Perspectives on Medical Education最新文献

{"title":"Mental Imagery to Enhance Procedural Skills in Peripheral Venous Catheterization: A Randomized Simulation Study in Medical Students.","authors":"Nicolas Boulet, Hugo Nairv, Myriam Mezzarobba, Laysa Saadi, Denis Morin, Claire Roger","doi":"10.5334/pme.2069","DOIUrl":"10.5334/pme.2069","url":null,"abstract":"<p><strong>Introduction: </strong>Procedural skill acquisition is fundamental to medical education, yet training opportunities are increasingly constrained. Mental imagery, a cognitive rehearsal method shown to enhance psychomotor performance in various domains, has gained attention in medical training as a low-cost, safe tool to improve technical proficiency. Evidence remains limited and heterogeneous. Specifically, its application to peripheral venous catheter (PVC) insertion, a frequent and essential clinical procedure, has scarcely been studied.</p><p><strong>Methods: </strong>In this single-center, open-label, randomized controlled simulation trial, fifth-year medical students from Nîmes University Medical School were randomized to either a mental imagery or control group prior to a simulated PVC insertion on a mannequin. Primary outcome was uncomplicated first-puncture success rate. Secondary outcomes included variations in adapted Mental Imagery Questionnaire (MIQ) score, number of punctures, and procedural complications.</p><p><strong>Results: </strong>Sixty-four students were included (33 in the mental imagery group, 31 in the control group). Baseline characteristics were similar, although the control group had greater prior experience with PVC insertion. The first-attempt success rate was significantly higher in the mental imagery group (76% versus 52%, p = 0.04). Complications occurred less frequently in the mental imagery group (0% versus 12.9%, p < 0.05). The median improvement in the adapted MIQ score was significantly greater in the mental imagery group (+17 [+12, +22] versus +11 [+8, +18]; p = 0.004), indicating enhanced mental readiness and procedural confidence.</p><p><strong>Conclusion: </strong>Mental imagery is an effective, safe, low-cost strategy that significantly enhances simulation-based procedural performance and learner confidence in PVC insertion.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"176-184"},"PeriodicalIF":3.5,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272291","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":"Dual Pathways From Self-Compassion and Self-Criticism to Academic Achievement: The Roles of Engagement and Exhaustion.","authors":"Piermarco Consiglio, Marjon Fokkens-Bruinsma, Marie-Christine Opdenakker, Ellen P W A Jansen, Joke Fleer","doi":"10.5334/pme.1821","DOIUrl":"10.5334/pme.1821","url":null,"abstract":"<p><strong>Background: </strong>Engagement and burnout symptoms among medical students are key factors influencing their academic performance, risk of dropout, and overall well-being. While research has primarily focused on negative constructs such as burnout symptoms, less attention has been given to how positive constructs, such as engagement, evolve over time. This study examines the temporal changes in medical students' engagement and exhaustion while exploring two distinct pathways: the 'bright path', which investigates engagement as a mediator between self-compassion and academic achievement, and the 'dark path', which examines exhaustion as a mediator between self-criticism and academic achievement.</p><p><strong>Methods: </strong>Self-report measures were used to assess self-compassion, self-criticism, engagement, and exhaustion, while academic achievement was measured objectively. The data were drawn from a longitudinal research project that followed 117 medical students throughout their entire Bachelor's program. Analyses included linear growth models and parallel process latent growth curve models to examine changes over time and potential mediation effects.</p><p><strong>Results: </strong>The findings show a decline in engagement and exhaustion throughout the Bachelor's program. Furthermore, neither engagement nor exhaustion mediated the relationships within the bright and dark pathways.</p><p><strong>Conclusions: </strong>Findings underscore the importance of fostering environments that promote well-being and engagement while addressing negative factors like exhaustion that can hinder student success. They also highlight the potential influence of contextual factors in shaping medical students' experiences, suggesting that interactions between personal resources and environmental demands may play a key role in shaping students' engagement, exhaustion and academic achievement.