Teaching and Learning in Medicine最新文献

{"title":"Global Para-Regulation in Medical Education: Validity, Capture, and the Case for Contextualised Quality Enhancement.","authors":"Janet Grant, Dujeepa Samarasekara, Nnaemeka U Nwakanma, Syed Moin Ali, Kadambari Dharanipragada, Fatima Kyari, Sateesh Arja, Samar Abdelazim Ahmed, Valdes Roberto Bollela, Junaid Sarfraz Khan, Idris Yahaya Mohammed, Mohammed Ahmed Rashid","doi":"10.1080/10401334.2026.2736025","DOIUrl":"https://doi.org/10.1080/10401334.2026.2736025","url":null,"abstract":"<p><p>As globalisation transforms medical education, supranational para-regulation, defined as the external evaluation of national accrediting agencies by non-statutory international bodies, has become increasingly prominent, notably through the World Federation for Medical Education (WFME) Recognition Programme. This position paper critically analyses this para-regulatory approach, contending that it imitates the methods of statutory regulation yet lacks corresponding accountability, transparency, and demonstrable impact on educational quality. Although highly influential, the WFME Recognition Programme operates without statutory authority, applying uniform standards across diverse national contexts. It has created a global accreditation cross-border marketplace. Its paucity of outcome evidence and vulnerability to regulatory capture highlight questions regarding its legitimacy, validity, and contextual relevance. Moreover, the programme's financial demands and alignment with Global North priorities risk commodifying accreditation and entrenching global inequities in medical education. We therefore propose a contextually sensitive, regionally anchored alternative for quality development. Our recommended framework prioritises developmental evaluation, transparency, and peer-reviewed local stewardship. Rather than imposing fixed global benchmarks, it fosters sustained regional collaboration, adaptability to local contexts, and rigourous documentation as principles essential to effective quality assurance. By critically examining the concept of para-regulation, this paper urges medical educators, accrediting bodies, and policymakers to reconsider existing approaches to global quality assurance. We advocate for global transparency alongside local accountability, thereby facilitating sustainable and contextually relevant enhancements in medical education worldwide.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":2.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying the Servingness Framework from Hispanic-Serving Institutions to Advance the Latinx Physician Workforce.","authors":"Katherine Arias Garcia, Nicole A Perez","doi":"10.1080/10401334.2026.2741700","DOIUrl":"https://doi.org/10.1080/10401334.2026.2741700","url":null,"abstract":"<p><p>To address the ongoing recruitment and retention of diverse students in medicine, new and cultural frameworks need to be applied to repair the academic outcomes and experiences of diverse students in US medical schools. This article introduces the multidimensional conceptual framework of \"servingness\" in a medical school context to understand the structural barriers in US medical schools that hinder and promote servingness for Latinx and underrepresented medical students.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interprofessional Entrustment Framework for Midwife-Led Labor Ward Teaching in Oman: A Modified Delphi Study.","authors":"Amira Burhan, Shahenaz Satti, Wisal Nabag, Nazik Elmalaika Husain, Munira Al Masoudi","doi":"10.1080/10401334.2026.2743130","DOIUrl":"https://doi.org/10.1080/10401334.2026.2743130","url":null,"abstract":"<p><p><i>Introduction</i>: The labor ward is an important interprofessional setting for undergraduate obstetric education, where medical students work closely with midwives who contribute substantially to their clinical learning. However, this teaching role is often informal. In addition, what students should learn through midwife-led teaching and the level of supervision expected for these activities are often not clearly defined. This study, conducted in the Sultanate of Oman, aimed to establish consensus on intended learning outcomes (ILOs) for midwife-led labor ward teaching and the level of supervision expected of medical students at graduation, with the broader goal of strengthening the educational role of midwives and making more effective use of the labor ward as a workplace learning environment. <i>Method</i>: In June-August 2025, we conducted a three-round modified Delphi study with a multi-professional panel of 22 participants, including consultant obstetricians, obstetrics and gynecology faculty, midwifery educators, practicing midwives, and final-year medical students. We generated an initial ILO pool through a structured literature search and expert interviews. Panelists rated ILO suitability using