Perspectives on Medical Education最新文献

{"title":"Beyond the Numbers: Exploring Tensions Between Formal Entrustment and Trainee Readiness in Internship Training - A Mixed-Methods Study.","authors":"Tarik Al-Diery, Sally Marotti, Yu Ting Sim, Myriam Jaam, Debra Rowett, Jacinta L Johnson","doi":"10.5334/pme.2259","DOIUrl":"10.5334/pme.2259","url":null,"abstract":"<p><strong>Purpose: </strong>Entrustment decision-making is shaped by both supervisor and trainee. Existing research has focused largely on supervisor decision-making; however, less is known about how trainees experience and internalize entrustment. This study explores how trainee entrustment develops over a pharmacy internship and examines lived experiences that influence progression toward unsupervised practice.</p><p><strong>Methods: </strong>A convergent mixed-methods design explored the entrustment journey of provisionally registered (intern) pharmacists in Australia. Quantitative data were collected via self-administered questionnaires at three time points (beginning, middle, end of internship), capturing perceptions of entrustable professional activities (EPA) utility and self-perceived readiness for entrustment across ten EPAs. At year-end, focus groups explored pharmacy interns' perceptions of the EPA framework and how they interpreted and internalized it in relation to their development. Qualitative data were analyzed using reflexive thematic analysis and triangulated with quantitative findings to examine convergence and divergence over time.</p><p><strong>Results: </strong>Seventeen pharmacy interns completed questionnaires; 16 of these participated in focus groups. Self-perceived readiness for entrustment increased significantly across most EPAs, with median entrustment ratings reaching level 3 (independent with reactive supervision) by the end of internship. Pharmacy interns described that being entrusted supported confidence development, particularly when paired with structured feedback and reflective practice. Some noted that an emphasis on meeting numeric benchmarks risked reducing the process to a \"numbers game,\" overshadowing diverse and complex learning opportunities, and diminishing feedback opportunities once level 3 was achieved. At times, this created asymmetry between being entrusted by a supervisor and the interns' own sense of readiness for more complex practice.</p><p><strong>Conclusion: </strong>EPAs support trainees' progression toward autonomy by embedding structure, feedback, and self-reflection that affirms competence and guides development. When entrustment decisions are tied to achieving a predetermined number of EPA observations, there is a risk that entrustment may be conferred prematurely, thereby reducing the depth of feedback and reflection that follows. When framed as assessments <i>for</i> learning, EPAs better support trainees' transition to confident, autonomous practice.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"279-295"},"PeriodicalIF":3.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500425","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":"Bridging the Gap: Designing Medical Integration Curricula for Foreign Healthcare Graduates in the Netherlands.","authors":"Eva Stortelder, Fokie Huizenga, Iris Homan, Hodayseh Miaei, Richard Horenberg, Annet van Royen-Kerkhof, Harold V M van Rijen, Joyce L Browne","doi":"10.5334/pme.1994","DOIUrl":"10.5334/pme.1994","url":null,"abstract":"<p><strong>Background and rationale for innovation: </strong>Each year, numerous refugees with medical training are forced to migrate. Although refugee healthcare professionals are generally highly motivated to continue practicing their professions, they face substantial barriers when integrating into the host country health systems. Given the Dutch healthcare system's urgent healthcare workforce shortages and lack of diversity, a bridging program to facilitate integration offers mutual benefits. Yet, to date, few integrated curricula for newcoming healthcare professionals exist or have been evaluated.</p><p><strong>Aim and developmental approach of innovation: </strong>This article presents the development of a bridging module -an educational innovation- designed by an academic hospital to support newly arrived professionals in entering the Dutch healthcare system. The process followed the eight steps of Design-Based Research in Medical Education.</p><p><strong>Outcome: </strong>Between 2022 and 2024, two pilot refugee observerships and a health systems' analysis - including a scoping review - led to a six months integration curriculum for newcoming healthcare professionals held in 2024 and 2025. The innovative program received an overwhelming number of applications. Participants reported improved integration and language skills, which supported entry-level employment opportunities. The second edition expanded regionally, with participation of two additional hospitals.</p><p><strong>Conclusion: </strong>Bridging curricula, coordinated by hospitals, medical faculties and their stakeholders can accelerate the integration of motivated and skilled newly arrived professionals into host country health systems through training and practice. Such initiatives respond to societal needs for a sustainable, adequately staffed, inclusive and diverse healthcare system.