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"162-176"},"PeriodicalIF":3.5,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272115","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":"Development and Validation of Narrative Competence Scale for Medical Students.","authors":"Shao-Yin Chu, Hung-Che Wang, Bang-Yuan Kuo, Meei-Ju Lin, Yu-Che Chang, Chi-Wei Lin","doi":"10.5334/pme.1707","DOIUrl":"10.5334/pme.1707","url":null,"abstract":"<p><strong>Background: </strong>Narrative competence in medicine enabled physicians to listen to patients' illness experiences, construct their narratives, and enhance reflective practice, empathy, humanistic literacy, and person-centered care. However, systematic research and clear definitions for measurable indicators of narrative competence assessment were lacking. This study aimed to develop and validate a narrative competence scale for medical students.</p><p><strong>Methods: </strong>A 57-item draft scale was developed, and categorized into four dimensions and eleven sub-dimensions after interdisciplinary literature review. Three rounds of the Delphi method were conducted with eleven experts specializing in narrative medicine. Pilot testing involved 200 fifth- and sixth-year medical students in Taiwan (136 males, 64 females). Confirmatory factor analysis CFA) and Cronbach's α were used to evaluate the NCS-MS's reliability and validity.</p><p><strong>Results: </strong>The NCS-MS was refined through three rounds of the Delphi method, focusing on item revisions and sub-dimension definitions. The results of CFA indicated a good fit for the four-factor model (RMSEA = 0.055, SRMR = 0.045, GFI = 0.911, NFI = 0.926, IFI = 0.971, CFI = 0.970). The Cronbach's α coefficients for the four dimensions ranged from 0.797 to 0.942, with an overall α of 0.972, demonstrating excellent internal consistency reliability.</p><p><strong>Conclusions: </strong>The NCS-MS effectively evaluated the narrative competence of medical students. From the perspective of narrative medicine, the NCS-MS served as a research or teaching assessment tool for assessing medical students' narrative competence in narrative medicine research, instructional design, and implementation.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"150-161"},"PeriodicalIF":3.5,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272754","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":"Burnout and Engagement Within Medical Education: A Repeated Measures Study on Their Evolution and Main Determinants.","authors":"Anke Boone, Jonas Steel, Olivia Lavreysen, Marie-Claire Lambrechts, Sofie Vandenbroeck, Lutgart Braeckman, Nele Michels, Dirk Devroey, Ann Roex, Hanne Kindermans, Lode Godderis","doi":"10.5334/pme.2013","DOIUrl":"10.5334/pme.2013","url":null,"abstract":"<p><strong>Introduction: </strong>Burnout is a major concern in medical education and healthcare. Despite growing attention, little is known about how burnout and engagement evolve within the different phases of medical education or which factors shape these outcomes within each phase. This study assesses phase-specific trajectories of burnout and engagement and identifies the demands, resources, and personality traits associated with these outcomes.</p><p><strong>Methods: </strong>A prospective cohort study with three annual measurement waves was conducted among medical students and residents (n = 1.257) from all five universities in Flanders, Belgium. Three cohorts (i.e. bachelor students, master students, and residents) were followed for three consecutive years, using an open cohort design. Data were collected annually: at baseline (T0), after one year (T1), and after two years (T2). Linear mixed-effects models and cross-lagged panel analyses were used to examine temporal changes in burnout complaints and engagement; and to identify key demands, resources and personality traits within each cohort.</p><p><strong>Results: </strong>Within each cohort, burnout complaints increased gradually over time, while engagement declined. Within all learning phases, workload and work-home conflict were identified as primary demands, whereas meaningfulness was identified as the main resource, followed by learning opportunities. Neuroticism was positively associated with burnout complaints and negatively with engagement, while perfectionistic strivings correlated positively with engagement.</p><p><strong>Conclusion: </strong>This study demonstrates how burnout complaints and engagement evolve within learning phases in medical education and identifies key determinants underlying these trajectories. Efforts should prioritize reducing perceived workload and work-home conflict, while strengthening meaningfulness and learning opportunities. In addition, acknowledging individual personality traits may help tailor interventions.