Perspectives on Medical Education最新文献

{"title":"Barriers to Implementing Shared Decision-Making in Postgraduate Medical Education: The Role of Disease-Centered Beliefs.","authors":"Laura Alexandra van der Woude, Gera A Welker, Paul L P Brand, Suzanne Festen","doi":"10.5334/pme.1465","DOIUrl":"10.5334/pme.1465","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the well-documented benefits of shared decision-making (SDM), its implementation in practice remains limited. Efforts to promote SDM often fail to produce lasting behavioral change among physicians. Underlying conscious or unconscious beliefs may shape their decision-making processes, influencing the extent to which SDM is applied. This study aimed to explore the perceptions, beliefs and behaviors of Dutch residents and medical specialists regarding SDM and to identify potential barriers to its integration into postgraduate medical education.</p><p><strong>Methods: </strong>A mixed-method study was conducted, involving a survey (comprising control preference scale (CPS) and iSHARE) and focus group interviews among residents and medical specialists from seven Dutch teaching hospitals.</p><p><strong>Results: </strong>SDM was supported by 93% (292/315) of survey respondents, with 89% (280/315) agreeing that it should be an integral part of postgraduate medical education. Seven residents (6%) and 33 medical specialists (18%) indicated they had followed an SDM training. Thematic analysis of the focus group interviews identified four disease-centered beliefs that influenced clinical thinking and decision-making among both residents and medical specialists. This disease-centeredness emerged as the primary barrier to the successful implementation of SDM.</p><p><strong>Discussion: </strong>While SDM is widely endorsed, its practical implementation is constrained by disease-centered thinking. Achieving sustainable integration of SDM in postgraduate medical education requires a fundamental paradigm shift, in which residents and medical specialists become aware of their disease-centered beliefs and instead learn to think and act in a more person-centered manner.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"436-446"},"PeriodicalIF":3.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734072","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":"'As You Set Out for Ithaca': VIEW- A Visual Tool for Teaching Ethical Decision Making in Medical Practice.","authors":"Dikla Agur Cohen, Liv Shadmi, Aya Biderman, Gila Yakov","doi":"10.5334/pme.1543","DOIUrl":"10.5334/pme.1543","url":null,"abstract":"<p><strong>Background & need for innovation: </strong>Ethical dilemmas in healthcare often involve navigating emotional and value-laden challenges. Traditional teaching approaches, such as principle-based frameworks, highlight the theory but do not contain tools to integrate emotional reflection and value prioritization, leaving a gap in preparing physicians for real-world ethical decision making.</p><p><strong>Goal of innovation: </strong>We introduce a novel visual tool named VIEW (<b>V</b>isual <b>I</b>nsight for <b>E</b>thical <b>W</b>isdom) that enhances ethical decision making by fostering reflection on values, emotions, and professional identity.</p><p><strong>Steps taken for development and implementation: </strong>The VIEW tool was developed as an interactive framework that allows users to map ethical dilemmas visually. It was implemented in three workshops with 31 participants, including junior and senior physicians and medical educators. Participants used the VIEW to analyze real-life ethical challenges. They created 31 visual maps that captured emotional responses, core values, and interpretations of dilemmas. We qualitatively analyzed these maps, alongside other observations and interviews, to identify key themes.</p><p><strong>Outcomes of innovation: </strong>Preliminary evaluations indicated that the VIEW tool effectively bridges theory and practice. It externalized thought processes, encouraging emotional awareness, and promoting value-based reasoning. Participants reported improved capacity to navigate complex dilemmas and deeper engagement with their professional identity.</p><p><strong>Critical reflection on the process: </strong>This visual tool integrates cognitive and emotional dimensions of ethical reasoning, addressing the limitations of traditional approaches. Its implementation highlights the importance of reflection in medical education and clinical practice. Further research is needed to explore the tool's broader applicability.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"427-435"},"PeriodicalIF":3.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734071","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":"Showing Up is Still Resistance: Contextualizing Black Trainee Resistance in Medical Education.","authors":"Oriaku A Kas-Osoka, Patricia Poitevien","doi":"10.5334/pme.1972","DOIUrl":"10.5334/pme.1972","url":null,"abstract":"<p><p>This commentary amplifies the contributions of Horton et al.'s study on Black physician trainees' professional resistance, situating it within the broader landscape of health professions education (HPE). As Black women physician-educators, we reflect on the profound resonance of the study's themes-resistance as survival, as existence, and as professionalism. Horton et al. employ Endarkened Storywork and Black quilting to not only document Black trainee experiences but to disrupt conventional research paradigms that marginalize their truths. This commentary argues that their work challenges the field to reimagine equity by centering marginalized voices, redefining resistance as a daily, embodied practice, and questioning research frameworks rooted in whiteness. We emphasize the urgency of methodological transformation in HPE and the ethical imperative to design and interpret data in ways that affirm rather than exploit minoritized communities. By framing the acts of showing up, mentoring, and refusing assimilation as legitimate resistance, this work redefines professionalism and provides a roadmap for institutional accountability. To advance equity, educators and researchers must not only study resistance-they must practice it.