Teaching and Learning in Medicine最新文献

{"title":"\"Those Darn Kids\": Having Meaningful Conversations about Learner Resistance in Medical Education.","authors":"Tasha R Wyatt, Lisa Graves, Rachel H Ellaway","doi":"10.1080/10401334.2024.2354454","DOIUrl":"10.1080/10401334.2024.2354454","url":null,"abstract":"<p><p>The concept of <i>professional resistance</i> describes the principles professionals should follow when they seek to counter social harm and injustice. Applied to medical education, the principles of professional resistance can help learners and teachers balance the responsibilities to respond to harm and injustice with their roles and responsibilities as health professionals. However, there remains the problem of how educators and leaders can constructively respond to learner acts of resistance. It would seem that many leaders have dismissed learner resistance with variations on \"Those Darn Kids!\", a complaint that has long been levied at those in younger generations who challenge power and authority. How can productive change in medical education be achieved if learners' complaints are not taken seriously? Rather than dismissal, leaders and educators in these situations need the tools to engage learners in conversations that draw out their concerns.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"422-429"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076680","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":"Professionalism Policies and Practices as Experienced by First-Generation Medical Students, Residents, and Physicians.","authors":"Lynn Shaull, Paolo C Martin, Jessica Bunin, Tasha R Wyatt","doi":"10.1080/10401334.2024.2345394","DOIUrl":"10.1080/10401334.2024.2345394","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: While professionalism is largely understood to be complex and dynamic, it is oftentimes implemented as if it were static and concrete. As a result, policies and practices reflect dominant historical norms of the medical profession, which can cause tension for trainees from marginalized groups. One such group comprises those who identify as first-generation physicians - those whose parents have not earned an associate's degree or higher. This group is highly diverse in terms of gender, race, ethnicity, and socioeconomic status; however, their experiences with institutional professionalism policies and practices has not yet been fully explored. In this study, our aims were to understand the ways in which these participants experience professionalism, and to inform how professionalism can be more inclusively conceptualized. <b><i>Approach</i></b>: In November 2022-March 2023, we conducted semi-structured interviews with 11 first-generation medical students, residents, and physicians and analyzed select national and institutional professionalism policies in relation to key themes identified in the interviews. The interviews were designed to elicit participants' experiences with professionalism and where they experienced tension and challenges because of their first-gen identity. Data were analyzed using thematic analysis through a critical perspective, focused on identifying tensions because of systemic and historical factors. <b><i>Findings</i></b>: Participants described the ways in which they experienced tension between what was written, enacted, desirable, and possible around the following elements of professionalism: physical appearance; attendance and leaves of absence; and patient care. They described a deep connection to patient care but that this joy is often overshadowed by other elements of professionalism as well as healthcare system barriers. They also shared the ways in which they wish to contribute to changing how their institutions conceptualize professionalism. <b><i>Insights</i></b>: Given their unique paths to and through medicine and their marginalized status in medicine, first-generation interviewees provided a necessary lens for viewing the concept of professionalism that has been largely absent in medicine. These findings contribute to our understanding of professionalism conceptually, but also practically. As professionalism evolves, it is important for institutions to translate professionalism's complexity into educational practice as well as to involve diverse voices in refining professionalism definitions and policies.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"311-322"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877863","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":"Identifying Physician Public Health Competencies to Address Healthcare Needs in Underserved, Border, and Outer Island Areas of Indonesia: A Rapid Assessment.","authors":"Perigrinus Hermin Sebong, Jerico Pardosi, Roberta Ellen Goldman, Anindyo Pradipta Suryo, Indra Adi Susianto, Andreasta Meliala","doi":"10.1080/10401334.2024.2353573","DOIUrl":"10.1080/10401334.2024.2353573","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> Most medical schools in Indonesia have developed innovations to integrate public health content into the curricula. However, ensuring that all schools meet appropriate standards regarding the quality of subjects, content relevancy, and course delivery takes time and effort. <b><i>Approach:</i></b> This