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"134-149"},"PeriodicalIF":3.5,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272632","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":"Computer Testing, Formative or Summative, and Proctoring: Does it Matter? Lessons Learned From the Dutch Interuniversity Progress Test of Medicine During the Corona Pandemic.","authors":"Jan Hindrik Ravesloot, Jeroen Donkers, Ariadne A Meiboom, Alexandra M J Langers, Bram Jacobs, Rene Tio, Cees van der Vleuten, Andreas J A Bremers","doi":"10.5334/pme.1771","DOIUrl":"10.5334/pme.1771","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic prompted significant changes in the administration of the Dutch Interuniversity Progress Test of Medicine, offering a unique opportunity to investigate the effects of various test formats. This study explores the impact of transitioning from paper-based to computer-based testing, the shift from summative to formative testing, and the effectiveness of remote proctoring compared to live supervision.</p><p><strong>Methods: </strong>Data from over 10,000 participants across five medical schools were analyzed.</p><p><strong>Results: </strong>Results showed no significant difference in student performance between paper-based and computer-based tests. Additionally, remote proctoring proved to be as effective as live supervision in preventing dishonest behavior. Formative testing yielded slightly better results than summative testing in most schools, although the effect varied between institutions.</p><p><strong>Discussion: </strong>Overall, our study concludes that computer-based testing is a viable alternative to paper-based formats, and remote proctoring can effectively replace live invigilation, at least in our setting and under COVID-19-related circumstances.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"122-133"},"PeriodicalIF":3.5,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12904123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203379","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":"Struggling with Discrimination: An Intersectional Exploration of Why Unequal Social Relations Persist in Residency Training Programs.","authors":"Justin T H Lam, Ryan J Giroux, Han Yan, Adelle R Atkinson, Abhaya V Kulkarni, Christopher R Forrest, Maria Athina Tina Martimianakis","doi":"10.5334/pme.1961","DOIUrl":"10.5334/pme.1961","url":null,"abstract":"<p><strong>Introduction: </strong>Although postgraduate medical education programs in North America have committed to addressing equity, diversity, and inclusion (EDI) issues, learning environment inequities persist and negatively impact learning outcomes. We conducted an exploratory qualitative study to identify mechanisms contributing to ongoing discrimination experiences.</p><p><strong>Methods: </strong>We took an intercategorical intersectional approach to conduct a qualitative thematic analysis that focused on unequal social relations as the unit of analysis. Participants were recruited from paediatrics, neurosurgery, and plastic surgery residency training programs. We performed multi-level inductive and deductive coding of semi-structured interviews informed by intersectionality and systemic and aversive racism.</p><p><strong>Results: </strong>13 participants were interviewed. Participants identified their social identities as marginalized or dominant, and reported intersectional exclusion experiences related to the former that disadvantaged them compared to their peers. Persistent unequal social relations could be mechanistically accounted for by aversive or systemic racism regardless of intersectional identities. Aversive discrimination appeared through performative EDI commitments, microaggressions, and social exclusion. Systemic discrimination contributed to exclusion stemming from the operationalization of cultural norms such as scheduling, social events, and censorship of taboo topics. Participants described variably successful compensatory strategies to overcome their marginalization.</p><p><strong>Discussion: </strong>Systemic and aversive discrimination contribute to reproducing unequal social relations. Evidence-based approaches exist to address these mechanisms and make learning environments fairer.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"105-121"},"PeriodicalIF":3.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12904131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203331","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":"Exploring \"Talent\" in Medical Education: A Scoping Review.","authors":"Rebecca Preyra, Sujata Mishra, Heba Khan, Shreya Saha, Armaanpreet Dhillon, Amy Keuhl, Sandra Monteiro, Elizabeth M Wooster, Michael Gottlieb, Alexander Peever, Teresa M Chan","doi":"10.5334/pme.1859","DOIUrl":"10.5334/pme.1859","url":null,"abstract":"<p><strong>Background: </strong>The term 'talent' appears in health professions education (HPE) but is variably defined and often conflated with performance proxies. Through a scoping review, the authors sought to map how 'talent' and related terms are used/defined in medical education across stages and use cases.