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"270-278"},"PeriodicalIF":3.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500408","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":"In Support of Meaningful Assessment and Feedback: A Study of Clinical Reasoning Tasks Used in Ambulatory Case Reviews.","authors":"Jacqueline M I Torti, Susan Humphrey Murto, Kristen A Bishop, Azin Ahrari, Mark Goldszmidt","doi":"10.5334/pme.2294","DOIUrl":"10.5334/pme.2294","url":null,"abstract":"<p><strong>Introduction: </strong>Assessing clinical reasoning and offering meaningful feedback to residents through workplace-based assessments remains challenging. Part of this challenge lies not only in articulating how well residents perform clinical tasks, but also in having a shared language to describe the underlying reasoning that supports those tasks. This study aimed to explore clinical reasoning tasks in an ambulatory setting and their relationship to clinical expertise.</p><p><strong>Method: </strong>This single-site instrumental case study explored clinical reasoning of junior and senior residents in new and follow-up rheumatology cases. Case reviews, including resident, attending, and patient interactions were audio-recorded and transcribed. Data analysis combined template and content analysis to explore reasoning. Coding was iterative, with regular consensus meetings among researchers. Findings were confirmed through a focus group with clinic faculty and residents.</p><p><strong>Results: </strong>53 cases were reviewed in ambulatory rheumatology clinics. New consultations focused more on tasks of identifying most likely diagnosis and establishing management plans, whereas follow-up encounters focused on assessing rate of progression, response to treatment, estimating prognosis, and determining follow-up. There were no consistent differences in the number of tasks addressed between junior and senior residents, nor between strong and weak case presentations. However, strong presentations demonstrated selectivity in addressing tasks related to specific patient needs.</p><p><strong>Discussion: </strong>Sharing common patterns of reasoning tasks addressed and omitted can better prepare residents for ambulatory encounters. A shared language around metacognitive tasks can enhance feedback and guide assessment instruments in competency-based training, helping residents broaden their perspectives beyond individual cases.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"257-269"},"PeriodicalIF":3.5,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12985855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463516","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":"Rhetorical Candour: When and How to Say It Straight in Your Academic Manuscript.","authors":"Lorelei Lingard","doi":"10.5334/pme.2269","DOIUrl":"10.5334/pme.2269","url":null,"abstract":"<p><p>This <i>Writer's Craft</i> explores <i>rhetorical candour</i>: the art of saying what you mean and saying it straight, while remaining scholarly and credible. Through control of modality and sentence structure, writers can avoid the habitual academic hedge so that their work is nuanced where necessary and plainspoken where effective.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"251-256"},"PeriodicalIF":3.5,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12985812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463808","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":"When Assessment Theory Meets Generative AI: Reimagining SBA Design in Medical Education.","authors":"Nora Al-Shawee, Gerry McElvaney, Judith Strawbridge, Muirne Spooner","doi":"10.5334/pme.2033","DOIUrl":"10.5334/pme.2033","url":null,"abstract":"<p><p>Current evaluations of generative artificial intelligence (GenAI) in item-writing within medical education often concentrate on isolated dimensions such as validity or reliability, overlooking the broader theoretical foundations that underpin a trustworthy assessment design. This narrow emphasis risks oversimplifying GenAI's role and obscuring how its adoption reshapes the relationship between quality, efficiency, and educational value. To address this complexity, this paper presents the Co-Created SBA Design (CCSD) framework, which reconceptualises assessment theory for the GenAI era through the lens of Van der Vleuten's Utility Index. The framework offers a coherent structure for integrating GenAI into Single Best Answer development, maintaining equilibrium across the Utility Index dimensions while redefining collaboration among educators, higher education institutions, and GenAI, a technological partner that enriches the item-writing process. Within this triadic model, each contributor plays a distinct yet complementary role in sustaining assessment quality. Collectively, their interaction ensures that validity, reliability, educational impact, acceptability, and cost-efficiency remain balanced, supporting both educational integrity and sustainable innovation in medical education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"239-250"},"PeriodicalIF":3.