Teaching and Learning in Medicine最新文献

{"title":"Indigenous Mentorship for the Health Sciences: An Appraisal of a Contemporary Model by Indigenous Stakeholders.","authors":"Elaine J Atay, Adam T Murry, Cheryl Barnabe, Olivia Sawyer, Michael Alex Bednar","doi":"10.1080/10401334.2023.2230577","DOIUrl":"10.1080/10401334.2023.2230577","url":null,"abstract":"<p><p><b><i>Construct</i></b><i>:</i> In 2021, Murry et al. put forward a model of Indigenous mentorship within the health sciences based on the behaviors of Indigenous mentors toward their Indigenous mentees. This study explored mentees' endorsements and/or criticisms of the IM model and how <i>IM constructs</i> and behaviors described in the model benefited them. <b><i>Background</i></b>: Models of Indigenous mentorship have been developed previously yet have not yet been empirically examined, restricting our ability to measure or make claims as to their consequences, correlates, and antecedents. <b><i>Approach</i></b><i>:</i> Interviews with six Indigenous mentees asked about their: 1) resonance with the model, 2) stories related to mentors' behaviors, 3) perceived benefits of their mentors' behaviors on their journey, and 4) components they felt were missing from the model. Data were analyzed using qualitative content analysis. <b><i>Findings</i></b><i>:</i> Overall, the model resonated with participants. Mentees told stories about mentors engaging in the IM constructs <i>practicing relationalism</i> most frequently, followed by <i>fostering Indigenous identity development, utilizing a mentee-centered focus,</i> and <i>imbuing criticality</i>, <i>advocacy</i>, and <i>abiding by Indigenous ethics</i>. Benefits included improved career and work attitudes, motivation, and overall well-being, engaging in helping behaviors, and enhanced criticality. Recommendations to expand the model included incorporating: 1) additional mentor behaviors (e.g., transference of traditional knowledge), 2) higher-order dimensions (e.g., the impact of the institution), 3) specific mentee characteristics (e.g., age and gender), and 4) additional types of mentoring relationships (e.g., peer, multiple mentors). <b><i>Conclusions</i></b><i>:</i> This study showed that Murry et al.'s model resonated with primary stakeholders (i.e., Indigenous mentees), that Indigenous mentorship behaviors have perceived consequences that are important for adjustment, and ways the model is limited or mis-specified. This information can inform mentor practices, selection and support, and program evaluation.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"637-653"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9769803","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":"Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory.","authors":"Kevin C McMains, Abigail Konopasky, Steven J Durning, Holly S Meyer","doi":"10.1080/10401334.2023.2230188","DOIUrl":"10.1080/10401334.2023.2230188","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. <b><i>Approach</i></b>: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. <b><i>Findings</i></b>: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only <i>engagement</i> with educator roles but disengagement with other roles; <i>imagination</i> of future roles with the support of mentors; and fluid <i>alignment</i> with multiple mutually reinforcing identities. Participants identified <i>boundary objects</i> like resumes and formal roles that helped them negotiate across Community of Practice boundaries. <b><i>Insights</i></b>: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"613-623"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054192","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 Invitation to Probe Reality and Theorize Daringly About Human Experience: Exploring 'Secret Affinities' in Medical Education Inquiry.","authors":"Sven P C Schaepkens, Anna T Cianciolo","doi":"10.1080/10401334.2024.2414658","DOIUrl":"10.1080/10401334.2024.2414658","url":null,"abstract":"","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"684-688"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480120","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":"Finding Themselves, Their Place, Their Way: Uncertainties Identified by Medical Students.","authors":"Ciara Lee, Katherine Helen Hall, Megan Anakin","doi":"10.1080/10401334.2023.2233003","DOIUrl":"10.1080/10401334.2023.2233003","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: Navigating uncertainty is a core skill when practicing medicine. Increasingly, the need to better prepare medical students for uncertainty has been recognized. Our current understanding of medical students' perspectives on uncertainty is primarily based on quantitative studies with limited qualitative research having been performed to date. We need to know from where and how