predefined consensus criteria (≥80% agreement, median ≥4, interquartile range ≤1); in Round 3, they assigned expected supervision levels using a four-level scale ranging from observation only to independent performance. <i>Results</i>: Twenty of 23 proposed ILOs achieved consensus for inclusion. Consensus on supervision level (≥70% agreement on a single level) was reached for 14 of 20 ILOs. Most competencies were assigned to Level 2 (performance under direct supervision), consistent with the supervised participation model characteristic of undergraduate entrustment in safety-sensitive clinical environments. Higher autonomy levels (Levels 3-4) were assigned mainly to communication, patient-centered care, and professionalism outcomes. Greater variability was observed for higher-risk procedural activities, including episiotomy repair, neonatal resuscitation, and perineal assessment, for which no single supervision level reached consensus. These outcomes were therefore considered areas where expectations of student autonomy remained uncertain. Inter-rater agreement strengthened progressively across the three rounds, confirming iterative convergence. <i>Conclusions</i>: This study offers a consensus-based interprofessional framework that defines learning outcomes and supervision expectations for midwife-led labor ward teaching. The predominance of direct supervision highlights the safety-sensitive nature of labor ward learning. The model is intended to support structured and collaborative clinical education in the labor ward and should be interpreted in relation to this setting. Nevertheless, it may offer analytically transferable insights to comparable interprofessional clinical learning environments.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Study Using the PIES Implementation Framework to Implement a Vertically Integrated Multisite Team-Based Learning Curriculum.","authors":"John M Cunningham, Katy E Trinkley, Vishnu Kulasekaran, Sheilah Jiménez, Jennifer E Adams","doi":"10.1080/10401334.2026.2740007","DOIUrl":"https://doi.org/10.1080/10401334.2026.2740007","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Scaling curricular innovations require an understanding of contextual barriers and facilitators. Implementation science offers theory-based methods to systematically assess contextual factors influencing implementation. We present a case report employing the PIES (Prescribed, teacher-Intended, Enacted, and Sustainable curriculum) framework to evaluate local contextual enablers and barriers to the implementation of a multisite, vertically integrated Team-Based Learning (TBL) curriculum embedded in the core clerkship year at a single institution with a multisite longitudinal integrated clerkship (LIC). We used a convergent mixed-methods case study design to evaluate the TBL implementation. Data collection was informed by the PIES framework and pragmatically selected based on feasibility and potential for actionable change. Data sources included: 1) surveys of faculty, 2) interviews with faculty, 3) narrative feedback from student surveys, and 4) direct observations of TBL sessions. We assessed the &lt;i&gt;Prescribed&lt;/i&gt; curriculum by measuring perceptions of faculty development: 91% (30/33) of TBL facilitators participated in training sessions, and 25/29 (86%) felt faculty development was helpful for understanding the prescribed curriculum. In qualitative analysis, the subtheme \"adapting faculty development to site needs\" captured barriers to disseminating faculty development materials equally across sites. Conversely, the subtheme \"longitudinal team-building\" described how the prescribed TBL implementation was facilitated through stable year-long relationships between students and faculty. Within the teacher-&lt;i&gt;Intended&lt;/i&gt; curriculum, 85% (28/33) of faculty responded that they agree/strongly agree with TBL's acceptability for teaching the learning objectives. The subthemes within the theme \"supporting faculty transition from lecturer to TBL facilitator\" elaborated on factors enabling and inhibiting this transition. In the &lt;i&gt;Enacted&lt;/i&gt; curriculum, 39.4% (13/33) of faculty reported never/rarely deviating from the facilitator guides. Direct observations of TBL indicated divergent results, with deviations occurring in 56% of observed sessions. Within the &lt;i&gt;Sustainable&lt;/i&gt; curriculum, 20/33 (62.5%) agreed or strongly agreed that the amount of time to recruit faculty was feasible, while the qualitative subtheme \"challenges sustaining volunteer faculty engagement\" explored barriers and strategies across diverse sites sustaining volunteer faculty. We describe an illustrative example of how an implementation science approach guided by the proposed PIES framework was applied to scaling a multisite and multispecialty TBL curriculum. Locally, results will be used to improve