Teaching and Learning in Medicine最新文献

{"title":"Characterization of Distinctive Teaching Practices in Longitudinal Integrated Clerkships: Perspectives From Students and Faculty.","authors":"Jennifer E Adams, Sheilah Jiménez, Vishnu Kulasekaran, Anne Frank, Catherine Ard, Kristina Sandquist, Heather M Cassidy","doi":"10.1080/10401334.2024.2328171","DOIUrl":"10.1080/10401334.2024.2328171","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: Longitudinal integrated clerkships (LICs) are novel curricula that place medical students in long-term learning and coaching relationships with faculty and require adaptation of teaching practices on the behalf of faculty to maximize learning outcomes. An understanding of how teaching in an LIC model differs from teaching trainees in more traditional models is critical to ensuring curricular innovation success through faculty development. <b><i>Approach</i></b>: A qualitative approach was used to describe the teaching practices of faculty and learning experiences of student participants in longitudinal integrated clerkships in different clinical and community settings. Forty-five faculty and 20 students participated in focus groups. Thematic analysis of focus group data was used to identify differences and similarities between groups, sites, and specialties. <b><i>Findings</i></b>: Two groupings of themes emerged in thematic analysis: (1) precepting strategies distinctive to the longitudinal integrated clerkship model and (2) precepting strategies enhanced when employed in the LIC model. Distinct to the LIC model, preceptors and students described the importance of understanding the curricular structure and supporting students in longitudinal care of patients. Enhanced in the LIC model are the strategies of relationship-based teaching, support of autonomy, feedback, and support of longitudinal growth in skills. <b><i>Insights</i></b>: Students and faculty across LIC sites were broadly aligned in their opinions of best practices for teaching in an LIC model. The longitudinal relationship between student and faculty in an LIC distinguishes this model from traditional block rotations and a distinctive approach to successful teaching is demonstrated. Preceptors use time afforded to build trusting relationships with students, which created opportunity for novel teaching approaches and enhanced otherwise effective teaching strategies. A focus on orientation to the curricular model and support of longitudinal relationships with patients may serve as an anchor for faculty development efforts in the development of an LIC.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"205-217"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295248","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":"Empowerment of Learners through Curriculum Co-Creation: Practical Implications of a Radical Educational Theory.","authors":"Hugh A Stoddard, Annika C Lee, Holly C Gooding","doi":"10.1080/10401334.2024.2313212","DOIUrl":"10.1080/10401334.2024.2313212","url":null,"abstract":"<p><p><i>Framing the Issue</i>: Medical education programs in the U.S. rely on the aphorism that faculty own the curriculum; that is, the specialized knowledge, skills, and attitudes of a physician are the province of the faculty to be delivered to tuition-paying students. From this view, the learner's role is one of passivity and deference. A contrasting approach, termed curriculum co-creation, frames education as a bi-lateral partnership. Co-creation results from learners, in collaboration with instructors, taking an active role in creating the goals and processes of an educational program. Such a partnership requires substantial revision of the expectations for both learners and instructors. In this Observations article, the idea of co-creation is applied to medical education and an aspirational vision for the role and value of faculty-student co-creation is advocated. <i>Description and Explication</i>: Co-creation partnerships of faculty and students occur in many forms, varying in degree of departure from traditional educational practice. Co-creation principles and partnerships can be deployed for almost all aspects of training including selection and organization of content, effective methods of instruction, and assessment of student learning. The outcomes of co-creation occur at three levels. The most specific outcome of co-creation is characterized by increased student engagement and enhanced learning. Broader outcomes include improved efficacy and value in the educational program and institution while, at the farthest-reaching level, a co-creative process can modify the medical profession itself. Although some specific instructional techniques to promote student involvement and input have historically been deployed in medical education, there is little evidence that students have ever been permitted to share in ownership. <i>Implications for Medical Education</i><b>:</b> When fully embraced, curricular co-creation will be recognizable through improved student engagement and learning along with a revised understanding of how faculty-student relationships can foment reform in medical education and the culture of the profession. Further scholarship and research will be indispensable to examine how co-creative partnerships can flatten hierarchies within medical education and inspire the medical profession to be more inclusive and effective. Following the model of co-creation is expected to inspire learners by empowering them to participate fully as co-owners of their own education and prepare them to lead medical education in a different direction for the future.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"261-267"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Inquiry to Insight: Unlocking the Potential of Students' Questions in Medical Education in Singapore.","authors":"Amanda Huee-Ping Wong, Lik-Wei Wong, Shing Chuan Hooi, Shuh Shing Lee","doi":"10.1080/10401334.2025.2481400","DOIUrl":"https://doi.org/10.1080/10401334.2025.2481400","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Question-asking serves as a fundamental tool for active learning, allowing students to articulate uncertainties, link concepts, and refine their understanding. Despite its recognized value, the potential of student-generated questions in medical education remains underexplored, particularly in Asian academic settings where sociocultural norms may discourage students from speaking up in classroom discussions. Research on students' questions has overlooked their application as a resource for understanding cognitive engagement and identifying problem areas in student learning. This study, conducted at the National University of Singapore, addresses this gap by exploring student-generated questions as a lens into cognitive engagement with course content. