Advances in Health Sciences Education最新文献

{"title":"Longitudinal integrated clerkships: a hermeneutic literature review","authors":"David L. Garne,&nbsp;Judy R. Mullan,&nbsp;Paul Worley,&nbsp;Ian G. Wilson,&nbsp;Lambert W. T. Schuwirth","doi":"10.1007/s10459-026-10500-8","DOIUrl":"10.1007/s10459-026-10500-8","url":null,"abstract":"<div>\u0000 \u0000 <p>The longitudinal integrated clerkship (LIC) approach to medical education, offering students sustained, immersive clinical experiences, is in stark contrast with traditional block rotations. Although evidence shows that LICs are an effective way of educating medical students, much is still unknown on why or how this is so. This hermeneutic review of the literature aimed to produce a synthesis of the pedagogical understanding of LICs by addressing questions about the principles and philosophies of LICs, their intended outcomes, and how student learning is different in LICs compared with more traditional pedagogical structures. This review of 70 peer-reviewed publications identified three core principles underpinning LICs: continuity, meaningful relationships, and immersion in clinical and community settings. These factors may contribute to transformative learning in the form of deeper clinical reasoning, greater patient-centredness, and increased social accountability. Within LICs, the development of long-term, meaningful relationships with the clinical teams in which students are embedded and with patients could be important in fostering the understanding that dealing with patients is an organic, complex process rather than a straightforward mechanistic one. This provides the potential benefit of producing doctors who are more aligned to patient, societal and healthcare needs. The review highlights that LICs could be well-positioned to meet the evolving expectations of modern medical education by producing patient-centred, adaptable, reflective and socially accountable graduates who have the ability to deal flexibly with uncertainty and to be life-long learners.</p>\u0000 </div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1381 - 1398"},"PeriodicalIF":3.4,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10459-026-10500-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeing the world upside down: historical insights for medical Education's future.","authors":"Z Arfeen, M Robert, D Kadambari, J S Khan, L Liu, A Mold, Y You, M A Rashid","doi":"10.1007/s10459-025-10496-7","DOIUrl":"https://doi.org/10.1007/s10459-025-10496-7","url":null,"abstract":"<p><p>In a world that is increasingly globalised and fragmented, medical education is shaped by complex political, social, and economic forces at local and international levels. This article argues that preparing for the future of medical education in such a changing landscape requires engagement with long-term historical perspectives. Drawing on the history of empires, it highlights how former imperial metropoles, entrenched colonial legacies, and inequities in medicine influence governance and the professional mobility of students and practitioners, notably through international accreditation standards. The article emphasises the importance of recognising historical and regional specificities, cautioning against overly uniform narratives - such as the \"Global North-Global South\" divide. Through case studies of China and Pakistan, it aims to demonstrate how historical insights can reveal comparable yet divergent trajectories in medical education. It concludes that our present is not outside of history but shaped by it, urging educators to critically examine inherited assumptions and to imagine more equitable futures by metaphorically seeing the world \"upside down.\"</p>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positionality using the lens of social identity complexity theory: a worked example","authors":"Mo Al-Haddad,&nbsp;Susan Jamieson,&nbsp;Evi Germeni","doi":"10.1007/s10459-025-10498-5","DOIUrl":"10.1007/s10459-025-10498-5","url":null,"abstract":"<div>\u0000 \u0000 <p>Reflexivity enhances our understanding of qualitative research, adds to its trustworthiness and promotes ethical research practice. Despite calls to engage in reflexivity practice in deep and meaningful ways, reflexity remains poorly practiced and/or reported in the Health Professions Education (HPE) literature. Possible explanations for this are that reflexivity is poorly understood, or that researchers do not know where to begin. This article highlights positionality as the starting point to the practice of reflexivity. Positionality is the position that researchers hold – <i>at any one time</i> – in relation to the research project (topic, participants, context and processes), influenced by the intersection of their multiple identities, experiences, viewpoints and beliefs. Identifying researchers’ positionality is important, especially regarding their <i>insider</i> or <i>outsider</i> status and the impact of their positionality on their research. However, positionality is fluid and requires time to identify. This article discusses positionality, shifting positionality and the impact on research and presents a worked example of an empirical qualitative study with International Medical Graduates (IMGs) and explores the use of theory – specifically <i>Social Identity Complexity Theory (SICT)</i> - as a lens to aid the identification of researcher positionality. The article concludes with a tool that uses <i>SICT</i> to aid researchers – especially novices – to identify their own positionality and continuously reflect on it throughout the research process with the ultimate aim of facilitating deeper and more meaningful reflexivity practice in HPE research.