faculty development, student orientation, and continuous quality improvement processes essential to ensuring quality and comparability. We present our methods and findings as a case study for educators seeking to pragmatically and systematically evaluate and scale their curricular inn","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-16"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Against the Odds? Lessons from Establishing a Clinician Educator Career Track in a Non-Academic Medical Centre.","authors":"Joel Lumpre, Julius Juurmaa, Liisa Aasa, Raul Kohava, Kaspar Kruup, Stephanie N E Meeuwissen","doi":"10.1080/10401334.2026.2741708","DOIUrl":"https://doi.org/10.1080/10401334.2026.2741708","url":null,"abstract":"<p><p>Teaching and learning are often positioned as secondary to patient care, research, and leadership. In non-academic medical centres (NAMCs), this can make it difficult to justify investments in faculty development, as educational activities may be perceived as peripheral, even disruptive, to patient care. Although academic medical centres face similar challenges, far less is known about how they manifest in non-academic contexts. In 2020, East Tallinn Central Hospital, a secondary care NAMC in Estonia, took deliberate steps to rethink teaching and learning as central to quality patient care. A key innovation was the clinician educator (CE) career track, designed to provide healthcare professionals with the resources, skills, and support needed to fulfil their educational roles. We designed and implemented the CE career track using the social practice theory to translate and adapt contemporary academic faculty development practices to a non-academic setting. In this traveling concept, we first describe the CE career track as the contextualized application of faculty development practices using the social practice theory, illustrating its applicability for translating and adapting faculty development to non-academic contexts. Second, we reflect on the CE career track's implementation to derive five key lessons from \"importing\" faculty development to non-academic settings: (1) time allocated to teaching needs to be collaborative and visible; (2) teaching skills are transferable across patient care; (3) developing specific, shared educational expertise early is a priority; (4) reflection is key to meaningful and purposeful collaborations; and (5) teaching and learning are inherent to patient care. Together, these insights suggest the social practices approach to faculty development can help reposition teaching and learning within NAMCs as integral to patient care.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching Social Inequities in Canadian Occupational Therapy: Tensions and Strategies for an 'Embedded Sociologist'.","authors":"Brenda L Beagan","doi":"10.1080/10401334.2026.2741234","DOIUrl":"https://doi.org/10.1080/10401334.2026.2741234","url":null,"abstract":"<p><p>Health professions education increasingly addresses social inequities, cultivating student awareness of structured power relations. Yet such teaching is met with resistance, with students prioritizing \"hard\" sciences and demanding immediate relevance and clinical application for everything taught. Sociological teaching and pedagogies are too often dismissed as \"fluffy\" and \"wasting time.\" In Canada, professional competencies in occupational therapy now require practitioners to engage in anti-oppressive practice, which means education programs need to teach those skills. This article employs an autoethnographic approach to critically reflect on 25 years of teaching about social inequities in occupational therapy. Four challenges arise: 1. Epistemological dissonance, with objectivity and individualism deeply unsettled by sociological thinking; 2. Insistence on immediate relevance and application, which can lead to a problematic reliance on first-voices guests; 3. Simultaneous privilege and absence-of-privilege in the classroom, alongside a \"charitable model\" rescuing stance; and 4. The importance of emotion in learning difficult topics. A pedagogy of discomfort invites learners to stay present to the unsettling emotions that may arise as they confront systemic social power relations. This means moving away from notions of \"safe\" classrooms toward emphasizing courage in the face of complex feelings. Helplessness and powerlessness may be countered through cultivating critical hope, as a necessary step toward social change.