Margaret A Chell,Caroline Smith,Damon P Leader Charge,Stephanie W Sun,Michael A Sundberg,Vikas Gampa
{"title":"Community Collaboration to Develop a Curriculum on Settler Colonialism and the Social Determinants of Health.","authors":"Margaret A Chell,Caroline Smith,Damon P Leader Charge,Stephanie W Sun,Michael A Sundberg,Vikas Gampa","doi":"10.1080/10401334.2024.2403991","DOIUrl":"https://doi.org/10.1080/10401334.2024.2403991","url":null,"abstract":"American Indian/Alaska Native (AI/AN) communities continue to experience health disparities and poor health outcomes, which are influenced by social determinants of health. The theory of settler colonialism provides a framework for understanding the structures that affect social determinants of health and the resulting health disparities. Western biomedicine and medical education have been implicated in perpetuating settler colonialism, and as a result Indigenous medical educators and leaders have called for increased education and understanding of the structural and social determinants of health affecting Indigenous populations. One important method is through community-based approaches to curriculum design. In collaboration with community leaders and experts, we identified the need for a curriculum on health in the context of settler colonialism, with a focus on resilience and community-directed efforts to improve wellness and care. Alongside Indigenous leaders and educators, we developed a unique curriculum focused on settler colonialism, the social determinants of health, and the assets inherent to the Native Nation where we work. Developed for non-Native learners and clinicians, the curriculum is designed to help provide context for the historical and political etiologies of health inequities experienced by the local community. Local educators helped shape a video lecture series associated with readings and experiential learning activities in 10 domains, providing an overview of settler colonialism and how it affects the social determinants of health. Our model of education draws upon the strengths and assets of communities and can improve health outcomes as well as learners' understandings of AI/AN-specific needs. We expect that our collaborative approach results in improved relationships among the Non-Native learners and providers and community members.","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":"69 1","pages":"1-8"},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255589","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}
Hannah L Kakara Anderson, Xandro Xu, April Edwell, Laura Lockwood, Pricilla Cabral, Anna Weiss, Rachel Stork Poeppelman, Kathryn Kalata, A I Shanker, Joshua Rosenfeld, Emily Borman-Shoap, Matt Pearce, Courtney Karol, Johannah Scheurer, Patricia M Hobday, Meghan O'Connor, Daniel C West, Dorene F Balmer
{"title":"<i>How Might we Build an Equitable Future?</i> Design Justice, a Counternarrative to Dominant Approaches in Medical Education.","authors":"Hannah L Kakara Anderson, Xandro Xu, April Edwell, Laura Lockwood, Pricilla Cabral, Anna Weiss, Rachel Stork Poeppelman, Kathryn Kalata, A I Shanker, Joshua Rosenfeld, Emily Borman-Shoap, Matt Pearce, Courtney Karol, Johannah Scheurer, Patricia M Hobday, Meghan O'Connor, Daniel C West, Dorene F Balmer","doi":"10.1080/10401334.2024.2404008","DOIUrl":"10.1080/10401334.2024.2404008","url":null,"abstract":"<p><strong>Phenomenon: </strong>Marginalized individuals in medicine face many structural inequities which can have enduring consequences on their progress. Therefore, inequity must be addressed by dismantling underlying unjust policies, environments, and curricula. However, once these injustices have been taken apart, how do we build more just systems from the rubble? Many current strategies to address this question have foundational values of urgency, solutionism, and top-down leadership.</p><p><strong>Approach: </strong>This paper explores a counternarrative: Design Justice. As a set of guiding principles, Design Justice centers the experiences and perspectives of marginalized individuals and communities. These principles include mutual accountability and transparency, co-ownership, and community-led outcomes, and honoring local, traditional, Indigenous knowledge.</p><p><strong>Findings: </strong>Rooted in critical scholarship and critical design, Design Justice recognizes the interconnectedness of various forms of marginalization and works to critically examine power dynamics that exist in every design process. These co-created principles act as practical guardrails, directing progress toward justice.</p><p><strong>Insights: </strong>This paper begins with an overview of Design Justice's history in critical scholarship and critical design, providing foundational background knowledge for medical educators, scholars, and leaders in key concepts of justice and design. We explore how the Design Justice principles were developed and have been applied across sectors, highlighting its applications, including education applications. Finally, we raise critical questions about medical education prompted by Design Justice.