sources of uncertainty can arise so that educators can better support medical students learning to respond to uncertainty. This research's aim was to describe the sources of uncertainty that medical students identify in their education. <b><i>Approach</i></b>: Informed by our previously published framework of clinical uncertainty, we designed and distributed a survey to second, fourth-, and sixth-year medical students at the University of Otago, Aotearoa New Zealand. Between February and May 2019, 716 medical students were invited to identify sources of uncertainty encountered in their education to date. We used reflexive thematic analysis to analyze responses. <b><i>Findings</i></b>: Four-hundred-sixty-five participants completed the survey (65% response rate). We identified three major sources of uncertainty: insecurities, role confusion, and navigating learning environments. Insecurities related to students' doubts about knowledge and capabilities, which were magnified by comparing themselves to peers. Role confusion impacted upon students' ability to learn, meet the expectations of others, and contribute to patient care. Navigating the educational, social, and cultural features of clinical and non-clinical learning environments resulted in uncertainty as students faced new environments, hierarchies, and identified challenges with speaking up. <b><i>Insights</i></b>: This study provides an in-depth understanding of the wide range of sources of medical students' uncertainties, encompassing how they see themselves, their roles, and their interactions with their learning environments. These results enhance our theoretical understanding of the complexity of uncertainty in medical education. Insights from this research can be applied by educators to better support students develop the skills to respond to a core element of medical practice.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"577-587"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9773165","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":"Moving the Field Forward: Using Self-Determination Theory to Transform the Learning Environment in Medical Education.","authors":"Adam Neufeld","doi":"10.1080/10401334.2023.2235331","DOIUrl":"10.1080/10401334.2023.2235331","url":null,"abstract":"<p><p><b><i>Issue</i>:</b> The learning environment (LE) is known to be the main determinant of physician distress, yet most wellness interventions continue to focus on the learner. Additionally, few wellness interventions that focus on the LE have derived from well-established theory. These limitations represent major barriers in our progress toward improving the LE and supporting medical learner wellness in an evidence-based, humanistic, and scalable way. <b><i>Evidence</i>:</b> To remedy the situation, I highlight a cross-section of promising experimental research in self-determination theory (SDT) and its potential applications in medical education. <b><i>Implications</i>:</b> I propose that we incorporate SDT-based faculty development workshops to improve leaders' awareness and motivating style with learners. These interventions are known to improve the LE and thus learners' engagement, performance, and wellness. SDT-trained personnel would be needed to train medical faculty, including about the reciprocal benefits of being autonomy-supportive.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"654-659"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9775538","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":"COVID As a Catalyst: A Qualitative Study Of Professional Identity Formation among U.S. Medical Students During COVID-19.","authors":"Rebecca R Henderson, Christine A Adams, Lillianna Thomas, Elizabeth Gundersen, Zareen Zaidi, Melanie Hagen","doi":"10.1080/10401334.2023.2240774","DOIUrl":"10.1080/10401334.2023.2240774","url":null,"abstract":"<p><strong>Phenomenon: </strong>Students become physicians not only by mastering medical knowledge, but also through a process of Professional Identity Formation (PIF). In this study, we used the conceptual framework of Jarvis-Selinger et al. to explore the impact of COVID, as a major public health crisis, on the PIF of preclinical medical students in our country.</p><p><strong>Approach: </strong>At two U.S. medical schools, we interviewed 28 medical students twice as they moved from first to second year during the 2020-2021 COVID pandemic and explored the impact of COVID-19 on PIF. We coded the transcribed interviews and identified themes using constructivist thematic analysis.