</p><p><strong>Methods: </strong>A scoping review (Arksey-O'Malley; Levac; PRISMA-ScR) with descriptive mapping and content analysis of charted items was performed. The search was conducted across OVID-Medline, PubMed, Scopus, and Web of Science, focusing on studies related to talent in medical education from 1946 to May 20, 2024. The authors included not only the term talent but also broadened the review to include adjacent concepts, such as aptitude and giftedness. Two reviewers independently assessed titles, abstracts and full texts using predefined inclusion and exclusion criteria. A third reviewer resolved screening discrepancies. Relevant concepts were mapped for reporting, and a content analysis identified research gaps, trends, and patterns across global, regional and specialty contexts. The papers were tiered into two groups: Tier 1, directly mentioning the term talent; Tier 2, adjacent terms often related to talent.</p><p><strong>Findings: </strong>The authors reviewed 189 studies loosely related to talent in medical education: 47 (25%) were Tier 1 papers that directly mentioned talent, and 142 (75%) were Tier 2 (adjacent terms). The literature primarily originated from North America (41%, 77/189) and Europe (30%, 56/189) Most papers focused on identifying individuals with high potential (74%, 141/189), particularly in medical school selection, while less attention was given to themes like retention, equity and leadership.</p><p><strong>Conclusion: </strong>Although 47 papers contained the term \"talent\", there was a paucity of papers that defined talent within medical education or applied a framework/theory. Interdisciplinary research may be a way to better introduce this concept to our field.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"75-92"},"PeriodicalIF":3.5,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12879997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144220","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":"Judging Oneself and the Feedback: Using a Feedback Literacy Lens to Explore How Learners Experience Professionalism Feedback.","authors":"Daniela Maristany, Karen E Hauer, Vincent Grospe, Andrea N Leep Hunderfund, Martha L Elks, Bridget C O'Brien","doi":"10.5334/pme.2320","DOIUrl":"10.5334/pme.2320","url":null,"abstract":"<p><strong>Introduction: </strong>Professionalism is a core competency on which learners should, ideally, receive feedback to improve their performance. Feedback literacy conceptualizes how learners make sense of and use feedback. The contextual and subjective nature of professionalism, along with concerns about professionalism's potential to encode majority culture norms, add unique complexity to receiving and responding to professionalism feedback. This study used feedback literacy as a framework to explore how diverse learners experience and respond to professionalism feedback.</p><p><strong>Methods: </strong>The authors conducted a multi-center qualitative study with a critical constructivist orientation. Fourth-year medical students and senior residents were interviewed about their experiences with professionalism feedback. Interviews were analyzed using reflexive thematic analysis. Feedback literacy provided an analytic lens for theme development.</p><p><strong>Results: </strong>Thirty-one medical students and 18 residents were interviewed between 2021 and 2022. Learners saw little value in professionalism feedback when viewing professionalism as a character trait rather than a skill to be improved. Learners who received constructive professionalism feedback critically reflected on the quality of their own professionalism and of the feedback, specifically evaluating the feedback for racial or other bias. Constructive professionalism feedback generated protracted emotional responses, and learners often lacked agency to respond to professionalism feedback due to the method of feedback delivery.</p><p><strong>Discussion: </strong>Learners engage with professionalism feedback by spending significant time examining the context of the feedback and searching for evidence of racial or other bias. Understanding how learners experience professionalism feedback is important for fostering strong professionalism feedback literacy for learners and educators.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"93-104"},"PeriodicalIF":3.5,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144185","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":"Charged Topics in Medical Education: Students' Perspectives on Power, Voices, and Faculty Engagement.","authors":"Maram Alkhatib, Shazia Samanani, Megan Murphy, Bridget O'Brien, Zareen Zaidi","doi":"10.5334/pme.2253","DOIUrl":"10.5334/pme.2253","url":null,"abstract":"<p><strong>Introduction: </strong>Medical education learning environments involve charged topics at the intersection of social, political, and cultural domains. Growing student diversity and political polarization add complexity to the discussion of charged topics, yet current literature lacks insight into student perspectives. This study explores how medical students position themselves during charged topic discussions and their preferences for educators' engagement.