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300354","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":"Data, Discrimination, and Harm: LGBTQI People Left Behind.","authors":"Anna-Leila Williams, Rose Lassalle-Klein","doi":"10.1080/10401334.2024.2392147","DOIUrl":"https://doi.org/10.1080/10401334.2024.2392147","url":null,"abstract":"<p><p>Guidelines and recommendations to properly elicit and document sexual orientation and gender identity in the clinical setting are rapidly emerging; however, in the epidemiologic research setting, information about collection, analysis, presentation, and dissemination of LGBTQI data is nascent. Federal agencies have worked to optimize epidemiologic research data collection from LGBTQI people. Despite these efforts, research data collection guidelines are inconsistent, and the data remain inadequate. The consequence of neglecting to collect data accurately from LGBTQI people is epidemiologic datasets that distort health professionals' and policymakers' perception of who comprises our communities and what the disease burden truly is. Additional harm is accrued by members of the neglected groups, including medical students and trainees, who may feel invisible, disrespected, and unsafe when presented with discriminatory data. With this article, we use our perspectives as a medical educator and a medical student to describe the challenge of working with inadequate LGBTQI datasets. We recommend five actions that can be taken by individuals, departments, and institutions to mitigate harm from the existing datasets: 1) acknowledge the limitations of the data; 2) develop, disseminate, and encourage use of an inclusive lexicon; 3) include LGBTQI-related criteria on peer teaching reviews; 4) engage students and trainees as partners, and if appropriate, content experts to review curriculum; and 5) self-identify as an agent of social change. In addition, we discuss systems-level considerations for realizing the goal of having comprehensive, accurate, and inclusive national data to drive health care delivery and health policy decisions. These include expanding research guidelines to address reporting and dissemination best practices for LGBTQI data, and widespread adoption of data reporting guidelines by biomedical journals. There is an urgent need for data to support quality care of LGBTQI communities. The health of our family, friends, neighbors, and nation depends on inclusive, accurate data.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009924","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}
Sinibaldo R Romero Arocha, Nicole Theis-Mahon, Pilar Ortega
{"title":"Two Decades of Medical Spanish Education: A Narrative Review.","authors":"Sinibaldo R Romero Arocha, Nicole Theis-Mahon, Pilar Ortega","doi":"10.1080/10401334.2024.2390017","DOIUrl":"https://doi.org/10.1080/10401334.2024.2390017","url":null,"abstract":"<p><p><b><i>Purpose</i></b><i>:</i> Education on medical Spanish, defined as the use of Spanish by clinicians for communication with patients, has proliferated rapidly since the first guidelines were published in 2008. This study aims to characterize the scope of the field, identify gaps, and propose emerging questions for future study. <b><i>Method</i></b><i>:</i> The authors conducted a narrative review of the medical Spanish education literature published from 2000 to 2023. First, a comprehensive search algorithm was developed across three databases (Medline, Scopus, and Web of Science Core Collection) and conducted on August 2, 2023. Two reviewers then independently assessed articles for inclusion/exclusion and subsequent categorization of included articles. <b><i>Results</i></b><i>:</i> The search identified 1,303 articles, and authors added ten articles from other sources. A total of 138 individual articles were included in the final categorization and sub-analysis. There has been an upward trend in the number of articles published yearly since 2000. Most publications were educational interventions (67/138, 49%), followed by commentaries/perspectives (27/138, 20%), proficiency testing (17/138, 13%), needs assessments (16/138, 12%), reviews (6/138, 4%), and vocabulary analyses (5/138, 4%). Slightly over half of publications (72/138, 52%) were centered on physicians or physicians-in-training, with 23 (17%) articles applicable across health professions, and a few focused on pharmacists, nurses, physical therapists, psychologists, physician assistants, and genetic counselors. The vast majority (119/138, 86%) were published in medical/scientific journals and 19 (14%) in language/humanities journals. All but two first authors were affiliated with United States institutions, representing 30 states and Puerto Rico. <b><i>Conclusions</i></b><i>:</i> Over the past two decades, many medical Spanish educational interventions have been published, and several assessment tools have been developed and validated. Gaps remain in evaluation data to demonstrate course effectiveness, the use of pedagogical frameworks to guide curricula, faculty development opportunities, and the role of heritage Spanish learners. Future work should address medical Spanish gaps in health professions and medical specialties, explore patient-engaged approaches to research, and evaluate longitudinal outcomes.