</p><p><strong>Findings: </strong>We identified three themes: 1) mental health and wellness impacts; 2) inhabiting identity as a health professional during COVID; and 3) questioning the role of physicians in society. Routines and support systems were disrupted, undermining wellness and confidence in professional choices. Students noted the need to be public health role models, and COVID prompted feelings of pride, while also causing them to question expectations of self-sacrifice amid a new politicization of medicine. Students felt that physicians must be increasingly engaged in public health and political communication.</p><p><strong>Insights: </strong>Our findings inform medical educators seeking to build a scaffolding to support PIF during a public health crisis, and highlight the importance of current events and politics on PIF. Our recommendations include the need for student support, longitudinal mentorship, curricular space to discuss the impact of sociopolitical factors on PIF, and revisiting foundational concepts such as professionalism to take into account the social and political context. Our findings add to understanding of PIF during the COVID pandemic, but are also relevant to teaching and learning during future public health crises.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"601-612"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10375150","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":"How Are We Doing? A Scoping Review of Published Patient-Centered Outcomes Research in United States Student-Run Free Clinics.","authors":"Francesca Silvestri, George Mellgard, Jonathan Goldstein, Susmita Chennareddy, Justin Tang, Michelle Tran, Isabelle Band, Daniel Qian, Sean Fischer, Abigail Castillo, Joy Jiang, David Skovran, David Thomas, Yasmin S Meah","doi":"10.1080/10401334.2023.2245805","DOIUrl":"10.1080/10401334.2023.2245805","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: Student-run free clinics (SRFCs) serve an integral role in most United States (US) medical schools and contribute substantially to literature on the quality of care to uninsured persons. There has been substantial growth over the past decade of scholarly work produced by SRFCs as they have increased in size and number. Research on patient care outcomes informs better care structures for patients, however there is no current synthesis of patient care outcomes research among SRFCs. This article provides an overview of SRFC research on patient outcomes to understand current research domains and to identify gaps in the literature. <b><i>Approach</i></b>: We completed a scoping review by searching Scopus, PubMed, and Journal of Student Run Clinics in June 2021. All peer-reviewed, English-language articles focused on patient-centered outcomes at SRFCs in the US were included. Two independent reviewers performed title, abstract, and full-text screening of relevant works, and eight reviewers conducted data extraction. Descriptive data analysis was performed along with relevant content analysis of patient-centered outcomes. <b><i>Findings</i></b>: The search strategy identified 784 studies, of which 87 met inclusion criteria. Most studies were published within the last six years (81.6%), located in California, New York, or Florida (43.7%), and intervention based (33.3%). Many studies (46.0%) had a specific disease of focus of which diabetes was the most researched(19.5%). Patient-centered studies were the leading focus of the study aims (40.2%), where key findings demonstrated primarily improved outcomes in clinic metrics post-intervention (36.8%) or equivalent/better clinical performance than national metrics (20.7%). <b><i>Insights</i></b>: This review brings to light gaps in the literature reporting research in SRFCs and can be applied to other low-resource settings. Future efforts to expand SRFC outcomes research should focus on community relationship building, understanding institutional support, and ensuring education on best practices for research within SRFCs. Doing so informs patient care improvement as SRFCs continue to operate as safety net clinics for marginalized populations.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"624-636"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982696","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":"Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.","authors":"Erhan Eser, Elif Cil, Nesibe Efruz Sen Gundogan, Meltem Col, Elif Nur Yildirim Ozturk, David Terence Thomas, Ahmet Tevfik Sunter, Hatice Nilden Arslan, Riza Citil, Yalcin Onder, Metin Picakciefe, Bahadir Dede, Can Demirel, Neriman Aydin, Cigdem Caglayan, Ahmet Alp Aker, Arda Borlu, Hasan Durmus, Gunay Can, Esin Siddikoglu, Ergun Haldun Sumer, Tunahan Uygun, Seval Alkoy, Kubra Aktas Aycan, İbrahim Koruk, Rustem Kuzan, Lutfi Saltuk Demir, Esra Hacilar, Hidir Sari, Zehra Kilinc, Ozgur Onal, Edanur Dogan, Mestan Emek, Rıdvan Terzioglu, Gulcin Yapici, Deniz Erdal, Sultan Eser, Emine Ayhan Akman, Zahide Kosan, Sinan Yilmaz, Ferruh Niyazi Ayoglu, Bilgehan Acikgoz, Berna Musal, Ahmet Furkan Suner, Aysegul Erdogan, İdris Cilburunoglu, Meral Saygun, Didem