</p>\u0000 </div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1259 - 1272"},"PeriodicalIF":3.4,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weaving care from the margins: how LGBTIQA+ medical trainees craft professional identity through vulnerability","authors":"Francisco M. Olmos-Vega,&nbsp;Camilo A. Caicedo-Montaño,&nbsp;Juan C. Gelvez-Nieto,&nbsp;Felipe Aluja-Jaramillo","doi":"10.1007/s10459-025-10495-8","DOIUrl":"10.1007/s10459-025-10495-8","url":null,"abstract":"<div>\u0000 \u0000 <p>Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, Asexual and other minoritized and underrepresented sexual and gender (LGBTIQA+) medical trainees face distinct forms of discrimination that could shape their professional identity formation (PIF). These challenges influence how they engage with the social and cultural dynamics of medical training. While research on PIF is expanding, little is known about how LGBTIQA+ trainees craft their professional identities. Guided by intersectionality theory and employing constructivist grounded theory methodology, we conducted 18 semi-structured interviews with LGBTIQA+ medical students and residents in Bogotá, Colombia. Data were analyzed through constant comparison and iterative coding, with theoretical sampling used to reach theoretical sufficiency. Reflexivity was central, with researchers drawing on their intersectional positionalities to enrich interpretation. LGBTIQA+ medical trainees navigated environments shaped by heteronormativity, where exclusion and violence were commonplace. To safeguard their well-being, they looked for safe spaces within and outside medicine. Experiencing vulnerability in this way deepened their empathy, especially toward marginalized patients. From this arises the figure of the <i>Care Weaver</i>—a physician identity grounded in relational care and committed to challenging detached models of professionalism towards a more humane conscious approach. This study advances PIF understanding by illustrating how LGBTIQA+ trainees actively resist and reconfigure medical norms, transforming marginalization into relational capacities. Their identity work reveals the limitations of existing PIF models and points to the value of integrating intersectionality into both research and educational design. We argue that fostering such identities must not rely on the endurance of systemic harm, but instead on structural reforms that affirm diverse ways of becoming a doctor.</p>\u0000 </div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1191 - 1211"},"PeriodicalIF":3.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first step in visual diagnosis: a study of novices developing the ability to distinguish normal from abnormal cases","authors":"So-Young Oh,&nbsp;J. Burk-Rafel,&nbsp;I. Reinstein,&nbsp;R. Hatala,&nbsp;P. W. M. Van Gerven,&nbsp;F. W. J. M. Smeenk,&nbsp;M. V. Pusic","doi":"10.1007/s10459-025-10490-z","DOIUrl":"10.1007/s10459-025-10490-z","url":null,"abstract":"<div>\u0000 \u0000 <p>Visual diagnosis training in medicine often struggles to efficiently build learners’ skill, with existing instructional approaches lacking consensus and showing variable effectiveness. This study introduces a two-phase conceptual framework for visual diagnosis training, using electrocardiogram interpretation as an example to explore how novices develop discriminatory skills and diagnostic certainty. Through a prospective cohort study involving 78 medical students and residents who completed at least 75 cases with demonstrated improvement, we applied a version of item-response modeling to analyze their learning trajectories. Findings showed that diagnostic cases could be represented on a continuous scale from normal to abnormal, with a “confusability zone” where cases are difficult to classify. Participants’ ability to calibrate diagnostic certainty improved modestly, reflected in more organized use of certainty ratings. Learning curves showed that the ability to distinguish normal from abnormal developed earlier and more rapidly than the capacity to assign specific diagnostic labels, with both skills improving over time but at different rates. These results suggest that visual diagnosis training could be structured in distinct phases, beginning with abnormality detection and progressing to detailed diagnostic classification. The framework supports targeted curriculum design, including the use of confusable cases for focused training and monitoring of diagnostic certainty as an educational assessment tool, with likely broad applicability across medical imaging domains.</p>\u0000 </div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1153 - 1170"},"PeriodicalIF":3.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the development of clinical empathy among Chinese medical students: a transition from simulation-based learning to clerkship","authors":"Haichun Zhou,&nbsp;Ziyue Shen,&nbsp;Hongbin Wu","doi":"10.1007/s10459-025-10497-6","DOIUrl":"10.1007/s10459-025-10497-6","url":null,"abstract":"<div><h3>Background</h3><p>Little is known about how simulation-based learning and clinical clerkship—two key learning contexts—shape medical students’ interaction with simulated and actual patients and influence students’ clinical empathy. This study investigated the development of clinical empathy among medical students from simulation-based learning to clerkship in China.