study employed a rapid assessment procedure to identify the current knowledge and competencies required to practice medicine effectively in underserved, border, and outer island areas of Indonesia. Ninety-three participants from six remote districts were involved in 12 focus group discussions. Qualitative data were analyzed using content analysis using the social determinants of health as a guiding framework. <b><i>Findings:</i></b> Under decentralized health system governance, the local socio-geographical context is critical to understanding the current public health landscape. Medical education with respect to public health must emphasize physicians' ability to advocate and encourage the coordination of healthcare services in responding to disasters, as well as community-based surveillance and other relevant data for synergistic disease control. As part of a healthcare facility management team, prospective doctors should be able to apply systems thinking and provide critical input to improve service delivery at local health facilities. Also, recognizing underlying factors is essential to realizing effective interprofessional collaboration practices and aligning them with leadership skills. <b><i>Insights:</i></b> This study outlines recommendations for medical schools and relevant colleges in formulating compulsory block or integrated public health curricula. It also provides a public health learning topic that may aid medical schools in training their students to be competent for practice in underserved, border, and outer island areas. Medical schools should offer initiatives for students to acquire the necessary public health competencies merited by the population's health needs.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"363-374"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923569","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":"Exploring Factors Influencing Medical Trainees' Specialty Choice: Insights from a Nationwide Cross-Sectional Survey in Jordan.","authors":"Osama Aldahamsheh, Sereen Halayqeh, May Alfayyadh, Zina Smadi, Sara Abu Halimeh, Mary AlMadani, Wathiq Shatnawi, Sarah Ellouzy, Mohammad Abufaraj","doi":"10.1080/10401334.2024.2364265","DOIUrl":"10.1080/10401334.2024.2364265","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> Choosing a medical specialty is a critical decision that significantly impacts medical students' future career. Understanding the factors influencing this decision-making process is important for medical educators, policymakers, and healthcare providers to develop effective strategies that support and guide students in making informed decisions. <b><i>Approach:</i></b> We distributed an online self-administered questionnaire to clinical-year medical students (Years 4 to 6) and interns from all medical faculties in Jordan. The questionnaire gathered demographic information, specialty preferences, and factors influencing specialty decision-making. We analyzed the data using descriptive statistics and logistic regression. <b><i>Findings:</i></b> 1805 participants completed the questionnaire (51.7% women). General surgery was the most preferred specialty among both genders, followed by internal medicine. Women significantly preferred family medicine, pediatrics, obstetrics and gynecology, and dermatology, whereas men significantly preferred urology, orthopedic surgery, neurosurgery, general surgery, and internal medicine. The factors that most strongly influenced respondents' specialty preferences were the specialty's perceived stress levels and working hours, whereas the least influential factors were the specialty's perceived prestige and role models in the specialty. Women's specialty preferences were significantly more influenced by their family than men's. Men were substantially more influenced by specialties' perceived action-orientation and stress levels than women. <b><i>Insights:</i></b> Gender significantly influences medical trainees' specialty preferences in Jordan. Women tended to prefer specialties that provided greater work-life balance, such as family medicine, pediatrics, obstetrics and gynecology, and dermatology, while men were more drawn toward competitive and profitable surgical specialties like orthopedic surgery, neurosurgery, urology, and general surgery. Additionally, family had a stronger influence on women's decisions, likely due to cultural and social expectations prioritizing marriage and family for women. Career counseling and mentorship programs are needed to provide guidance, support, and networking opportunities that can help women overcome barriers and biases that may hinder their career advancement.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"300-310"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293925","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 U.S. Pediatric Trainees to Discuss Race and Racism in the Primary Care Setting: Implications of Learners' and Families' Differing Perspectives.","authors":"Josh Kurtz, Emma Gerstenzang, Christine Liverpool, Sophie Lieberman, Hannah L Kakara Anderson, George Dalembert, Noreena Lewis, Jessica C Fowler, Aditi Vasan, Beth Rezet","doi":"10.1080/10401334.2025.2509173","DOIUrl":"https://doi.org/10.1080/10401334.2025.2509173","url":null,"abstract":"<p><p><b><i>Background.