qualitative study using semi-structured interviews with 11 paediatric residents from three of the seven Dutch training regions. Interviews were transcribed verbatim, anonymised, and analysed using template analysis to identify themes related to residents' learning and professional development within EPA-based training.</p><p><strong>Results: </strong>Residents described increasing confidence and competence in the phase prior to entrustment. Some linked this development to the EPA structure, as it supported goal setting and feedback-seeking, while others attributed this development primarily to learning through clinical experience.The entrustment decision process-particularly the Clinical Competence Committee (CCC) feedback-was seen as reassuring, though residents also described discomfort with being evaluated by a group. After entrustment, residents experienced greater autonomy but noted variation in supervision practices. Some felt unsure about when to request supervision, particularly in apparently straightforward settings. Others described feeling empowered to pursue individualised learning opportunities.</p><p><strong>Discussion: </strong>In reflecting on these findings, we drew on the concept of Self-Regulated Learning to explore how residents engaged with their training. Making these principles more explicit within EPA-based programmes may support residents in optimising their learning and strengthen their preparation for independent practice.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"255-263"},"PeriodicalIF":4.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning from Reflection on Patient Outcomes Data: How EHR Can Support Trainees in Graduate Medical Education on Inpatient Rotations.","authors":"Margaret A Robinson, Christy Boscardin, Marieke Van der Schaaf, Justin L Sewell, Glenn Rosenbluth","doi":"10.5334/pme.1627","DOIUrl":"https://doi.org/10.5334/pme.1627","url":null,"abstract":"<p><strong>Introduction: </strong>As healthcare evolves into interdisciplinary, complex, team-based care that often includes shiftwork and sub-specialization, patient outcomes data has become necessary for trainees to engage in reflective practice in clinical environments. However, current practices around collecting and distributing such data to trainees are not effective. Specifically, it is not clear what patient data are significant and compelling to trainees for reflective practice. The goal of our study was to characterize trainee perspectives on what data are meaningful to promote reflective activities for learning in the clinical work environment.</p><p><strong>Methods: </strong>From 2020-2021, we conducted a longitudinal cross-sectional study to assess trainee interest in clinical outcomes data. Over 14 days, pediatrics and internal medicine residents doing inpatient work at the University of California San Francisco completed surveys corresponding to recently opened patient charts.</p><p><strong>Results: </strong>958 surveys were completed by 41 participants (average 23 unique patient encounters per participant). Trainees expressed interest in follow-up for 32.9% of encounters (n = 315/958), most often to 'learn if something significant or unexpected happened.' Trainees most often desired follow-up patient data when they had made significant decisions or felt responsible.</p><p><strong>Discussion: </strong>Trainees were interested in clinical outcomes data for a limited number of patient encounters, highlighting challenges with current strategies to promote reflective practice using clinical outcomes data. While refinement of such approaches continues through consideration of what trainees find meaningful in data, understanding motivating and demotivating factors in trainees' outcomes data-seeking behaviors will also be crucial for success in using such data for learning opportunities.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"264-273"},"PeriodicalIF":4.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Nothing Comes to Mind…\": Challenges With Identifying One's Own Role in Preventable Adverse Outcomes in Interprofessional Birthing Unit Teams, and the Implications for Quality Improvement Initiatives.","authors":"Lauren Columbus, Ayma Aqib, Rachael Pack, Harrison Banner, Taryn Taylor","doi":"10.5334/pme.1651","DOIUrl":"https://doi.org/10.5334/pme.1651","url":null,"abstract":"<p><strong>Introduction: </strong>Preventable adverse perinatal outcomes have a devastating impact on patients and providers and form the basis of many quality improvement (QI) and patient safety initiatives in birthing unit teams, including fetal health surveillance (FHS) training programs. Birthing unit staff attitudes regarding the role of interprofessional relationships on FHS decisions remain largely unexplored with respect to preventable adverse outcomes.</p><p><strong>Methods: </strong>In this intervention-primed, constructivist grounded theory study, members across all five professions providing intrapartum care at one academic centre attended an interprofessional workshop on improving their FHS interpretation, response, communication, and teamwork skills. Twenty-three birthing unit team members across midwifery, obstetrics, family medicine, nursing, and obstetrical trainees were purposively sampled and completed semi-structured interviews. Self-serving bias theory was used as a sensitizing concept to explore the social phenomena observed.</p><p><strong>Results: </strong>Birthing unit staff constructed a self-schema of their role in FHS management that was more flattering than the person-schema created by their colleagues about them. The schemas encoded four categories of information that included (1) Identifying the offender, (2) Assigning blame (3) Aligning with the \"right\" philosophy of care, and (4) Defending one's profession. Participants demonstrated distorted perceptual processes where they described errors other team members had made with ease but struggled to acknowledge their own role in poor outcomes.