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-18"},"PeriodicalIF":2.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972233","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}
Caitlin M Drumm, Paolo C Martin, Elizabeth V Schulz, Tasha R Wyatt
{"title":"\"<i>I Thought Everyone Was Going to Hate Me for Being Pregnant</i>\": The Enduring Influence of the Ideal Worker Image in GME.","authors":"Caitlin M Drumm, Paolo C Martin, Elizabeth V Schulz, Tasha R Wyatt","doi":"10.1080/10401334.2024.2386986","DOIUrl":"https://doi.org/10.1080/10401334.2024.2386986","url":null,"abstract":"<p><p><b><i>Introduction</i>:</b> Patriarchal norms continue to disadvantage women in Graduate Medical Education (GME). These norms are made salient when women trainees are pregnant. Although it is known that pregnant trainees experience myriad challenges, their experiences have not been examined through the lens of gendered organizations. To understand why these challenges persist, this study critically examined the experiences of pregnant trainees and their program directors (PDs) with navigating pregnancy. <b><i>Methods</i>:</b> From October 2022 to April 2023, we recruited 13 resident or fellow trainees who experienced pregnancy while in training and their corresponding PDs. Data, in the form of semi-structured interviews, were collected, transcribed, and analyzed using thematic analysis. Guiding the analysis was feminist theory, in particular Acker's conceptualization of the ideal worker. The ideal worker norm promotes a culture of individuals who are singularly dedicated to their work with no external distractions or demands upon their time or effort. <b><i>Results</i>:</b> Both sets of participants struggled with medicine's image of the ideal worker (i.e., a selfless and untethered professional). Trainees experienced guilt for using entitlements meant to assist them during this time, concern that their requests for help would signal personal weakness, and pressure to sacrifice their own wellbeing for work. While most PDs were aware of these phenomena, they experienced varying degrees of success in combating the negative effects of the ideal worker norm. <b><i>Discussion</i>:</b> In each case, the image of the ideal worker lurked in the background of medical training, shaping trainees' experiences and PDs' perceptions and guidance. This study shows that even though the number of women has increased in medicine, the profession's underlying culture continues to signal that they must live up to the profession's expectations of the ideal worker.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903495","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}
Adam Neufeld, Greg Malin, Oksana Babenko, Cesar Orsini
{"title":"Workplace Causality Orientations Moderate Impostorism and Burnout: New Insights for Wellness Interventions in Graduate Medical Education.","authors":"Adam Neufeld, Greg Malin, Oksana Babenko, Cesar Orsini","doi":"10.1080/10401334.2024.2388223","DOIUrl":"https://doi.org/10.1080/10401334.2024.2388223","url":null,"abstract":"<p><p><b><i>Theory</i>:</b> Impostor phenomenon (IP) is strongly linked to physician burnout, but the nature of this association is not well understood. A better grasp of the mechanism between these constructs could shed new light on ways to mitigate physician IP and burnout. Grounded in self-determination theory (SDT), the present study explores whether and how residents' general causality orientations at work-impersonal, controlled, and autonomous-each moderate the effect of IP on physician burnout. <b><i>Hypotheses:</i></b> We theorized that the autonomous orientation would buffer the facilitative effect of IP on burnout, while the controlled and impersonal orientations would each enhance it to varying degrees. <b><i>Method:</i></b> Two hundred forty-three residents from the Universities of Saskatchewan, Calgary, and Alberta, across various programs, specialties, and years of training, completed a survey containing demographic questions and three previously validated instruments: the Clance Impostor Phenomenon Scale, Causality Orientations at Work Scale, and Oldenburg Burnout Inventory. We used partial correlation analyses to test our