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A content analysis approach was used to classify questions submitted anonymously by first-year medical students via a shared question-and-answer document embedded in the self-directed learning segment of a cardiovascular physiology course. Questions were categorized by cognitive levels using the revised Bloom's taxonomy, which provides a structured framework for assessing cognitive complexity. A chapter-based analysis examined question distribution across content areas to identify patterns in topic-specific inquiry. Two independent raters performed the classification, reaching an inter-rater agreement of 83.2%. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Two-hundred ninety-eight (298) questions were analyzed, with most categorized at the 'Understand' (56%) and 'Apply' (29%) levels. This distribution closely aligns with the educational objectives of the self-directed learning segment and foundational medical curriculum, which prioritize comprehension and practical application. Slight variations across cognitive levels, particularly in higher-order categories, suggest that the nature of certain topics or instructional activities may promote deeper engagement. Question frequency was not uniformly distributed across topics, with electrocardiogram and clinical examination topics eliciting the most questions, likely due to the foundational relevance and integration with subsequent teaching activities. &lt;b&gt;&lt;i&gt;Discussion:&lt;/i&gt;&lt;/b&gt; Incorporating opportunities for question-asking within the curriculum is a promising strategy for examining students' cognitive engagement in medical education. The prevalence of 'Understand' and 'Apply' questions highlights a strong engagement pattern aligned with early-stage medical education, while chapter-based trends suggest topic complexity or instructional activities may influence question-asking patterns. By systematically analyzing student-generated questions, this study provides a structured means of assessing how students engage with course content at different cognitive levels. These insights can be used to inform instructional strategies that better support student engagement, allowing educators to refine teaching approaches according to","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755809","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 Daily Fact Pile: Exploring Mutual Microlearning in Neurology Resident Education.","authors":"Kasser Saba, Benjamin Jiang, Rabia Yasin, Joseph Chad Hoyle","doi":"10.1080/10401334.2024.2326477","DOIUrl":"10.1080/10401334.2024.2326477","url":null,"abstract":"<p><p><b><i>Problem</i></b>: A significant proportion of learning during residency takes place through informal channels. Spontaneous collaboration among medical learners significantly contributes to this informal learning and is increasingly recognized as a component of the hidden curriculum in medical education. Yet historically, a disproportionate emphasis in medical education has been placed on didactic, structured, and faculty-initiated methods, leaving an important force in medical education understudied and underutilized. We hypothesize that there is significant educational potential in studying and deploying targeted tools to facilitate collaboration among medical learners. <b><i>Intervention</i></b>: At our institution, neurology residents implemented the \"Daily Fact Pile\" (DFP), a resident-led, email-based collaboration that served as a platform to share clinical pearls in an informal, digital way. Participation was voluntary and participants were encouraged to share facts that were new to them and thought to be clinically relevant. Motivated by the positive collective experience, we conducted a retrospective examination of this phenomenon. In this context, we developed the concept of \"mutual microlearning\" to characterize this efficient, multidirectional exchange of information. <b><i>Context</i></b>: Thirty-six residents in a single neurology residency program utilized the DFP at a large university hospital in the USA between 2018 and 2019. After 21 months of spontaneous and voluntary participation, we assessed the feasibility of the DFP, its impact on the education and morale of neurology residents, and compared its mutual microlearning approach to traditional lectures. This was done through a survey of the DFP participants with a response rate of 80.7%, and analysis of the statistics of participation and interaction with the DFP. <b><i>Impact</i></b>: Most participants felt that the DFP was beneficial to their education and thought they often or always learned something new from reading the DFP. The impact of the DFP extended beyond education by improving interest in neurology, morale, and sense of teamwork. The DFP was feasible during neurology residency and participation was high, though participants were more likely to read facts than share them. <b><i>Lessons learned</i></b>: Mutual microlearning represents an opportunity to augment residents' education, and well-designed mutual microlearning tools hold promise for complementing traditional teaching methods. We learned that efficiency, ease of use, and a supportive, non-judgmental environment are all essential to the success of such tools. Future research should delve deeper into the underlying mechanisms of mutual microlearning to establish its position within the theoretical frameworks of medical education.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"249-260"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102770","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 Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review.","authors":"Lauren M McDaniel, Matthew J Molloy, Jaime Blanck, Jimmy B Beck, Nicole A Shilkofski","doi":"10.1080/10401334.2023.2298870","DOIUrl":"10.1080/10401334.2023.2298870","url":null,"abstract":"<p><strong>Phenomenon: </strong>Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature.</p><p><strong>Approach: </strong>We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term \"chief resident\" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies.</p><p><strong>Findings: </strong>We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency.</p><p><strong>Insights: </strong>After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"182-191"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514195","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":"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}