Daymaz, Didem Arslantas, Muhammed Fatih Onsuz, Nazim Ercument Beyhun, Medine Gozde Ustundag, Galip Ekuklu, Fulya Ozder Tas, Filiz Abacigil, Selcen Oncu, Seyhan Hıdıroğlu, Ayse Nilufer Ozaydin, Edibe Pirincci, Irem Bulut, Mustafa Tozun, Muzaffer Eskiocak, Pinar Gunel, Sebahat Dilek Torun, Melike Yavuz, Metin Hasde, Derya Camur, Gulsen Gunes, Burak Kurt, Nuket Guler Baysoy, Nadi Bakirci, Figen Demir, Binali Catak, Ferda Ozyurda, Mustafa Turan","doi":"10.1080/10401334.2023.2229810","DOIUrl":"10.1080/10401334.2023.2229810","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. <b><i>Approach:</i></b> This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. <b><i>Findings:</i></b> Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the \"working conditions in the country\" (OR: 1.89, 95% CI: 1.56-2.28) whereas the \"social environment/lifestyle abroad\" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). <b><i>Insights:</i></b> Although the percentage of those who want to emigrate \"definitely\" was at the same level as in the other developing countries, the tendency to migrate \"permanently\" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"588-600"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942336","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":"Praxis-Informed Pointers: A Student Guide for Optimizing Clinical Learning in a Resource-Constrained Setting.","authors":"E Archer, L Govender, R Meyer, A A Nadkar, L Smit","doi":"10.1080/10401334.2023.2237480","DOIUrl":"10.1080/10401334.2023.2237480","url":null,"abstract":"<p><p><b><i>Issue</i>:</b> Health professions education (HPE) is intimately linked with teaching and learning in the clinical environment. While the value of authentic clinical experiences is acknowledged, whether learning actually occurs is to a large extent dependent on students' behaviors and attitudes. The kinds of student behaviors and attitudes that are necessary to optimize learning in the clinical environment thus becomes relevant. <b><i>Evidence</i>:</b> Tips and recommendations to maximize clinical learning in a variety of settings have been well documented. There is, however, a dearth of literature which takes a narrative-based praxis approach focused on resource-constrained environments. We developed this praxis-orientated article as a means to translate the available literature and theory into a simple, practical guide, focused on optimizing clinical learning from a student perspective, remaining cognizant of the particular challenges present in a resource-constrained setting. <b><i>Implications</i>:</b> Based on the resource-constrained environments our students are exposed to, we outline the following six key aspects: student-driven learning, integration into the community of practice, student engagement, empathy, interprofessional learning opportunities, and feedback for learning. These aspects provide useful pointers for students in general. Furthermore, exploration into what strategies students may utilize in resource-constrained clinical contexts is addressed.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"669-675"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951064","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 Sense of Belonging: Perceptions of the Medical School Learning Environment among URM and Non-URM Students.","authors":"Alison Karasz, Samuel Nemiroff, Pablo Joo, Irene Blanco, Ariel Y Fishman, Mary S Kelly, Steven M Henick, Maryl Lambros, William B Burton","doi":"10.1080/10401334.2023.2232347","DOIUrl":"10.1080/10401334.2023.2232347","url":null,"abstract":"<p><p><b><i>Approach</i>:</b> Using Gruppen et al's model, this study investigated experiences of the LE from the perspectives of both URM and non-URM students at a medical school in New York City. In examining experiences of the organizational, social, and physical domains of the LE, we sought to explore the symbolic and experiential links across domains and identify concrete needs for improvement.</p><p><p><b><i>Findings:</i></b> Institutional structures and policies, features of the built environment, and social relationships that put learning first and generated a sense of community were highly valued. Although both URM and non-URM students shared many perceptions and experiences, URM students expressed heightened vulnerability to the experiences of devaluation and exclusion.</p><p><p><b><i>Insights</i>:</b> All participants in the study greatly appreciated aspects of the LE that made them feel like valued members of the community. Medical schools should approach the task of improving the LE for URM students using a comprehensive, multi-dimensional approach.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"566-576"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9768610","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}