</i></b> Despite their impact on children's health and well-being in the U.S., race and racism are not routinely discussed during pediatric outpatient visits. It is unclear whether families want to discuss race and racism with their pediatrician and - if so - how pediatric residents should be trained to facilitate these conversations effectively. <b><i>Objective.</i></b> We explored the perspectives of physician parents, community members, and pediatric residents on discussing race and racism during outpatient pediatric visits as part of a needs assessment to inform the development of a curriculum to teach pediatric residents how to discuss race and racism with families in the primary care setting. <b><i>Methods.</i></b> We recruited pediatric residents (n = 6), physician parents (n = 6), and community members (n = 2) to participate in focus groups. Participants were divided into focus groups based on their stakeholder role and self-identified race. We recorded and transcribed focus group dialogue and used thematic analysis to examine the data. Results: Participants expressed hesitancy regarding discussions about racism between families and their pediatrician, given possible unintended consequences. Participants felt that shared experiences amongst patients and providers could help improve provider and patient comfort during these conversations. Black physician parents and community members highlighted the importance of celebrating children's racial identities and avoiding preemptively broaching conversations about racism. White physician parents and residents, in contrast, expressed desire for standardized guidance and suggested phrasing to improve their comfort. To effectively train pediatricians to have conversations about racism, all participants expressed the importance of pediatricians learning about racism's effects on children's health, both broadly and locally. To learn this information, community members felt community involvement would be most beneficial, whereas pediatric trainees and white physician parents felt standardized training with role play would be most helpful. <b><i>Conclusions.</i></b> Facilitating conversations about race and racism in the outpatient setting requires a patient-and family-centered, nuanced approach. Educators developing curricula to teach trainees how to have these conversations should consider including information on how racism impacts children's health, both broadly and locally. Recognizing the divergent perspectives between stakeholder groups, educators may consider developing structured, longitudinal curricula focused on the current and historical health impacts of race, racism, bias, and discrimination, incorporating experiential learning in the community setting instead of focusing on developing curricula specifically focused on teaching trainees how to discuss racism in the primary care setting.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192498","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":"\"To Serve My Community Better\": Exploring Resistor Identity Formation and Its Impact on Physician Professional Identity.","authors":"TingLan Ma, Vinayak Jain, Tasha R Wyatt","doi":"10.1080/10401334.2025.2509835","DOIUrl":"https://doi.org/10.1080/10401334.2025.2509835","url":null,"abstract":"<p><p><b><i>Introduction</i></b>. Medical trainees often confront a healthcare system entrenched in longstanding social harm, including racism, sexism, and homophobia. Yet, advocacy remains vaguely addressed in U.S. medical training, leaving trainees without structural support as they engage in acts of professional resistance to social injustice. This study explores medical trainees' development of a \"resistor identity\" and how this identity shapes their professional identity as physicians committed to challenging systemic injustices. <b><i>Methods</i></b>. Using a qualitative approach, we applied constructivist grounded theory to semi-structured interviews with 18 medical trainees known for engaging in professional resistance. Data collection spanned two interview rounds, 10 months apart. Drawing from Selinger's professional development identity framework of \"being\" and \"becoming,\" and Syed and McLean's identity integration theory, our analysis examined the origins of resistor identity and its dynamic interrelations with professional identity. We employed constant comparative analysis to identify patterns. <b><i>Results</i></b>. Findings reveal that trainees' resistor identities emerge in response to conflicts between their professional roles and their desire to address systemic injustice within medical education and practice. Three relationships between their resistor and professional identities were identified: (1) Conflict: Trainees perceived tension between their resistor and professional identities, and avoided the former being assimilated into the latter to maintain awareness of systemic injustice. (2) Intertwining: Some saw these identities as deeply connected but maintained some level of distinctness. They observed role models who demonstrated ways to help both identities coexist harmoniously. (3) Integration: Some trainees experienced an initial conflict or intertwinement between identities, but later achieved integration, transforming their professionalism to include humane concerns and mature expressions of resistance. <b><i>Discussion.