</p><p><strong>Methods: </strong>Using educational cultural hegemony as a theoretical framework and a critical constructivist approach, the research team conducted semi-structured interviews with sensitizing scenarios addressing three charged topics: gun control, reproductive healthcare coverage, and affirmative action. Following IRB approval, twenty medical students across all training years were interviewed. Transcripts were analyzed using Braun and Clarke's reflexive thematic analysis.</p><p><strong>Findings: </strong>We identified four themes: 'Constrained Voices' describes how power hierarchies influence student engagement with charged conversations. 'Burdened Voices' reveals how marginalized students bear a disproportionate burden when educator avoidance of discussions can reinforce dominant perspectives. 'Finding Voice' highlights how students use personal experience to center patient perspectives despite hierarchical constraints. In 'Guiding Voice', students describe the ideal educator as one who uses their experience and evidence-based knowledge to facilitate discussions.</p><p><strong>Conclusion: </strong>Power hierarchies constrain student engagement in charged discussions, with marginalized students bearing a disproportionate burden when educators avoid these topics. Despite these constraints, students assert agency through personal experience to center patient perspectives. Students seek educators who actively guide discussions using expertise and evidence, viewing neutrality as itself a stance. The findings underscore the need for faculty development addressing these dynamics.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"65-74"},"PeriodicalIF":3.5,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144218","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":"Inside Their Minds: A Multi-Institutional Exploration into the Decision-Making of Medical School Competency Committee Members.","authors":"Michael S Ryan, Pim W Teunissen, Andrew S Parsons, Elizabeth Bradley, Sally A Santen, Anita V Shelgikar, Daniel J Schumacher, Matthew Kelleher, Shahab Jolani, Christina M Vitto, Alexandra H Vinson","doi":"10.5334/pme.2361","DOIUrl":"10.5334/pme.2361","url":null,"abstract":"<p><strong>Introduction: </strong>A competency committee is a group of experts who make a consensus-based judgement about a learner's competence. While evidence-based practices for post-graduate committees have been described, research and standards are lacking in undergraduate medical education. Medical school competency committees often distribute student reviews to individual members; therefore, understanding how they interpret assessment data is critical.</p><p><strong>Methods: </strong>Approaching our investigation from a social constructionist orientation, we conducted think aloud interviews with 22 competency committee members at 7 medical schools in the United States from 2023-2025. Participants were tasked with reviewing local student assessment data in preparation for a competency committee meeting and verbalizing thoughts to an investigator. We analyzed transcripts using an interpretivist approach, with sociocultural cognition theory as the primary interpretive lens.</p><p><strong>Results: </strong>Two major concepts depicted how participants processed student assessment data to arrive at competency determinations: contextual influences and internal reasoning processes. Contextual influences (i.e. goals, data available, and standards for interpreting the data) were outside the direct control of participants. Internal reasoning processes included: first impressions, interpreting trends, and negotiating conflicting data. Contextual influences varied and served as the lens through which participants interpreted assessment data.</p><p><strong>Discussion: </strong>This study provides the first examination into the thought processes used by medical school competency committee members to make their decisions. Participants used decision-making strategies that parallel those observed in other cognitive reasoning tasks. Contextual influences were foundational in how participants interpreted assessment data, highlighting how competence is socially constructed.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"53-64"},"PeriodicalIF":3.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107957","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}