Teaching and Learning in Medicine最新文献

{"title":"Patterns of Ostracism Experienced by Canadian Medical Trainees of Asian Sub-ethnicities.","authors":"Sun Young Kim, Yebin Shin, Amrit Kirpalani","doi":"10.1080/10401334.2023.2297066","DOIUrl":"10.1080/10401334.2023.2297066","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: Ostracism has negative effects on one's fundamental needs. North Americans of Asian ethnicities are at an increased risk of ostracism due to stereotypes labeling them as inherently different to Western cultural norms. We explored Asian Canadian medical trainees' experiences with ostracism during their clinical training. <b><i>Approach</i></b>: We conducted semi-structured interviews with 20 medical trainees of Asian ethnicities at 3 Canadian medical schools to explore experiences of ostracism and conducted a thematic analysis guided by the theoretical framework of the temporal need threat model of ostracism. <b><i>Findings</i></b>: Participants from East-, South-, and Southeast-Asian sub-ethnic groups completed the study. They voiced experiences of being excluded from clinical and social settings. Ostracism was mainly fueled by systemic racism, power dynamics in medical education, and non-diverse training environments. The model minority myth was a significant contributor to experiences of ostracism. Trainees felt their well-being threatened and many felt resigned to accept ostracism going forward. <b><i>Insights</i></b>: Ostracism poses a significant threat to the wellbeing and career progression of Asian Canadian medical trainees. Trainees facing covert ostracism were particularly at risk of entering the resignation stage of hopelessness. This underrecognized problem needs to be addressed by institutions to dismantle harmful stereotypes and prejudiced practices facing these minoritized communities.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"160-168"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032817","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 Untested Feasibilities: Critical Pedagogy's Approach to Addressing Abuse and Oppression in Medical Education.","authors":"Ligia Maria Cayres Ribeiro, Marco Antônio de Carvalho Filho","doi":"10.1080/10401334.2025.2453809","DOIUrl":"10.1080/10401334.2025.2453809","url":null,"abstract":"<p><p>Abuse and oppression in medical education persists. Particularly when transitioning to practice, students and residents face dissonance between what they perceive as the ideals of patient care and reality. They witness, and eventually take part in, joking about fellow students and patients, discriminating against minorities, and imposing unbearable workload to subordinates, to mention some practices that have been normalized as the reality of medical training, beyond any possibility of change. We suggest that Critical Pedagogy, an educational movement rooted in Brazil that aims to empower learners and educators as full citizens, can help medical education reinstitute hope for a more humanistic culture by testing new realistic transformative actions, i.e., untested feasibilities, to promote change. We use vignettes based on real situations of oppression to present three concepts of Critical Pedagogy contextualized to medical education: (a) critical consciousness as <i>praxis</i>; (b) pedagogy with learners; and (c) education as a democratic relationship between individuals. The vignettes explore how each one of these concepts can support educators and learners to break chains of injustice and oppression. Perceiving disagreements as opportunities for change, legitimizing the perspectives and values of all engaged in analyzing reality, is needed to nurture critical consciousness. Critical Pedagogy understands education as a partnership of trust between learners and educators and seeks a pedagogy that is built with learners, not on them. Finally, we present suggestions for individual- and systems-level actions that can translate these principles of Critical Pedagogy into a <i>praxis</i> of untested feasibilities for medical education.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"273-282"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025465","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":"Aesthetic Labour in Health Professional Education: Dress, Discrimination and Resistance.","authors":"Edward Waters","doi":"10.1080/10401334.2025.2484391","DOIUrl":"https://doi.org/10.1080/10401334.2025.2484391","url":null,"abstract":"<p><strong>Phenomenon: </strong>In organizational studies and management literature, the term aesthetic labor is used to describe how employee appearance is managed to provide particular customer experiences. Health professional education programs also manage the appearance of students, particularly by formulating dress codes. Previous literature has shown that dress codes can reflect racist, sexist and class biases and reinforce hierarchies of privilege within and between health professions.</p><p><strong>Approach: </strong>This critical perspective reappraises this literature to develop an account of aesthetic labor in health professional education.</p><p><strong>Findings: </strong>The aesthetic labor process is shown to support structural discrimination, but also to invoke a variety of student responses that incorporate professional resistance.</p><p><strong>Insights: </strong>This article relates these to the aesthetic labor literature using labor process theory, and identifies areas for future research as well as implications for educational institutions and practitioners.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732970","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":"Disrupting Health Professions Education Research: A Guide to Critical Reflexive Praxis during Research Planning.","authors":"Danica Sims, Paul Saunders","doi":"10.1080/10401334.2025.2478291","DOIUrl":"https://doi.org/10.1080/10401334.2025.2478291","url":null,"abstract":"<p><p>Research is never truly neutral; all research is inherently subjective because it is shaped by who conducts it, how they think, and the systems they operate within. Paradoxically, despite reflexivity's critical intent - a practice for recognizing and addressing researcher influence - it too often becomes a superficial checkbox exercise that fails to meaningfully challenge deeper structural and systemic inequities. As a result, Health Professions Education (HPE) research often reinforces global power imbalances, privileging Western perspectives while excluding knowledge from the Global South and marginalized communities. This article advocates for Critical Reflexive Praxis (CRP), an approach grounded in Critical Theory, that combines self-reflection with deliberate action to disrupt power dynamics and promote equity in research. CRP extends beyond traditional reflexivity by interrogating and transforming the underlying structures that shape knowledge production and dominant research practice. By adopting CRP, researchers can challenge entrenched hierarchies, include and amplify marginalized perspectives, and create research that fosters meaningful social transformation. This article offers practical guidelines for enacting CRP across individual, interpersonal, local, and global levels during HPE research planning, paving the way for more equitable and impactful contributions to HPE and beyond.