</i></b> These interrelations are fluid rather than fixed or mutually exclusive. Trainees critically reflect on what it means to be a physician, actively expanding their professional identities to incorporate values of advocacy and justice. The resistor identity allows trainees to resist privileged norms of the profession while still fulfilling their roles as competent and effective physicians. Findings highlight both challenges and possible pathways to professional identity integration, while call for acknowledging advocacy and professional resistance as key roles for future physicians.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163245","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 Master Adaptive Learner Approach to Cognitive Disability Support in a U.S. Urology Residency.","authors":"Rebecca J Stetzer, Joshua Schammel, Brian Inouye","doi":"10.1080/10401334.2025.2502670","DOIUrl":"10.1080/10401334.2025.2502670","url":null,"abstract":"<p><p>Medical education is witnessing a growing need for disability support, particularly for cognitive and psychiatric disabilities, yet many medical learners do not receive the necessary accommodations. These barriers may arise from uncertainty in how to approach multifaceted challenges, lack of disability recognition by both learners and educators, fear of stigma, and unclear or inadequate institutional policies and support systems. This case study about a urology resident in a U.S. training program, presented from the viewpoint of his competency development coach and residency program leadership with case description and insights from the resident, explores how adopting a Master Adaptive Learner (MAL) approach to identifying multiple intertwined challenges enables targeted remediation and disability support efforts. While situated in a U.S. surgical graduate medical education program, this case offers insights that can be helpful to medical educators in a variety of settings about how to effectively support struggling learners, while emphasizing the importance of early identification, tailored accommodations, and the value of creating an inclusive learning environment for all medical learners. By modeling how the ability to be vulnerable is a strength in the learning environment, this case aims to reduce the stigma associated with having learning requirements that fall outside a program's standard curriculum. Ultimately, this paper advocates for shifting the remediation process from a stigma-laden experience to one that fosters growth, helping both learners and programs evolve.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020257","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":"Comparisons of Validity of the New and Prior MCAT Exams in Predicting Performances on Steps 1, 2, and 3 of the United States Medical Licensing Examinations.","authors":"Aaron Douglas, Alisa Alfonsi LoSasso, Bernard L Lopez, Charles Pohl, Anita Wilson, Mohammadreza Hojat","doi":"10.1080/10401334.2025.2495353","DOIUrl":"https://doi.org/10.1080/10401334.2025.2495353","url":null,"abstract":"<p><p>This study examined the validity of the new MCAT exam (administered since 2015) for predicting medical students' performance on United States Medical Licensing Examinations (USMLE) and compared the findings with those of the prior MCAT version. Participants comprised two samples of students who entered Sidney Kimmel Medical College at Thomas Jefferson University between 2012 and 2020. One sample included 1,111 students (559 men, 552 women) with new MCAT scores who matriculated between 2016 and 2020, and the other comprised 1,312 students (668 men, 644 women) with prior MCAT scores who matriculated between 2012 and 2015. We used students' MCAT scores as predictors of performance on Steps 1, 2, and 3 of the USMLE. Bivariate correlations and path analysis were used for statistical analyses. Path analysis showed new MCAT total scores resulted in <i>R²</i> values of 0.14, 0.11, and 0.16 for predicting performance on Steps 1, 2, and 3 of the USMLE, respectively. The new MCAT total scores demonstrated levels of validity comparable to the prior MCAT for predicting students' performances on the criterion measures. Additional path analyses showed an impact of gender on the predictive validities for some section scores of the new (but not prior) MCAT exam. Replication of this study is recommended in other medical schools to examine generalizability of our findings regarding predictive validities of section scores of the new MCAT exam, particularly regarding gender and section.