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"423-426"},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734074","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":"How We Built Workplace Based Assessment-for-Learning in Irish GP Training.","authors":"Karena Hanley, Edward McSwiney, Brian O Malley, Aileen Barrett, Brian McEllistrem","doi":"10.5334/pme.1428","DOIUrl":"10.5334/pme.1428","url":null,"abstract":"<p><strong>Introduction: </strong>Programmatic Assessment displays the comprehensive picture of a learner's competence through selection of assessment methods and design of organisational systems [1]. This paper describes how the Irish College of GPs (ICGP) designed and implemented a new, national, workplace-based assessment (WBA) system for GP training as part of an ongoing evolution towards Programmatic Assessment, with a focus on assessment-for-learning [1].</p><p><strong>Methods: </strong>Six overlapping workstreams over five years led to success: iterative consultation and design, entrustable professional activities, software design, stepwise implementation, separation of mentor/assessor roles and WBA training embedded in feedback literacy and growth mindset learning.</p><p><strong>Results: </strong>Our design focused on collecting longitudinal, low stakes assessments organised into core competences in a manner to support learners. 18 entrustable professional activities were developed and implemented, along with a software platform designed to enter and display accumulated data. Competence committees assess both qualitative and quantitative data periodically on the learner's journey to oversee progression and make high stakes decisions. We describe the development of the system along with aids and barriers to its adoption.</p><p><strong>Discussion: </strong>Structured continuous consultation with the training community and constant reference to the educational literature were both important for success. Novel features of our system are the distancing of mentor and assessor roles, the avoidance of recommended minimum numbers of WBA entries, and consideration of the validity and reliability of the system as a whole rather than of the tools.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"411-422"},"PeriodicalIF":3.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734073","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 and Interprofessional Identity Formation in Healthcare Students During Placement in an Interprofessional Training Unit - A Multicentre Quantitative Study.","authors":"Saskia C M Oosterbaan-Lodder, Jan Jaap Reinders, Marco A C Versluis, Fedde Scheele, Rashmi A Kusurkar","doi":"10.5334/pme.1649","DOIUrl":"10.5334/pme.1649","url":null,"abstract":"<p><strong>Introduction: </strong>Using Identity and Social Identity Theory as frameworks, we investigated the contribution of placement in an Interprofessional Training Unit (ITU) on a maternity ward to professional and interprofessional identity development, the interplay between these identities, and the association with some background factors.</p><p><strong>Methods: </strong>A prospective pre-post-intervention design was used. Before and after ITU placement, students in two Dutch hospitals participated in an online survey, comprising background characteristics, and scales measuring professional (PI) and interprofessional identity (IPI). PI and IPI scores between T0 and T1 were compared by means of a paired t-test. A two-way factorial ANOVA was used to test for differences between groups, based on background factors.</p><p><strong>Results: </strong>Out of 209 students, 179 students (89.9%) completed the pre- and post-placement surveys. We found no significant change in professional identity formation, but a significant increase in interprofessional identity formation across the placement for students from all three professions, with midwifery students having the highest increase. Students with higher PI scores had significantly higher IPI scores before placement compared to students with lower PI scores, without a significantly higher increase in IPI during the placement. No significant differences in IPI change were found for other variables.</p><p><strong>Discussion: </strong>We found that a one-week interprofessional placement significantly increased students' interprofessional identity, with midwifery students showing the largest raise. Students with a higher PI also had a higher IPI before the ITU placement, suggesting a stronger PI is associated with a greater propensity for fostering IPI. Possible explanations for these findings are offered.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"399-410"},"PeriodicalIF":4.