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659509","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":"Gaslighting the Racially and Ethnically Minoritized Medical Student: How US Medical School Assessment Practices Perpetuate Systemic Inequities.","authors":"Michael S Ryan, Jennifer Randall","doi":"10.1080/10401334.2025.2477094","DOIUrl":"https://doi.org/10.1080/10401334.2025.2477094","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Physicians from racially and ethnically minoritized (REM) populations are woefully under-represented in the medical profession. The consequences of under-representation are far reaching, with profound impacts on social justice efforts and public health. One solution to remedy this crisis involves the aggressive recruitment of students from REM backgrounds. Though medical education programs have advanced in the recruitment of REM students, their outcomes during medical school are worse than for students from non-REM populations. Previously, literature has focused on causes for this disparity including social determinants, biases, and burden. <b><i>Approach:</i></b> In this manuscript, we invoke Critical Whiteness Theory (CWT) to argue how the systems of assessment in medical schools are an under-appreciated contributor to disparities, effectively perpetuating inequities by promoting a white supremacist culture. We begin by examining the origins of assessment in medical education, exploring the historical desire to measure attributes of a <i>good doctor</i>, but the tendency to default toward measures of aptitude and rote medical content knowledge that support a white supremacist culture. The Flexner Report and a systemic shift to favor standardized testing are highlighted as major contributors to the foundation of medical school assessment programs. We then describe potential for progress, through a better definition of the <i>good doctor,</i> articulated by the competency-based medical education movement, and advanced further through a justice-oriented assessment program. <b><i>Findings:</i></b> Using an illustrative case example and review of the literature, we suggest that progress in admissions and remediation are commonly coupled, and misaligned, with a historical approach to assessment. Resulting from the misalignment, we argue that medical education programs effectively \"gaslight\" REM students by admitting them into programs poorly equipped to support their success and convincing REM students that their poor outcomes were earned. We share examples from pre-clinical and clinical assessment programs, including a continued reliance on standardized tests, arbitrary grading thresholds, shadow assessment programs, and focus on episodic remediation that results in stigmatization for failures. <b><i>Insights:</i></b> We conclude by providing a model for how issues identified through this perspective may be remedied through a justice-oriented approach to assessment. Through that approach, we propose improved alignment in the recruitment and retention of REM students, thereby resulting in better outcomes for patients, improved physician representation, and realization of a diverse and more complete picture of the <i>good doctor</i>.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-16"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607125","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":"Beyond Student Evaluations of Teaching and Educator Portfolios: A Multisource, Longitudinal System for Evaluating Teaching.","authors":"Kiran Pandit, Anabelle Andon, Corey Ptak, Emmagene Worley, Glen Davenport, Tiffany Murano","doi":"10.1080/10401334.2025.2461991","DOIUrl":"10.1080/10401334.2025.2461991","url":null,"abstract":"<p><p>Traditional student evaluations of teaching and educator portfolios do not adequately assess the breadth and depth of medical educators' efforts. Current processes use limited perspectives, focus on a small portion of educators' work, and emphasize subjective opinions, which introduce bias. Use of these data for high-stakes decisions such as academic promotion contributes to inequitable career advancement. We propose a holistic, growth-focused, behaviorally anchored system of evaluation which incorporates perspectives of the learner, peers, and self, and which examines the full scale of educator activities from a single session, to course design, to development of educator skills over years.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532193","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":"Evaluating the Instructional Strategies Influencing Self-Regulated Learning in Clinical Clerkship Years: A Mixed Studies Review.","authors":"Sahar Fatima, Wei-Han Hong, Mohamad Nabil Mohd Noor, Chan Choong Foong, Vinod Pallath","doi":"10.1080/10401334.2025.2468953","DOIUrl":"https://doi.org/10.1080/10401334.2025.2468953","url":null,"abstract":"<p><p>Self-regulated learning (SRL) can significantly improve academic achievement and clinical performance. The clinical clerkship is a crucial setting for reinforcing and extending SRL skills and behaviors into clinical practice. However, learning in clinical settings is often opportunistic and contextual, requiring diverse instructional strategies and tailored learning opportunities. Studies from the past two decades have indicated challenges in implementing SRL strategies particularly in Asian countries. While many of the pedagogical approaches used in medical education include aspects of SRL theory, a comprehensive overview of effective SRL instructional strategies in clinical clerkships is lacking. We reviewed all studies (published between January 2012 and May 2024, identified <i>via</i> systematic search of EBSCOhost, PubMed, ScienceDirect, Scopus, and Web of Science) that discuss instructional strategies influencing SRL among clinical clerkship students, in general, and with special reference to the Asian context. Twenty seven articles were included in the final analysis. We conducted convergent integrated synthesis on the data extracted from all included studies to generate categories and themes. SRL instructional