Teaching and Learning in Medicine最新文献

{"title":"The McMaster Narrative Comment Rating Tool: Development and Initial Validity Evidence.","authors":"Natalie McGuire, Anita Acai, Ranil R Sonnadara","doi":"10.1080/10401334.2023.2276799","DOIUrl":"10.1080/10401334.2023.2276799","url":null,"abstract":"<p><strong>Construct: </strong>The McMaster Narrative Comment Rating Tool aims to capture critical features reflecting the quality of written narrative comments provided in the medical education context: valence/tone of language, degree of correction versus reinforcement, specificity, actionability, and overall usefulness.</p><p><strong>Background: </strong>Despite their role in competency-based medical education, not all narrative comments contribute meaningfully to the development of learners' competence. To develop solutions to mitigate this problem, robust measures of narrative comment quality are needed. While some tools exist, most were created in specialty-specific contexts, have focused on one or two features of feedback, or have focused on faculty perceptions of feedback, excluding learners from the validation process. In this study, we aimed to develop a detailed, broadly applicable narrative comment quality assessment tool that drew upon features of high-quality assessment and feedback and could be used by a variety of raters to inform future research, including applications related to automated analysis of narrative comment quality.</p><p><strong>Approach: </strong>In Phase 1, we used the literature to identify five critical features of feedback. We then developed rating scales for each of the features, and collected 670 competency-based assessments completed by first-year surgical residents in the first six-weeks of training. Residents were from nine different programs at a Canadian institution. In Phase 2, we randomly selected 50 assessments with written feedback from the dataset. Two education researchers used the scale to independently score the written comments and refine the rating tool. In Phase 3, 10 raters, including two medical education researchers, two medical students, two residents, two clinical faculty members, and two laypersons from the community, used the tool to independently and blindly rate written comments from another 50 randomly selected assessments from the dataset. We compared scores between and across rater pairs to assess reliability.</p><p><strong>Findings: </strong>Single and average measures intraclass correlation (ICC) scores ranged from moderate to excellent (ICCs = .51-.83 and .91-.98) across all categories and rater pairs. All tool domains were significantly correlated (<i>p</i>'<i>s</i> <.05), apart from valence, which was only significantly correlated with degree of correction versus reinforcement.</p><p><strong>Conclusion: </strong>Our findings suggest that the McMaster Narrative Comment Rating Tool can reliably be used by multiple raters, across a variety of rater types, and in different surgical contexts. As such, it has the potential to support faculty development initiatives on assessment and feedback, and may be used as a tool to conduct research on different assessment strategies, including automated analysis of narrative comments.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"86-98"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592756","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":"Supporting Patient Involvement in U.S. Medical Education Through Changes in Accreditation.","authors":"Sean Tackett, Yvonne Steinert, Jeffrey L Jackson, Gayle Johnson Adams, Darcy A Reed, Cynthia R Whitehead, Scott M Wright","doi":"10.1080/10401334.2024.2439850","DOIUrl":"https://doi.org/10.1080/10401334.2024.2439850","url":null,"abstract":"<p><p>For over half of a century, there have been calls for greater patient and community involvement in U.S. medical education. Accrediting agencies, as the regulatory authorities for medical education, develop policies that impact every program in the U.S.; they have the ability to support patient involvement across the medical education system. In this article, we first review the requirements of U.S. accrediting agencies for undergraduate and graduate medical education to involve patients in educational programs. While agencies have patient members on their committees, they do little to encourage patient involvement through their standards or procedures. We then describe opportunities for accreditation to support patient involvement across teaching and learning activities, curriculum design and evaluation, policymaking and governance, and scholarly endeavors. We link these opportunities to specific standards that could be revised or have their data reporting requirements adjusted. U.S. agencies could also follow the examples of their counterparts outside the U.S., which have created new standards to encourage patient involvement. Ensuring patient representation on educational programs' governing and policymaking bodies is one among many immediate actions that could be taken by accrediting authorities to encourage system-level reforms. As medical school and residency training represent the beginnings of decades of practice for physicians, properly involving patients would maximize benefits for learners, educators, and society.