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12985870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463781","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 Simulation to Conversation: Simulated Patients' Contribution to Meaningful Feedback Dialogues.","authors":"Annelies Lovink, Karlijn Geelkerken, Heleen Miedema, Jan-Joost Rethans, Walther van Mook, Marleen Groenier","doi":"10.5334/pme.2247","DOIUrl":"10.5334/pme.2247","url":null,"abstract":"<p><strong>Introduction: </strong>Simulated patients (SPs) play a key role in medical communication training, yet their contribution to feedback dialogues during post-simulation feedback sessions remains underexplored. This study explored how SPs contribute to meaningful feedback dialogues among students during feedback sessions after simulation-based consultations.</p><p><strong>Methods: </strong>Using an interpretivist qualitative approach, video-recorded feedback sessions with first-year technical medical students and SPs were analyzed. Episodes identified as meaningful feedback dialogues were thematically analyzed, focusing on SP contributions.</p><p><strong>Results: </strong>Of the 120 one-minute episodes during feedback sessions, 36 episodes were classified as meaningful feedback dialogue. These were characterized by one or more of the following aspects: SPs' guidance on task performance, shifting positions of SPs, and SPs supporting the contribution of students by facilitating and creating space.</p><p><strong>Discussion: </strong>SPs' guidance on task performance appears to respond to students' need for direction. While such guidance can support learning, it also risks reducing student reflection. Therefore, SPs need awareness of when and how to provide guidance. Although instructed to remain in the patient positions, SPs adopt multiple positions: the patient's position, the expert's position, and the meta-position during the feedback dialogue, which can enrich learning if managed consciously. Increasing SPs' awareness of these different ways of contributing to students' learning may enhance their educational impact in communication training.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"226-238"},"PeriodicalIF":3.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12985862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463547","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 Presence and Nature of AI-Use Disclosure Statements in Medical Education Journals: A Bibliometric Study.","authors":"Muhammad Ans, Lauren A Maggio, Hamzah Algodi, Joe A Costello, Erik Driessen, Kevin Oswald, Lorelei Lingard","doi":"10.5334/pme.2431","DOIUrl":"10.5334/pme.2431","url":null,"abstract":"<p><strong>Background: </strong>As AI use becomes more common in research, disclosure policies have emerged to ensure transparency and appropriateness. However, database research in other fields suggests that disclosure may lag behind AI use. Medical education journal editors report that submitted manuscripts rarely include AI-use disclosures, and they perceive a lack of clarity regarding when and how AI use should be disclosed. However, we lack objective evidence regarding the incidence and nature of AI-use disclosure in medical education.</p><p><strong>Methods: </strong>Using bibliometric methods, we searched a database of 24 leading medical education journals for articles published between January and July 2025 (n = 2,762 articles). Screening with <i>Covidence</i> software excluded 716 non-empirical and/or non-English language articles. The remainder (n = 2,046) were examined for the presence of AI-use disclosures, which were content-analyzed.</p><p><strong>Results: </strong>2.5% of empirical articles (n = 51) had an AI disclosure statement. <i>BMC Medical Education</i> contained the most disclosures (24), followed by <i>Medical Teacher</i> (7) and <i>Journal of Surgical Education</i> (4). Forty-two articles were authored in non-native English-speaking countries, and 69.4% of all first authors had begun publishing in the past decade. Disclosures averaged 43 words and described use superficially: most commonly \"editing\" and \"translation\". Of 18 named tools, ChatGPT was most common. Most disclosures explicitly attested to author responsibility for AI-produced material. Disclosures usually appeared in acknowledgements; those located in methods lacked responsibility attestation. Negative disclosures attesting that AI was not used were also present.</p><p><strong>Discussion: </strong>AI-use disclosures in medical education journals are rare and appear mostly in work from non-native English-speaking regions of the world. A shared disclosure practice is evident: name the tool and affirm author responsibility, but describe use superficially. This suggests a practice of \"safe\" disclosure that may be more performative than informative, therefore failing to satisfy the goal of ensuring transparent and ethical AI use in research.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"212-225"},"PeriodicalIF":3.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379262","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":"\"I've Never Really Thought about This…\" - The Complexity of Patient Involvement in Education from the Teachers' Point of View.","authors":"Elias Schriwer, Agnes Elmberger, Anders Sondén, Terese Stenfors","doi":"10.5334/pme.1875","DOIUrl":"10.5334/pme.1875","url":null,"abstract":"<p><strong>Introduction: </strong>Patient involvement in health professions education (HPE) often takes the form of isolated, small-scale activities, where teachers' initiatives largely determine whether and how patients are included. Understanding how teachers make sense of patient involvement is therefore crucial for strengthening and sustaining this practice in HPE. Using a phenomenographic approach, our aim was to explore how teachers understand patient involvement in HPE and visualize these interrelated understandings in an outcome space.