strategies reported included implementing learning plans and goal setting, operationalizing formal mentoring and feedback processes, utilizing technology-enhanced learning, facilitating collaborative group learning, providing simulation-based learning experiences, and applying experiential learning strategies. When implemented effectively, such strategies were shown to promote self-regulated learning, motivational beliefs, self-monitoring, and self-reflection. Faculty support, mentoring and timely feedback were crucial in successfully implementing SRL strategies. Incorporating SRL into existing curricula was ideal for ensuring feasibility and long-term sustainability. Limited research from the Asian region indicates that SRL has not been used to its full potential in Asian medical education. Asian medical students' SRL potential could be maximized with shared roles of students and teachers in a student-driven approach. Medical educators should take responsibility for providing opportunities and a conducive environment to foster SRL among clinical clerkship students. Future research should prioritize longitudinal, experimental studies with comparison groups and objective SRL outcome measures to rigorously evaluate the impact of instructional strategies in the clinical clerkship context.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-19"},"PeriodicalIF":2.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493681","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":"Dismantling Ableism in Undergraduate Medical Education: Promising Practices in Disability-Conscious Training.","authors":"Liz Bowen, Kerry Devlin, Laura Guidry-Grimes, Gabrielle E Milner, Mildred Z Solomon, Dorothy W Tolchin, Lisa Young, Stephanie P Van, Erik Parens","doi":"10.1080/10401334.2025.2464672","DOIUrl":"10.1080/10401334.2025.2464672","url":null,"abstract":"<p><p>The healthcare workforce in the United States does not provide the same standard of care for people with disabilities as for nondisabled people. Many academic medical institutions do not routinely offer disability-conscious medical training, and many clinicians and medical educators feel ill-equipped to incorporate anti-ableist learning goals into their curricula. Drawing on a critical review of the literature and interviews with medical educators, representatives of professional organizations, and disability advocates, this article presents promising practices for disability-conscious undergraduate medical education. Disability-conscious education, which is grounded in the insights of disability studies and disability rights and justice frameworks, is distinguished from disability-specific education, which may not extend beyond biomedical models of disability. First, we define current approaches to teaching about disability, highlighting limitations and opportunities for further development. We then identify and analyze approaches to teaching about disability that support the development of disability consciousness among learners. With attention to both curricular format and theoretical frameworks, we offer concrete approaches that medical schools can take to equip students with the knowledge, attitudes, skills, and practices they need to provide equitable care for patients with disabilities.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-16"},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442755","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":"\"Encouraged to be Your True Self\": An Interpretative Phenomenological Study of Medical Students' Experiences of Role Models in Shaping Sexual Minority Identity in Medical School.","authors":"Antony P Zacharias, Debbie Aitken","doi":"10.1080/10401334.2025.2451911","DOIUrl":"10.1080/10401334.2025.2451911","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalizing SGM presence within healthcare spaces. <b><i>Approach:</i></b> Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to participants' relationship with their bespoke experiences, respecting differing narratives within the broad 'SGM' umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. <b><i>Findings:</i></b> The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modeling was often experienced more positively than vertical faculty-to-student role modeling. However, as expected, heteronormativity exerted an inhibitory effect on this process. <b><i>Insights:</i></b> We built upon existing social cognitive paradigms to develop a 'double-funnel' model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of student-led SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining 'normativity' in medical schools.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-16"},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015815","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":"Re-Imagining the Patient Panel: Introducing Lived Experiences of Psychosis into the Pre-clerkship Psychiatry Curriculum of a Canadian Medical School.","authors":"Sacha Agrawal, Moshe Sakal, Anne Borrelly","doi":"10.1080/10401334.2024.2447295","DOIUrl":"https://doi.org/10.1080/10401334.2024.2447295","url":null,"abstract":"<p><p>The involvement of people with lived experience (patients) in medical education offers a unique opportunity for students and residents to access personal and collective knowledge about the lived experience of health, ill health, and medical care. Involvement also has the potential to elevate the role of people with lived experience and their knowledge within medicine by providing a model for meaningful collaboration and partnership. However, involvement has been critiqued by critical disability scholars for its potential to harm without leading to meaningful change in professional knowledge or practice. In this article, we (two educators with lived experience and an academic psychiatrist) describe the development and delivery of an annual lived-experience presentation about psychosis for the second-year class of a large, urban medical school in Canada. We describe our reflexive process attempting to enact meaningful involvement and disrupt the uneven power relations that shape and constrain this work, in a setting where the risks of exploitation, tokenism, and co-optation are significant. Our goal has been to re-imagine the \"patient panel,\" which puts significant limits on the position of patients as knowers. By re-defining roles and shifting power from faculty to lived experience educators, we have aimed to present important non-medical ideas about psychosis and how to effectively support people who experience it, while disrupting interpersonal and structural bias.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984114","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}