</p><p><strong>Discussion: </strong>Dissonant schemas can be barriers to the accurate self-assessment of one's skills and have significant implications for interprofessional team competence. QI initiatives may be of limited efficacy given these findings, but addressing these distorted perceptual processes in QI initiatives could improve team performance.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"243-254"},"PeriodicalIF":4.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Boundaries: How Pharmacists Develop Their Clinical Identity in a Complex Multidisciplinary Healthcare Setting.","authors":"Lucille Crafford, Malou Stoffels, Chrisna Wagenaar, Elmien Bronkhorst, Andries Gous, Rashmi A Kusurkar, Anouk Wouters","doi":"10.5334/pme.1597","DOIUrl":"https://doi.org/10.5334/pme.1597","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical pharmacists are crucial for optimizing medication therapy and improving patient outcomes, yet their potential is underutilized in many low- to middle-income countries. Shifting from traditional dispensing to clinical roles requires professional development and identity transformation. In South Africa's public healthcare system, this shift faces additional challenges, such as a lack of formal positions, limited resources, and role ambiguity. Understanding how clinical pharmacists navigate this transition and develop their clinical identity is essential for their integration into healthcare teams and for improving patient care.</p><p><strong>Methods: </strong>Using a constructivist approach, this qualitative study employed semi-structured interviews with clinical pharmacists (n = 12) across South Africa's public healthcare sector. We analyzed data through the lens of boundary crossing. Through thematic analysis we explored how pharmacists navigate the complexities of transitioning from dispensing to broader clinical roles, and how these experiences shape their professional identity.</p><p><strong>Results: </strong>Clinical pharmacists navigated both intrapersonal and interpersonal boundaries in their evolving roles. Three key themes were identified: (a) Bridging the gap within: Pharmacists navigate intrapersonal boundaries for clinical identity formation, (b) Bridging the gap between: Pharmacists navigate interprofessional boundaries for collaboration and identity formation, and (c) Building bridges: Pharmacists employ strategies to promote collaboration and recognition.</p><p><strong>Discussion: </strong>This study uncovered the complex interplay between intrapersonal boundaries - such as role ambiguity, self-doubt, reconciling traditional dispensing roles with expanded clinical responsibilities, and the need for mentorship - and interpersonal boundaries, including hierarchical structures, unclear role expectations, limited recognition, and challenges in interprofessional collaboration, in shaping clinical pharmacists' identities. Fostering boundary crossing competence and interprofessional collaboration can help overcome systemic barriers, enabling pharmacists to navigate their roles, advocate for their expertise, and gain recognition within healthcare teams, ultimately enhancing their integration and improving patient care in resource-constrained settings like South Africa.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"230-242"},"PeriodicalIF":4.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Identity Formation Metaphors: Old Problems and New Promises.","authors":"Lara Varpio, Marije van Braak, Anne de la Croix, Adam P Sawatsky","doi":"10.5334/pme.1803","DOIUrl":"https://doi.org/10.5334/pme.1803","url":null,"abstract":"<p><strong>Introduction: </strong>While medical education scholars have made important contributions to our understanding of professional identity formation (PIF), some ways of thinking stubbornly endure despite being repudiated in the literature. We argue that two metaphors embedded in the PIF discourse contribute to obstructing change: PIF IS A JOURNEY and PIF INVOLVES FITTING INTO A MOLD.</p><p><strong>Pif is a journey: </strong>This metaphor assumes that each learner's PIF work starts the day they enter medical school; that their pre-matriculation PIF work isn't part of their PIF journey; and that the paths to PIF are equally accessible for all. We argue that this is not the case. Drawing on Appadurai's theories of aspiration, we critique this metaphor for neglecting each medical learner's unique cultural backgrounds and aspiration journeys.</p><p><strong>Pif involves fitting into a mold: </strong>This metaphor perpetuates expectations that medical learners and practicing physicians ought to adopt medicine's norms. It places the blame for the crises and dissonance individuals experience when adapting to medicine's culture on the individual-their failure to fit in. While standardization is necessary for maintaining professional standards, it should not suppress individuality, limit diversity, nor constrain adaptability.</p><p><strong>Pif as functional crafting: </strong>We propose that this new metaphor balances standardization with individuality in PIF. It makes room for both the enjoyable and challenging aspects of PIF, and allows for unique, personalized professional identities within the medical field. We propose that this new metaphor aligns with subjectification, an orientation that can encourage flexibility and respect diversity in professional identities.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"219-229"},"PeriodicalIF":4.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}