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-15"},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"United States Medical and Dental Curricula on Intellectual and Developmental Disabilities: Inclusion of People with IDD in Curriculum Creation and Delivery.","authors":"Kashia A Rosenau, Rachel Parks, Despina Goral, Emily Hotez, Matthew J Chang, Jackie Czyzia, Dawn Rudolph","doi":"10.1080/10401334.2026.2737281","DOIUrl":"https://doi.org/10.1080/10401334.2026.2737281","url":null,"abstract":"<p><p>Surveys of medical trainees have found that while students agree on the importance of understanding clinical care of people with disabilities, the majority of medical students do not feel competent treating these populations. The purpose of this descriptive mixed-methods study was to better characterize efforts in a non-random sample of US medical and dental schools to include material about intellectual and developmental disabilities (IDDs) in their curricula, with particular attention to the meaningful involvement of people with IDD in curriculum development and delivery. This study consisted of a 36-item, electronically delivered survey (<i>N</i> = 38 respondents from 24 institutions) of medical and dental school students, faculty, and administrators, including people with IDD, who were involved with inclusive IDD curricula design and implementation. This was followed by two focus groups (<i>N</i> = 13) with people with IDD who had been involved in medical or dental school curriculum design, implementation, and/or evaluation. While people with IDD were commonly involved in curriculum delivery, goal-setting and evaluation were two phases where people with IDD were included the least. While most schools provided content on the social and medical model of disability and basic knowledge and context about IDD, less than half included gender and sexuality/reproductive health or diagnostics in topics covered. Focus group findings from people with IDD found varied levels of meaningful engagement. Moving forward, a continued push to increase inclusive IDD-related content in medical and dental schools should include people with IDD at the forefront, from goal setting to curriculum evaluation, and integrate intersectional topics such as sexual health. Collaborative efforts are needed to ensure researchers, educators, clinicians, and medical students are collectively increasing IDD-focused training for future healthcare providers.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing Individuals with Intellectual Disabilities to Act as Simulated Patients to Enhance Clinical Communication Training in Belgium.","authors":"Laurie Lucassen, Romina Rinaldi, Elise Batsele","doi":"10.1080/10401334.2026.2737282","DOIUrl":"https://doi.org/10.1080/10401334.2026.2737282","url":null,"abstract":"<p><p>Adults with intellectual disabilities are at increased risk of experiencing unmet health needs, underscoring the importance of improving healthcare professionals' preparedness to respond to such needs. Direct contact between healthcare professionals and patients with intellectual disabilities appears to be associated with lower social distance and more inclusive care practices. Therefore, simulation-based education involving people with intellectual disabilities may offer a promising way to prepare future professionals. Little is known, however, about how adults with intellectual disabilities can be trained to act as expert patients in such simulations. A mixed-methods study was therefore conducted to evaluate a four-session training programme in Belgium designed to prepare adults with mild-to-moderate intellectual disabilities for the expert-patient role in healthcare simulations. Quantitative measures assessed changes in participants' comfort, self-confidence, scenario-related knowledge, and role-play quality across sessions. Qualitative data were collected to explore the experiences of people with mild-to-moderate intellectual disabilities participating as expert patients in simulation-based education. Eleven participants were trained. They reported gaining confidence and feeling more comfortable in their roles as expert patients. Researcher observation corroborated these improvements, showing improvements in participants' simulation skills at the end of the training. However, knowledge of the scenario during the sessions did not improve. The qualitative results highlight four main categories: sustaining engagement in simulation-based student training, the simulation experience, the debriefing experience, and learning through repetition. These findings support the feasibility and relevance of simulated patient training for adults with mild-to-moderate intellectual disabilities. They also contribute to the scholarly documentation of this approach, which can be used to guide future initiatives aimed at training healthcare professionals.