</p><h3>Methods</h3><p>Adhering to the consolidated criteria for reporting qualitative research (COREQ), this study employed an exploratory qualitative approach in a constructivist paradigm and used thematic analysis to gather and analyze the qualitative data. Data were collected through semi-structured interviews with eight fifth-year medical students and observations of 26 instances among 16 fourth-year students in a six-station objective structured clinical examination. Thematic analysis was used to analyse the qualitative data.</p><h3>Results</h3><p>In simulation-based learning, medical students focused on refining their clinical skills. Although they rarely seldom perceived simulators as real patients, they demonstrated empathetic concern in a performative manner to meet clinical standards. Furthermore, constrained by the lack of timely simulator feedback, they could inadvertently misscritical steps in clinical procedures. During clerkship, medical students experienced stronger emotional responses. Concern about potentially harming patients made students more cautious in procedural steps. Medical students gradually recognized patients’ uniqueness, becoming attuned to emotional cues and alleviating patient suffering by improving their clinical skills. Moreover, their perspective on patients shifted, enabling them to see patients as a whole to carry out medical procedures with empathetic concern.</p><h3>Conclusions</h3><p>While simulation provides skill training, its procedural nature limits empathy development. Clerkship, in contrast, fosters medical students’ emotional engagement, individualized thinking, and flexible views of patients.</p></div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1171 - 1190"},"PeriodicalIF":3.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unpacking educational approaches for social accountability in health professions education: a scoping review","authors":"Marco Zaccagnini,&nbsp;Erin Cameron,&nbsp;Roger Strasser,&nbsp;Saleem Razack,&nbsp;Monica Molinaro,&nbsp;Tim Dubé","doi":"10.1007/s10459-025-10494-9","DOIUrl":"10.1007/s10459-025-10494-9","url":null,"abstract":"<div><p>Health systems worldwide continue to face health inequities rooted in social, political, and economic structures. In response, health professions education (HPE) programs are increasingly aiming to prepare learners for socially accountable practice. Despite this growing attention, social accountability remains ambiguously defined and inconsistently taught, assessed, and enacted across curricula. The aim of this scoping review was to map the breadth and depth of educational approaches within HPE that promote social accountability. A scoping review was conducted following Arksey and O’Malley’s six-stage framework and the Joanna Briggs Institute methodology. MEDLINE, EMBASE, CINAHL, ERIC, APA PsycINFO, and Education Source were searched for articles published from January 2000 to May 2020, with an updated search in 2024. Screening involved a calibration exercise at both title/abstract and full-text stages. Descriptive numerical analysis and reflexive thematic analysis were employed, supported by knowledge user consultation. Most articles originated in North America (n = 179; 82%) and focused on undergraduate medical education (n = 157; 71.7%), especially among future physicians (n = 122; 55.7%). Common strategies included reflection-based learning (n = 90; 41.1%), small group learning (n = 82; 37.4%), and didactic lectures (n = 80; 36.5%). Many studies described using multimodal approaches (n = 85; 38.8%). Educational approaches emphasized experiential, reflective, and community-engaged learning and were grouped into ten overarching categories. These were organized using the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET). By synthesizing how educational approaches to social accountability are reported, this review offers a basis for reflection, dialogue, and further inquiry into their development, delivery, and integration in HPE curricula.</p></div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1355 - 1379"},"PeriodicalIF":3.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10459-025-10494-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can you really infer that? An exploratory study using the reasoning task typology to analyze clinic notes","authors":"David Chartash,&nbsp;Jacqueline Torti,&nbsp;Brandi E. Stevens,&nbsp;Ian Ferguson,&nbsp;Marc B. Rosenman,&nbsp;Cynthia Brandt,&nbsp;Mark Goldszmidt","doi":"10.1007/s10459-025-10493-w","DOIUrl":"10.1007/s10459-025-10493-w","url":null,"abstract":"<div><p>Assessing clinical reasoning is a challenge in all stages of medical education. Beyond the verbal communication of clinical reasoning within the hierarchy of medical education, written communication is a multi-purpose complex adjunct to support the educational process. This study applied and validated a retrospective template analysis of clinical notes using a comprehensive clinical reasoning typology intended to broaden the measurement of clinical reasoning beyond predominantly cognitive activities. Applying the typology to written communication demonstrates that increasing complexity of the analysis is mediated by intra-textual and discourse coherence, as well as the semantic ambiguity of clinical writing. The findings from this study suggest that a significant amount of information during the clinical encounter is pertinent to clinical reasoning but inferred within the contextual medical knowledge held by the writing and reading physician. Ultimately the structure and purpose of the clinical narrative reinforces both a physician-relative and culturally shaped practice of documentation. Beyond specific findings from this study, as the electronic medical record further matures and is shaped by both technology and the computer itself in the exam room, educators must seek to teach the task of clinical reasoning explication through writing, yet pay attention to the technology within the encounter and medical record itself, which shapes the clinical narrative.