moderation hypotheses. <b><i>Results:</i></b> In line with what we expected, the autonomous causality orientation buffered the facilitative effect of IP on burnout, while the controlled and impersonal causality orientations each enhanced it. <b><i>Conclusions:</i></b> Results suggest that possessing a stronger autonomous causality orientation (and creating learning/work environments that prime it) will dampen the effect of IP on burnout, while possessing a stronger controlled or impersonal causality orientation (and creating learning/work environments that prime them) will each augment it. Findings and their implications are discussed in terms of instigating theory-informed, system-level wellness interventions in graduate medical education.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903496","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":"Clinical Reasoning in Medical Education: A Primer for Medical Students.","authors":"Graham Ka-Hon Shea, Pun-Chuen Chan","doi":"10.1080/10401334.2023.2230201","DOIUrl":"10.1080/10401334.2023.2230201","url":null,"abstract":"<p><p><b><i>Issue:</i></b> Proper application of clinical reasoning is a prerequisite toward safe practice. Formal instruction on clinical reasoning remains lacking in medical curricula, especially in preparation for the transition from pre-clinical to clinical years. <b><i>Evidence:</i></b> Although medical educators have published abundantly on clinical reasoning and acknowledge this to be an essential part of medical education, there remains a global curricular deficiency in developing this skillset. Here we introduce the reader to clinical reasoning frameworks with an emphasis upon practical application. Our focus is upon medical students transitioning from pre-clinical to clinical years of medical school who tend to be overwhelmed with facts but have limited sense of diagnostic approaches due to lack of instruction. <b><i>Implications:</i></b> In understanding systematic approaches to clinical reasoning of relevance to medical diagnosis, students will be able to process knowledge in a clinically relevant and discriminatory manner to facilitate problem solving. Upon internship and residency, they will be better prepared for self-learning and reflection as they understand how to hone their capability for diagnosis and management. Medical educators need to acknowledge that clinical reasoning is a practical academic discipline requiring greater curricular emphasis.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"547-555"},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9795159","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":"Is West Really Best? The Discourse of Modernisation in Global Medical School Regulation Policy.","authors":"Mohammed Ahmed Rashid, Ann Griffin","doi":"10.1080/10401334.2023.2230586","DOIUrl":"10.1080/10401334.2023.2230586","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> In 2012, the World Federation for Medical Education (WFME) established a recognition programme to evaluate medical school regulatory agencies across the world, in response to a new U.S. accreditation policy. Given the predominantly Western origins and Eastern impacts of the WFME programme, this article deconstructs tensions in the programme using postcolonial theory. <b><i>Approach:</i></b> Critical discourse analysis examines the intersections of language, knowledge, and power relations to highlight what can or cannot be said about a topic. We employed it to delineate the dominant discourse underpinning the WFME recognition programme. We drew on the theoretical devices of Edward Said, whose work is foundational in postcolonial thinking but has not been widely used in medical education scholarship to date. An archive of literature about the WFME recognition programme dating back to 2003, when WFME first released global standards for medical education, was analyzed. <b><i>Findings:</i></b> In the globalization of medical school regulation, the discourse of <i>modernization</i> can be conceptualized as a means of holding knowledge and power in the West, and enacting this power on those in the East, playing on fears of marginalization in the event of non-engagement. The discourse allows these practices to be presented in an honorable and heroic way. <b><i>Insights:</i></b> By uncovering the representation of the WFME recognition programme as being modern and modernizing, this article explores how such conceptualisations can close off debate and scrutiny, and proposes further examination of this programme through a lens that recognizes the inherent inequities and geopolitical power differentials that it operates within.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"504-515"},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9803175","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}