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-18"},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Solitude to AI Companionship-Three Phases of a Writing Life and What They Reveal About Rethinking Scholarly Support in Academic Medicine.","authors":"Moshe Y Flugelman","doi":"10.1080/10401334.2026.2737803","DOIUrl":"https://doi.org/10.1080/10401334.2026.2737803","url":null,"abstract":"<p><p>I describe three phases of a physician-scientist's writing career: solitary writing, human collaboration, and engagement with generative artificial intelligence (AI) based on large language models. I use these phases to argue that academic medicine should rethink how it supports scholarly work. The central claim, offered from a single case as hypothesis rather than proof, is that a significant obstacle to scholarly productivity can be structural rather than cognitive: the unavailability of appropriate intellectual companionship at the moment of need. In the first phase, characterized by productive solitude, I built an original scholarly voice, but it led, over time, to epistemic loneliness and exhaustion. In the second phase, collaboration with a scientific editor restored my energy, but our interaction was constrained by scheduled availability. The third phase introduced generative AI as an unusually accessible intellectual companion that allowed me to engage at the moment of curiosity, bridged clinical science and the medical humanities, and made it less costly to admit uncertainty. I describe concrete examples in the text and in a supplementary appendix that serves as an extended disclosure of AI use. I argue that generative AI, grounded in deep research, teaching, and clinical experience, extends rather than replaces human thought and that the experience likely speaks to hybrid scholars of many kinds, not to physician-scientists alone. This essay draws implications for faculty development, equitable access, responsible AI use, and the formation of scholarly voice among learners and identifies research questions for the field.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-7"},"PeriodicalIF":2.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"[They] Assume You Don't Know Things\": How Immigrant Status and Language Shape the Professional Identities of Minoritized Medical Students in the US.","authors":"R Ellen Pearlman, Sunita Cheruvu, Tasha Wyatt, Nicole Rockich-Winston, Louis H Miller","doi":"10.1080/10401334.2026.2731477","DOIUrl":"https://doi.org/10.1080/10401334.2026.2731477","url":null,"abstract":"<p><p>Professional identity formation (PIF) is the developmental process through which medical trainees transition from laypersons to physicians. While recent scholarship has explored the challenges of a dominant standard influencing the PIF of minoritized students, much of this research employs a single-axis lens, focusing on race/ethnicity or gender in isolation. This study investigates how the intersection of race/ethnicity, immigrant status, and non-English language skills influences PIF among 1.5-generation immigrant medical students and second-generation children of immigrants in the US. This qualitative study was designed using a constructivist grounded theory approach to data collection and analysis. We recruited nine East Asian, 10 South Asian, six Black, and seven Latinx immigrant students in their third and fourth years of medical school. Participants were either foreign-born students who migrated to the US during childhood or adolescence and completed formative schooling in the US or US-born children of immigrants. We interviewed them about their PIF experiences and then analyzed the data iteratively using an intersectional lens. Using open, focused, and theoretical coding, we analyzed each group's PIF experiences then moved to constant comparative analysis to identify themes that cut across groups. Using re-storying, we incorporated common plot points from all four groups to create a collective narrative. Across participants, the dominant narrative reflected experiences of conditional belonging, in which students could be welcomed into medicine when their identities and language skills served institutional needs, but those same identities could also be used to perceive them as less competent, less professional, or less fully belonging. Perceived foreign accents, non-standard English communication styles, and distinct cultural frames of reference were treated as a deficit. However, students also found that their multilinguistic and cultural knowledge, often developed through their immigrant family experiences, were powerful assets in patient care. These assets could also become liabilities when students were pushed into unpaid labor for the institution and their communities. By adopting a multi-axis lens, this study shows conditional belonging is a common narrative that transcends individual racial/ethnic categories, while still taking different forms across groups. Non-English language skills are a core issue used to justify inadequate patient care and question competence across all groups. This key mechanism of marginalization for immigrant students adds nuance not thoroughly addressed in single-axis studies.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.4,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}