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830804","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":"Disabled Students in Health and Social Services Fieldwork: Perceptions of Canadian Fieldwork Educators and Academic Coordinators.","authors":"Brenda Beagan, Stuart Kamenetsky, Shahbano Zaman, Gurdeep Parhar, Tal Jarus","doi":"10.1080/10401334.2024.2439848","DOIUrl":"https://doi.org/10.1080/10401334.2024.2439848","url":null,"abstract":"<p><p>Ensuring equitable access to professional education programs for learners who need accommodations is distinctly challenging when education moves beyond the classroom into clinical or fieldwork sites. Fieldwork educators and university academic coordinators who arrange fieldwork placements work with university accessibility services and students to arrange required accommodations, while preserving confidentiality, maintaining high learning standards, and ensuring attainment of professional competencies. This work is complicated by time pressures and heavy caseloads in fieldwork settings. Here we report on a subset of data from a cross-Canada online survey of fieldwork educators (<i>n</i> = 233) and academic coordinators (<i>n</i> = 54) in 10 health and social service professions. Using descriptive statistics, we analyze responses to two question series concerning perceptions of the capacity of disabled students to attain professional competencies, and overall perceptions of students who need accommodations. Respondents showed most concern about competency attainment for learners with cognitive or learning disabilities, followed by neurological and mental health issues. Thematic analysis of open-ended comments suggests doubt regarding the ability of institutional fieldwork sites to adequately implement accommodations. In their perception of learners who need accommodations, academic coordinators were somewhat more negative than fieldwork educators, in particular seeing students who need accommodations as a potential burden that could harm placement relationships with fieldwork sites. They tended to indicate that fieldwork success depended on student insight and self-advocacy. Struggles faced by disabled students in health and social service professions appear to be occasioned not only by disabling systems and institutions, but also by perceptions that they may have diminished competence.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819953","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":"Policy analysis: an underutilised methodology in health professions education research.","authors":"Claire Palermo, Sarah Meiklejohn, Petah Atkinson, Bridget O'Brien","doi":"10.1080/10401334.2024.2431025","DOIUrl":"https://doi.org/10.1080/10401334.2024.2431025","url":null,"abstract":"<p><p>Government, organizational, and professional society policies are part of the complex system that underpins and influences the education of health professionals. Despite their significant influence, these policies rarely receive attention in scholarship examining the processes and outcomes of current health profession education systems. Policy analysis is a field of research that examines how and why policies are developed, the assumptions underpinning policies, and policies' effects. Given the potential value policy analysis can offer health professions education research, our manuscript aims to 1) describe policy analysis as a field of research that draws on multiple disciplines and methodologies, and 2) demonstrate and discuss what policy analysis research can contribute to health professions education by sharing examples of two studies and discussing their value. To explain how policy analysis can be applied in health professions education research, we describe four key steps and considerations for using policy analysis- (i) assemble your research team; (ii) develop the research questions; (iii) select the methodology for the policy analysis; and (iv) select methods for data collection and analysis.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689505","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":"Psychometric properties of the Ethiopian national licensing exam in medicine: an analysis of multiple-choice questions using classical test theory.","authors":"Shewatatek Gedamu Wonde, Stefan K Schauber","doi":"10.1080/10401334.2024.2428191","DOIUrl":"https://doi.org/10.1080/10401334.2024.2428191","url":null,"abstract":"<p><p><b><i>Background</i></b>: The Ethiopian Ministry of Health introduced medical licensure examinations to maintain high standards in medical practice and build public trust in healthcare professionals. Studies also suggested significant issues in clinical competence among Ethiopian junior doctors as well concerns regarding unlicensed practice. Given the need to ensure safe health care, we investigated the psychometric properties of the multiple-choice items comprising