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676128","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-by-Concordance Approach in Health Professions Education: A Scoping Review.","authors":"Antoine Roche, Ann Alexandra Rodriguez Turcot, Andréanne St-Pierre, Sarah Cherrier, Marie-Claude Audétat, Bernard Charlin, Joseph-Omer Dyer","doi":"10.5334/pme.1658","DOIUrl":"10.5334/pme.1658","url":null,"abstract":"<p><strong>Introduction: </strong>Learning by concordance (LbC) is an educational approach designed to develop expertise, particularly in the field of clinical reasoning (CR) among healthcare professionals. It is based on the script concordance test (SCT) with the addition of feedback based on expert responses. The objective of this study was to map the scientific literature on this rapidly growing learning approach.</p><p><strong>Methods: </strong>A scoping review was conducted following the Arksey and O'Malley framework and the PRISMA-ScR guidelines. A systematic search was conducted in MEDLINE, Embase, CINAHL, Web of Science and Google Scholar up to March 10, 2025. Eligible primary studies had to focus on the LbC approach targeting healthcare learners.</p><p><strong>Results: </strong>Twenty-eight studies met the inclusion criteria: twenty focused on the implementation of the LbC approach and eight on its development. Most of the studies used mixed methods (quantitative and qualitative). The results mainly indicate that learners perceive the LbC approach as engaging and beneficial for decision-making. The articles mention five elements related to the development of LbC that would contribute to its success.</p><p><strong>Discussion: </strong>The LbC approach could be applicable to a wide range of disciplines and learning levels. The variability in the procedures for developing the approach, as well as the variability of the objectives and methodologies of the studies, limit the comparability of the results.</p><p><strong>Conclusion: </strong>LbC is a promising approach for promoting decision-making skills in a variety of uncertain clinical contexts. The concept of standardized development and evaluation frameworks for this approach could improve its applicability, effectiveness and reproducibility.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"387-398"},"PeriodicalIF":4.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576711","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":"The Perils of Excessively Relying on Medicine's Tradition of Standardization.","authors":"Lara Varpio, Daniel J Schumacher, Sayra M Cristancho","doi":"10.5334/pme.1864","DOIUrl":"10.5334/pme.1864","url":null,"abstract":"<p><p>Medicine has long relied on standardization to ensure safety, consistency, and efficiency. From evidence-based guidelines to competency-based curricula, standardized practices have shaped both clinical care and medical education. Yet, as social conditions evolve and clinical complexity increases, this commentary argues that rigid adherence to standardized protocols can become a liability. We explore how excessive standardization can constrain expert judgment, perpetuate inequities in education, and hinder responsiveness to emergent societal needs. Drawing on examples from admissions, assessment, and clinical practice, we show how the very structures meant to promote fairness and safety can inadvertently undermine equity and adaptability. We call for a shift toward \"adaptive standardization\"-an approach that balances consistency with contextual flexibility. Such a shift requires not only individual discernment but also systemic support for clinicians and educators to tailor decisions to specific circumstances. Ultimately, we argue that fostering adaptability alongside standardization is essential for medical systems to remain responsive, just, and resilient in a rapidly changing world.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"383-386"},"PeriodicalIF":4.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576713","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":"From Crisis to Opportunity: Reinventing Medical Education After COVID-19.","authors":"Anita Samuel, Steven J Durning","doi":"10.5334/pme.1672","DOIUrl":"10.5334/pme.1672","url":null,"abstract":"<p><p>The COVID-19 pandemic dramatically disrupted traditional bedside teaching in medical education, emphasizing the need for innovative approaches to clinical training. This disruption highlights a critical opportunity to reassess and enhance medical education practices for future resilience. This paper examines the changes in bedside teaching brought about by the COVID-19 pandemic and explores the use of novel tools and technologies to support this essential educational practice. Key adaptations to bedside teaching involved virtual patient interviews, telemedicine clinics, and live-streamed surgeries. Hybrid models allowed for the co-location of some participants while integrating virtual supervision. Challenges included access disparities, technological limitations, and the inability to fully replicate hands-on training. Evidence supports the retention of traditional bedside teaching for high-contact encounters, hybrid models for limited-contact scenarios, and fully virtual teaching for non-contact educational needs. The pandemic has demonstrated the adaptability and resilience of medical education. By strategically incorporating virtual and hybrid approaches, we can enhance the quality, accessibility, and effectiveness of bedside teaching. These approaches not only address the challenges posed by the pandemic but also offer opportunities to prepare future healthcare professionals for a dynamic and technologically advanced healthcare environment.