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065049","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":"Comparability of Preceptor Assessment of Medical Students in a General Practice and Multispecialty Longitudinal Integrated Clerkship in a US Medical School.","authors":"Hana Smith, Henry Colangelo, Kari Mader, Roberto Silva, Jennifer E Adams, Tai Lockspieser","doi":"10.1080/10401334.2025.2495351","DOIUrl":"https://doi.org/10.1080/10401334.2025.2495351","url":null,"abstract":"<p><strong>Background: </strong>Continuity is the organizing principle of the Longitudinal Integrated Clerkship (LIC) and drives its outcomes. In a multispecialty LIC, students are paired with specialty-specific preceptors in each of the core clerkships approximately one half-day per week and work with each of these preceptors longitudinally throughout their clinical training. The general practice (GP) LIC differs in that students are primarily paired with full-scope generalist preceptors who teach the content of several specialties in one setting. It is unknown if assessments from a single preceptor teaching multiple specialties will include sufficient data for summative grading. The aim of this study was to demonstrate non-inferior assessment narrative quality and comparable clerkship clinical grades for students in an urban GPLIC compared to multispecialty LIC students at a United States (U.S.) medical school.</p><p><strong>Methods: </strong>In 2022, 16 GPLIC preceptors assessed 6 students in pediatrics, obstetrics and gynecology, internal medicine, and family medicine, using forms that allowed assessment in multiple specialties concomitantly. Assessment forms included both comments and ratings of student performance of entrustable professional activities (EPAs) and other skills. Sixteen GPLIC assessment forms were matched to 16 multispecialty forms, deidentified, and evaluated for quality. Adequacy of assessment data was determined by the school's curricular and assessment deans who observed all clerkship grading committee meetings. Feedback on the assessment process was solicited from all 1164 LIC preceptors through an electronic survey at the end of the year.</p><p><strong>Results: </strong>Overall comment quality did not significantly differ between the groups. There was no significant difference in word count or presence of EPA-specific comments between GPLIC and multispecialty LIC assessment forms. We found no difference in the presence of adequate assessment data between the two groups as judged by final grading committees. The clinical grade distributions of Honors, High Pass, and Pass were not significantly different, and no differences in preceptor feedback about the assessment forms were found.</p><p><strong>Conclusion: </strong>This study demonstrates that in the inaugural year of an all-LIC curriculum at a US medical school, GPLICs, where preceptors concurrently assess students across multiple specialties, produce noninferior assessment data when compared to multispecialty LIC preceptors. These results suggest the feasibility for parallel GP and multispecialty LICs. This offers medical schools flexibility in expanding clinical training sites beyond traditional specialty-focused academic contexts, while maintaining comparability in assessment.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994218","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":"The Historical Roots of Tiered Grading in U.S. Medical Education.","authors":"James F Smith, Nicole M Piemonte","doi":"10.1080/10401334.2025.2495352","DOIUrl":"https://doi.org/10.1080/10401334.2025.2495352","url":null,"abstract":"<p><p>Evaluation of medical students remains one of the most complex and challenging issues in academic medicine. Evaluation occurs in an educational environment that must cultivate a diverse, collaborative, and resilient physician workforce imbued with skills, drive, and stamina for a lifelong commitment to patient care, self-care, and professional development. Additionally, evaluation must not only be valid and reliable but also relevant to the public who medical students will eventually serve. In U.S. medical education, evaluation, and the assessments on which evaluation is based, has evolved over several centuries. Understanding the history of how, when, and why U.S. medical students have been assessed and subsequently evaluated can inform contemporary dialogue on curricular reform. In exploring this history, several important considerations emerge. First, tiered grading arose through the historical assimilation of U.S. medical schools into universities rather than as a mechanism for assessing clinical competence or acumen. Second, even before influences of university academia suffused medical education, imprudent academic emphasis on the memorization of facts over deeper understanding of, and reflection on, medical sciences and practice was already entrenched. Evaluation systems like tiered grading served to validate-if not accelerate-overreliance on the memorization and recall of scientific facts. As a result, other professional attributes important for medical practice, including intrinsic motivation, group cohesiveness, and diversity of the physician workforce were, and remain, adversely affected. Finally, despite early observations that tiered grading is associated with medical student stress and anxiety, there has been insufficient attention to and mitigation of these effects on medical student wellbeing over the last century. Our collective response to controversies surrounding tiered grading should account for the historical rationality of the adoption of this form of evaluation and its enduring effects on contemporary medical education.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031671","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}