</p></div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1127 - 1152"},"PeriodicalIF":3.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of ethnicity information in single best answer questions on student performance, item response time and psychometric properties","authors":"Jenanan Mohan,&nbsp;Michaela Pishia,&nbsp;Duaa Alim,&nbsp;Patrick J. McGown,&nbsp;Anjali Amin,&nbsp;Richard J. Pinder,&nbsp;Omid Halse,&nbsp;Celia Brown,&nbsp;Amir H. Sam","doi":"10.1007/s10459-025-10489-6","DOIUrl":"10.1007/s10459-025-10489-6","url":null,"abstract":"<div><p>Inclusion of patient age and sex in single best answer (SBA) questions is standard practice, whereas ethnicity is typically included only when considered clinically relevant. This selective use may inadvertently cue students or introduce bias. This study examined whether including patient ethnicity in SBA questions influences student performance, response time and item psychometric properties. A prospective randomised controlled study was conducted using two versions of a final-year formative assessment. In each version, approximately half of the questions included the patient’s ethnicity, while the corresponding questions in the alternate version omitted this information. Students were randomly assigned to one of the two exam versions. Two hundred and sixty-seven final-year medical students participated in the study. The mean score for questions without ethnicity was 80.3% and for questions with ethnicity was 79.8% (mean difference = −0.5 pp, <i>p</i> = 0.12). On average, students spent 1.6 seconds longer to answer questions with ethnicity compared to questions without ethnicity (<i>p</i> &lt; 0.01). In SBA questions with and without ethnicity, there was no significant difference in mean facility (79.8% vs. 80.3%, <i>p</i> = 0.17) or mean item–total score point-biserial correlation (0.20 vs. 0.21, <i>p</i> = 0.63). These indicate that including patient ethnicity did not significantly impact overall student performance or mean item-level psychometric properties. However, it was associated with longer response times, suggesting a small but significant increase in cognitive load. Educators involved in assessment design should carefully consider this added cognitive burden when deciding whether to include patient ethnicity in future assessments.</p></div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1113 - 1126"},"PeriodicalIF":3.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10459-025-10489-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does need strength influence the impact of supervision styles on junior doctors’ affective states?","authors":"Wieke E. van der Goot,&nbsp;Robbert J. Duvivier","doi":"10.1007/s10459-025-10491-y","DOIUrl":"10.1007/s10459-025-10491-y","url":null,"abstract":"<div>\u0000 \u0000 <p>Junior doctors’ motivation and well-being benefit from a safe environment where they can practice with and learn from clinical experiences. Supervising consultants are key figures in this environment by providing safe patient care, but also by supporting junior doctors in their professional development and learning. However, many junior doctors suffer from distress, which suggests that their needs are not optimally met in postgraduate medical education. Self-Determination Theory (SDT) states that a social environment that supports basic psychological needs of learners results in better learning and promotes their well-being. However, there is a theoretical debate whether individual differences, such as need strength, may also influence how learners, such as junior doctors, perceive the environment. A better understanding of the combined role of the environment and individual preferences is relevant to tailor supervision styles to promote motivation and well-being of junior doctors. This secondary analysis of an experimental vignette study on (de)motivating supervision styles examined whether junior doctors’ individual differences in work-related need strength modified the appraisal and effects of consultants’ supervision styles. The analysis included 150 junior doctors (<i>M</i>_<i>age</i> = 29.81, 73.3% female) and showed that supervision style impacted junior doctors’ positive and negative affect through need satisfaction and need frustration, respectively. Junior doctors’ work-related need strength did not modify these effects. These findings underline the importance of considering both need satisfaction and frustration as underlying mechanisms for explaining well-being in Postgraduate Medical Education. Furthermore, the lack of moderation of work-related need strength endorses the principle of universality underlying SDT.</p>\u0000 </div>","PeriodicalId":50959,"journal":{"name":"Advances in Health Sciences Education","volume":"31 4","pages":"1089 - 1111"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10459-025-10491-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}