the Ethiopian national licensing exam (NLE). These analyses help to provide an argument for the validity and reliability of the test scores. <b><i>Method</i></b>: We used a cross-sectional study design to analyze data from three cohorts of undergraduate medicine licensing examinations in Ethiopia (2020-2022, <i>N</i> = 2,213). Using Classical Test Theory, we assessed the psychometric properties of 600 MCQ items with 2400 single best answer choices, specifically item difficulty, item discrimination, and the number of nonfunctional distractors, and scale reliability. We provide results regarding the overall test and its sub-domains. <b><i>Results</i></b>: Ethiopia's undergraduate medical licensure examination demonstrated acceptable reliability (Alpha > 0.80), with significant variability in item difficulty and examinee performance. Although these results indicate a sufficiently defensible exam, our results point to issues regarding item statistics, especially a high number of nonfunctional distractors. <b><i>Conclusions</i></b>: This study provides first evidence regarding the psychometric soundness of the Ethiopian NLE. However, a significant number of items should be carefully reviewed and possibly revised. As the examination is relatively new, ongoing refinement to item-development and review processes is essential to improve and ensure its quality.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631337","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":"Disability Education for Health Personnel and Impact on Health Outcomes for Persons with Autism: A Scoping Review.","authors":"Anna C Quon, Leah McClellan, Sarah H Ailey","doi":"10.1080/10401334.2024.2419834","DOIUrl":"https://doi.org/10.1080/10401334.2024.2419834","url":null,"abstract":"<p><p>Autism manifests in various progressive, fluctuating, or static differences that may be disabling. This requires healthcare staff to provide individualized, culturally competent care for autistic people (AP). However, staff are underprepared since disability curricula are not universally implemented, which may exacerbate health disparities for AP. The Alliance for Disability in Health Care Education (ADHCE) delineated staff competencies to address disparities. The purpose of this review was to describe what is known about disability education initiatives and health-related outcomes for AP. The review included published literature on disability education for any health personnel providing services to AP in any setting where healthcare services are delivered. In June 2023, six databases were queried. Of 3,396 screened reports, 42 were extracted. Most articles originated in the United States and reported various instructional strategies on child-focused educational content for small interprofessional groups in various settings. The biomedical and biopsychosocial disability models were prominent. The training covered few, if any, ADHCE competencies and rarely involved collaboration with AP. Positive outcomes included improved functional health, behavior, and communication. Patient-reported outcomes and physical and psychosocial health were underreported. Future initiatives should involve scaled-up global efforts, address core competencies for care across the lifespan, and establish community partnerships to ensure meaningful outcomes.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631239","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":"Examining Scientific Inquiry of Queerness in Medical Education: A Queer Reading.","authors":"Abigail Konopasky, Jessica L Bunin, Krista B Highland, Michael Soh, Erin S Barry, Lauren A Maggio","doi":"10.1080/10401334.2024.2422381","DOIUrl":"https://doi.org/10.1080/10401334.2024.2422381","url":null,"abstract":"<p><p><b><i>Phenomenon.</i></b> The language of medicine (i.e., biomedical discourse) represents queerness as pathological, yet it is this same discourse medical education researchers use to <i>resist</i> that narrative. To be truly inclusive, we must examine and disrupt the biomedical discourse we use. The purpose of this study is to disrupt oppressive biomedical discourses by examining the language and structures medical educators use in their publications about queerness in relation to physicians and physician trainees. <b><i>Approach.</i></b> We searched PubMed, Web of Science, CINAHL, PsycINFO, and ERIC in October 2021 and again in June 2023 using a combination of controlled vocabulary (select terms designated by a database to enhance and reduce ambiguity in search) and keywords to identify articles related to sexuality, gender, identity, diversity and medical professionals. Searches were limited to articles published from 2013 to the present to align with the passage of The Respect for Marriage Act. Articles were included if they focused on the experiences and paths of physicians and physician trainees identifying with or embodying queerness, were authored by individuals based in the United States, and presented empirical studies. We excluded articles only discussing attitudes of cisgender heterosexual individuals about queerness. Two authors independently screened all articles for inclusion. We then used narrative techniques to \"re-story\" included articles into summaries, which we analyzed with four guiding questions, using queer theory as a sensitizing concept. Finally, we sought recurrent patterns in these summaries. <b><i>Findings.