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 20 teachers experienced in working with patient involvement across eight different HPE programs at one university. The interview guide was developed within the research group, in dialogue with a patient representative.</p><p><strong>Results: </strong>We identified four qualitatively different ways in which teachers understand patient involvement: as a way to 1) create variation in education, 2) improve education, 3) improve health care or 4) improve society. These four categories were comprised of seven themes of expanding awareness: the role of the patient, the role of the student, the role of the teacher, role of education, interaction between patient and student, view of workplace learning and teachers' perceived agency.</p><p><strong>Discussion and conclusion: </strong>Our findings suggest that there is considerable complexity in how teachers understand the purpose and value of patient involvement in education. These differences will influence why, how, and to what extent patients are involved in HPE. Striving towards a more complex understanding may support more beneficial, sustainable and meaningful patient involvement. Further research should explore how different stakeholders' understandings influence the practice of patient involvement in HPE.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"200-211"},"PeriodicalIF":3.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379217","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 Doctor Helped Me Decide\": A Linguistic Analysis of Contraceptive Shared Decision-Making Narratives in Clinical Encounters Supported by a Decision Aid Mobile Application.","authors":"Catherine T Witkop, Lauren A Maggio, Abigail Konopasky","doi":"10.5334/pme.2372","DOIUrl":"10.5334/pme.2372","url":null,"abstract":"<p><strong>Introduction: </strong>Shared decision-making, in which a patient's values and preferences facilitate the co-construction of a clinical decision, is a key component of patient-centered care and is of pedagogical interest in medical training. Yet, barriers exist to implementation, with limited information about how patients understand and exert agency. To help educators and health professionals facilitate shared decision-making, we examined how patients narrate their agentic experiences and the roles of their physician and a decision aid mobile application (app) in contributing to agency when engaged in contraceptive clinical encounters.</p><p><strong>Methods: </strong>We conducted a qualitative study of 21 female patients, aged 17-45, who utilized a decision aid app before an encounter for contraceptive services. We conducted linguistic analysis of semi-structured interviews where patients narrated their decision-making experiences, by coding for linguistic markers of agency.</p><p><strong>Results: </strong>Patients narrated <i>individual</i> agency, identifying agentive tasks required for decision-making, including gaining knowledge, asking questions, voicing needs, and making choices. Patients narrated the <i>app</i> as a source of information, identifying questions, validating previous knowledge/opinions, and as surrogate provider. Patients narrated <i>physicians</i> as supportive agents, cueing patient agency and actions during the visit. <i>Joint</i> agency of patient and physician and agency <i>distributed</i> across the patient, physician, app, and other resources were contributory.</p><p><strong>Discussion: </strong>Linguistic analysis can offer important perspectives on patient experiences. The patient, physician, and decision aid app each played roles as agents during shared decision-making. Attending to various roles of agency in clinical encounters and in educational interventions may help health professionals more effectively conduct shared decision-making.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"188-199"},"PeriodicalIF":3.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327779","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 Communication: Expressing the Language of Humanity in Medicine.","authors":"Sandra Apondo","doi":"10.5334/pme.2136","DOIUrl":"10.5334/pme.2136","url":null,"abstract":"<p><p>Written from the author's multiple perspectives as a medical educator, physician, and cancer survivor, this reflective piece explores professional identity formation as a process that extends beyond the acquisition of communication skills, drawing attention to the distinction between language and communication. By weaving together educational practice and lived experience, the text invites readers to pause and consider how becoming a doctor is a deeply personal process that requires space for reflection, uncertainty, and the search for one's own language and meaning, in teaching as well as in our personal and professional lives.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"185-187"},"PeriodicalIF":3.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327872","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}