Georgia F Evans, Joanna Brooks, Lisa Collins, Rebecca Farrington, Adam Danquah
{"title":"General Practitioner Educators on Clinical Debrief: A Qualitative Investigation into the Experience of Teaching Third-Year Medical Students to Care.","authors":"Georgia F Evans, Joanna Brooks, Lisa Collins, Rebecca Farrington, Adam Danquah","doi":"10.1080/10401334.2023.2222314","DOIUrl":"10.1080/10401334.2023.2222314","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b><i>:</i> There is a paucity of research reporting the experiences of general practitioner clinical educators. Providing education for students could lead to better clinical skills and greater job satisfaction for the educator. However, it could also result in increased stress and mental fatigue, adding to what is an already pressured situation in the current primary care climate. Clinical Debrief is a model of case-based learning with integrated supervision developed to prepare medical students for clinical practice. This study aimed to explore the experiences of general practitioners who facilitate Clinical Debrief. <b><i>Approach</i></b><i>:</i> Eight general practitioner educators with experience of facilitating Clinical Debrief participated in semi-structured qualitative interviews. Results were analyzed using Reflexive Thematic Analysis, and four main themes were developed. <b><i>Findings</i></b><i>:</i> Themes included: Personal enrichment: psychological \"respite\" and wellbeing; Professional enrichment: Clinical Debrief as a \"two-way\" door; <i>Becoming</i> a facilitator: a journey; and, Relationships in teaching: blurred boundaries and multiple roles. <b><i>Insights</i></b><i>:</i> Being a Clinical Debrief facilitator had a transformative impact on the personal and professional lives of the GPs who participated in this study. The implications of these findings for individual GPs, their patients, and the wider healthcare system, are discussed.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"425-434"},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9728020","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":"Students' and Instructors' Perspectives on Learning and Professional Development in the Context of Interprofessional Simulation.","authors":"Hadil Elsayed, Markus Nivala, Liisa Carlzon","doi":"10.1080/10401334.2023.2230562","DOIUrl":"10.1080/10401334.2023.2230562","url":null,"abstract":"<p><p><b><i>Phenomenon</i>:</b> Simulation-enhanced interprofessional education is a potentially valuable pedagogical approach in health professional education. Simulation-enhanced interprofessional education merits more empirical exploration particularly in terms of experiences from different perspectives. <b><i>Approach</i>:</b> The study aims to provide a multi-perspective in-depth understanding of students' engagement in a simulation-based interprofessional learning environment. Ninety students and thirteen facilitators participated. We analyzed data from examination sheets of medical and nursing students in a simulation-enhanced interprofessional education course and from a facilitator survey, using manifest inductive content analysis. The analysis was informed by actor network theory and Schön's reflection on action model. <b><i>Findings</i>:</b> Students reflected on their performance in relation to (1) personal attributes, such as systemization skills; (2) other team members, such as communication skills; and (3) the surrounding environment, such as efficient employment of resources. They also reflected on the consequences of their actions and future professional growth. We observed group differences in conceptualizations of performance and knowledge enactment. Facilitators' and students' perceptions of performance were mostly aligned. Leadership enactment in the learning environment was problematic for students as well as facilitators. <b><i>Insights</i>:</b> Students' engagement in the learning environment helped them develop a prototype of their professional identity and explore potential domains or tools for further learning and professional growth. Features of the learning environment fostered teamwork skills and allowed students to learn from each other, thus improving performance. Our findings have several implications for education, and professional practice, including the need for meticulous planning of learning environments and the importance of more intensive pedagogical efforts for soon-to-be health professionals regarding workplace dynamics and potential conflicts. It is also important to consider that an interactive learning environment can invoke reflection on action not only among students but also among facilitators and that this can contribute to the development of clinical praxis.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"454-469"},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9740464","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}