</i></b> We identified 2206 articles of which 23 were included. We found that biomedical discourse often: characterized individuals associated with queerness as a single homogenous group rather than as individuals with a breadth of identities and experiences; implied queer vulnerability without naming-and making responsible-the causes or agents of this vulnerability; and relied minimally on actual intervention, instead speculating on potential changes without attempting to enact them. <b><i>Reflections.</i></b> Authors each reflect on these findings from their positionalities, discussing: disrupting essentializing categories like \"LGBT\"; addressing harm through allyship around queerness; editorial responsibility to disrupt structures supporting oppressive biomedical discourse; the importance of program evaluation and interventions; and shifting the focus of medical education research toward queerness using QuantCrit theory.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565190","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":"\"I have established this support network\": How Chosen Kin Support Women Medical Students During their First Two Years in Medical School.","authors":"A Emiko Blalock, Jennifer McCurdy, Kehli Henry, Chelsea Wentworth","doi":"10.1080/10401334.2024.2416690","DOIUrl":"https://doi.org/10.1080/10401334.2024.2416690","url":null,"abstract":"<p><p>Women medical students experience unique stressors and challenges during medical school related to inherent structural androcentric norms. Through a longitudinal qualitative study of 17 women medical students in their first two years of medical school, we sought to investigate how they navigated their medical school experience. We used a critical lens and narrative inquiry to understand their experiences within the powerful and marginalizing culture of medical school. Our participants identified two essential support groups: those relationships made within, and those sustained outside, medical school. These findings invoked a kinship framework-one where women medical students have a network of chosen kin who provide essential support for them during their first 2 years. The participants' chosen kin <i>within</i> medical school provided support through recognition of one another, belonging by not belonging, being encouraged to reach out, and creating long-term relationships. The chosen kin <i>outside</i> medical school provided support by reminding the student who they are and creating stability. Integrating models of kinship into medical school as practiced by women medical students may have immense value in providing essential supports for medical students, preventing burnout, and changing the culture of care for future physicians that would align recognition and practice of self-care with patient care.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480119","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":"Applying the Panarchy Framework to Examining Post-Pandemic Adaptation in the Undergraduate Medical Education Environment: A Qualitative Study.","authors":"Gowda Parameshwara Prashanth, Ciraj Ali Mohammed","doi":"10.1080/10401334.2024.2411575","DOIUrl":"https://doi.org/10.1080/10401334.2024.2411575","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> The COVID-19 pandemic necessitated an abrupt shift to online medical education, disrupting learning across knowledge, skills, and social connections. Post-pandemic, medical schools must evaluate how these disruptions shaped student experiences to optimize the return to in-person learning. <b><i>Approach:</i></b> This cross-sectional qualitative study explored medical students' perceptions of their learning environment during the post-pandemic reintegration period in Oman. Fifty-four preclinical and clinical students participated in six focus group interviews. Content analysis identified key topics characterizing students' perceptions of change and change processes in the post-pandemic learning environment. The panarchy framework, developed to characterize complex adaptive systems in nature, was used to frame the results. <b><i>Findings:</i></b> The return to in-person environments presented a mix of renewed connectivity, involving collaborative benefits alongside transitional adjustment strains. Five major topics characterizing student perceptions of change and change processes in their post-pandemic learning environment were identified: learning skills, developing clinical competence, faculty interactions, physical atmosphere, and social connections. Managing academic schedules and cognitive load as the learning environment opened challenged students' learning skills. Learners valued a renewed opportunity for interactive application of knowledge through collaboration, patient