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"371-382"},"PeriodicalIF":4.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530481","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":"Spoilt for Choice in Undergraduate Medical Admission: Selection of Confident and Considerate Students Using Professional Prequalification and Situational Judgement Test.","authors":"Ina Mielke, Wolfgang Hampe, Maren Ehrhardt, Mirjana Knorr","doi":"10.5334/pme.1571","DOIUrl":"10.5334/pme.1571","url":null,"abstract":"<p><strong>Introduction: </strong>When considering personal characteristics in undergraduate medical admission, professional prequalification (i.e., previous work experience in the medical field) and performance on situational judgement tests (SJTs) are prominent criteria. Despite evidence on the ability of professional prequalification and SJT performance to predict general interpersonal skills, their benefit for students' concrete behavior in everyday situations remains unclear.</p><p><strong>Methods: </strong>With the present study, we examined how undergraduate medical students with prior professional qualification and students with better SJT performance act in actual social situations by using a behavior-focused observer approach. Supervisors rated the students after a mandatory one-week practical training in general medicine on three distinguishable interpersonal dimensions, namely agency (i.e., assured-dominant), communion (i.e., warm-agreeable), and emotional stability (i.e., calm and stable). Prior to admission, participants (<i>N</i> = 210) completed a traditional SJT (i.e., HAM-SJT), a natural science test (i.e., HAM-Nat), and responded to sociodemographic questions.</p><p><strong>Results: </strong>Controlling for cognitive admission criteria, age, and gender, students with prior professional qualifications were rated as more assured-dominant (<i>β</i> = 0.21; 95% CI [0.04; 0.39], <i>p</i> = 0.019), whereas students with better HAM-SJT performance were rated as more warm-agreeable (<i>β</i> = 0.17, 95% CI [0.02; 0.31], <i>p</i> = 0.024).</p><p><strong>Discussion: </strong>The results value both admission criteria as complements to cognitive criteria in undergraduate selection but emphasize their differentiated focus on students' interpersonal behavior. Medical schools are invited to review their admission criteria based on the present findings and on the question of required and learnable skills.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"360-370"},"PeriodicalIF":4.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576712","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":"Ready, Set, Clerkship: The 'Learning to Learn at the Workplace' Training to Prepare Medical Students for Workplace Learning.","authors":"Mila Van Dorst, Marije Lesterhuis, Renske De Kleijn, Annet Van Royen-Kerkhof, Marije Hennus","doi":"10.5334/pme.1567","DOIUrl":"10.5334/pme.1567","url":null,"abstract":"<p><strong>Background: </strong>Preparing medical students <i>how</i> to learn during clerkships is vital to support their transition from preclinical to workplace learning. However, training programs fostering students' workplace learning skills are sparse. To address this gap, the 'Learning to Learn at the Workplace' training program was developed, combining strategies for informal workplace learning with self-regulated learning (SRL) techniques.</p><p><strong>Approach: </strong>Using the 'ADDIE' instructional design model, the training was developed, implemented and evaluated. It consists of four classroom sessions combined with workplace assignments, each addressing a different SRL theme for informal workplace learning: learning goals, asking questions, feedback, and reflection. Additionally, the influence of the clerkship context on SRL is addressed, with the aim to enable students to recognize and utilize informal workplace learning.</p><p><strong>Outcomes: </strong>The training was piloted with medical students during their second or third clerkship (n = 33). Students provided written feedback following each session and completed a final questionnaire (n = 21). Teachers evaluated implementation fidelity after each session. Students reported that the training effectively supported their self-regulated workplace learning. They particularly valued its relevance, practical tools, and the opportunity to exchange clerkship learning experiences.</p><p><strong>Reflection: </strong>Students gained valuable insights into self-regulated informal workplace learning at clerkships. To further stimulate application of taught skills during clerkships, better integration of transfer tasks into the training is suggested. Involving numerous stakeholders and extensive literature in the developmental process ensured this training aligned with students' needs and received positive evaluations from students, teachers, and curriculum developers. Subsequently, the training will become a mandatory part of the current curriculum.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"352-359"},"PeriodicalIF":4.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303356","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}