contact, and empathy skill-building to feel prepared for future practice. Returning to in-person instruction renewed a sense of community and peer support networks disrupted by pandemic isolation. Some students continued to struggle with study-life imbalance and felt ill-equipped to handle post-pandemic demands. Improved access to student support and wellness services was emphasized to ease transitional stresses. Students defined an ideal learning climate as supportive, active, personalized, relevant, challenging, accessible, and collaborative. <b><i>Insights:</i></b> While pandemic disruptions posed challenges, they provide opportunities to strengthen the educational system's resilience moving forward. Our findings highlight an opportunity for medical educators and learners to capitalize on the innovations that emerged during this period, integrating technology with interactive learning activities and reconnecting students with the core values of the medical profession. Applying the panarchy framework to frame this adaptive process could enable the tracking of multi-level interactions within the medical education environment and the evaluation of interventions targeted at identified areas of concern. Further exploration to achieve complete mapping of specific environmental domains onto the panarchical cycles merits future investigation to build integrated resilience frameworks.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382316","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":"Two-Dimensional Deaths? A Discourse Analysis of Patient Death in Preclinical Tutorial Cases at a Canadian Medical School.","authors":"Paula Cameron, Victoria Luong, Olga Kits, Wendy A Stewart, Sarah Burm, Stephen Miller, Simon Field, Anna MacLeod","doi":"10.1080/10401334.2024.2409695","DOIUrl":"https://doi.org/10.1080/10401334.2024.2409695","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; The prospect of death is everywhere, but seldom directly addressed, in undergraduate medical education (UGME). Despite calls for UGME curricula to address the complex social and emotional aspects of death and dying, most curricula focus on biomedical, legal, and logistical aspects, or concentrate these topics within palliative care content and/or in simulations with simulated patients and manikins. We aimed to add to death education scholarship by exploring the complexities of death and dying within two dimensional simulations-i.e., in the text-based cases used in Case-Informed-Learning (CIL). &lt;b&gt;&lt;i&gt;Method:&lt;/i&gt;&lt;/b&gt; We conducted a critical discourse analysis exploring how death and dying were discursively constructed in the formal, planned curriculum at one medical school. We used two methods: (1) Document Analysis: We developed a template to analyze 127 cases regarding their discursive constructions of death and dying; (2) Longitudinal Interviewing: We conducted semi-structured interviews with a cohort of 12 medical students, twice annually throughout their medical program (total 92 interviews). We collectively analyzed data, attuning to how the format, content, and purpose of each case discursively constructed death and dying. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; There were 127 tutorial cases included in the undergraduate, pre-clerkship case-informed curriculum. In the five (4%) cases featuring a patient who dies, death and dying were discursively constructed as: (1) predictable; (2) a plot device; (3) a cautionary tale; (4) an epilogue; (5) deliberate and careful; and (6) an absence. Very few cases highlighted death and dying in their titles, learning objectives, or questions, and where it did feature, it was framed a biomedical fact or outcome. Only one case allowed for a nuanced, in-depth and open-ended discussion of patient death and dying, but it was scheduled at a time that prevented meaningful engagement. This glossing over the complexities of death was identified as a missed opportunity by students, who, as their clinical placements loomed, were eager to broach this topic in detail with tutors and other teaching faculty. &lt;b&gt;&lt;i&gt;Discussion:&lt;/i&gt;&lt;/b&gt; Death was often a conspicuous absence in this CIL curriculum. In the few cases that featured the death of the main patient character, multiple discourses were mobilized that worked together to construct death as something that happens elsewhere, outside the parameters of core curriculum. In other words, death happens-predictably, slowly, as a means to an end and the result of moral failures, in the case or somewhere in the future-but was not the primary concern. To deepen engagement with these subjects in CIL, we encourage medical educators to attend to representations of patient death by considering the format, content, purpose, and timing of these cases. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Carefully rendered cases thoughtfully embedded in the curriculum offer tremendous potential. We","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367350","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}