Teaching and Learning in Medicine最新文献

Healthcare and health professions education (HPE) organizations operate within complex ecosystems shaped by economic, workforce, regulatory, technological, political, educational, and societal pressures. These forces influence institutional priorities and the conditions in which people work and learn. Burnout and moral distress among clinicians, educators, staff, and learners can be understood in part as manifestations of misalignment between system demands and human needs and values. Although attention to burnout has been essential, approaches centered primarily on mitigating distress or strengthening individual resilience offer an incomplete aspiration for healthcare and HPE. Scholarship on flourishing points toward a higher-order aim: enabling people and communities not merely to avoid harm, but to experience meaning, connection, engagement, growth, contribution, and worthwhile purpose. Yet existing scholarship on flourishing, motivation, interdependence, organizational design, and organizational learning has largely illuminated separate parts of this challenge rather than providing an integrated account of how organizations can create the sustainable conditions for workforce and learner flourishing. We propose an integrated, multilevel framework for workforce and learner flourishing comprising four interconnected and mutually reinforcing foundations: (1) centering workforce well-being in service of flourishing; (2) fostering a culture of interdependence; (3) designing organizational and educational environments that support autonomy, competence, and relatedness; and (4) measuring and sustaining flourishing through organizational learning and accountability. These foundations operate within a broader healthcare and educational ecosystem that both constrains and enables institutional action. Our contribution is to integrate these previously distinct perspectives into a systems-oriented framework that shifts attention from helping individuals withstand demanding environments toward understanding how organizations can create, sustain, and advocate for conditions in which people and communities can flourish. The framework intentionally encompasses physicians, advanced practice professionals, nurses, allied health professionals, staff, educators, and learners. We position HPE as a formative subsystem within the broader healthcare ecosystem: one that can perpetuate existing norms and structures or serve as a critical lever for transforming them in support of a thriving and sustainable workforce.

As globalisation transforms medical education, supranational para-regulation, defined as the external evaluation of national accrediting agencies by non-statutory international bodies, has become increasingly prominent, notably through the World Federation for Medical Education (WFME) Recognition Programme. This position paper critically analyses this para-regulatory approach, contending that it imitates the methods of statutory regulation yet lacks corresponding accountability, transparency, and demonstrable impact on educational quality. Although highly influential, the WFME Recognition Programme operates without statutory authority, applying uniform standards across diverse national contexts. It has created a global accreditation cross-border marketplace. Its paucity of outcome evidence and vulnerability to regulatory capture highlight questions regarding its legitimacy, validity, and contextual relevance. Moreover, the programme's financial demands and alignment with Global North priorities risk commodifying accreditation and entrenching global inequities in medical education. We therefore propose a contextually sensitive, regionally anchored alternative for quality development. Our recommended framework prioritises developmental evaluation, transparency, and peer-reviewed local stewardship. Rather than imposing fixed global benchmarks, it fosters sustained regional collaboration, adaptability to local contexts, and rigourous documentation as principles essential to effective quality assurance. By critically examining the concept of para-regulation, this paper urges medical educators, accrediting bodies, and policymakers to reconsider existing approaches to global quality assurance. We advocate for global transparency alongside local accountability, thereby facilitating sustainable and contextually relevant enhancements in medical education worldwide.

To address the ongoing recruitment and retention of diverse students in medicine, new and cultural frameworks need to be applied to repair the academic outcomes and experiences of diverse students in US medical schools. This article introduces the multidimensional conceptual framework of "servingness" in a medical school context to understand the structural barriers in US medical schools that hinder and promote servingness for Latinx and underrepresented medical students.

Introduction: The labor ward is an important interprofessional setting for undergraduate obstetric education, where medical students work closely with midwives who contribute substantially to their clinical learning. However, this teaching role is often informal. In addition, what students should learn through midwife-led teaching and the level of supervision expected for these activities are often not clearly defined. This study, conducted in the Sultanate of Oman, aimed to establish consensus on intended learning outcomes (ILOs) for midwife-led labor ward teaching and the level of supervision expected of medical students at graduation, with the broader goal of strengthening the educational role of midwives and making more effective use of the labor ward as a workplace learning environment. Method: In June-August 2025, we conducted a three-round modified Delphi study with a multi-professional panel of 22 participants, including consultant obstetricians, obstetrics and gynecology faculty, midwifery educators, practicing midwives, and final-year medical students. We generated an initial ILO pool through a structured literature search and expert interviews. Panelists rated ILO suitability using predefined consensus criteria (≥80% agreement, median ≥4, interquartile range ≤1); in Round 3, they assigned expected supervision levels using a four-level scale ranging from observation only to independent performance. Results: Twenty of 23 proposed ILOs achieved consensus for inclusion. Consensus on supervision level (≥70% agreement on a single level) was reached for 14 of 20 ILOs. Most competencies were assigned to Level 2 (performance under direct supervision), consistent with the supervised participation model characteristic of undergraduate entrustment in safety-sensitive clinical environments. Higher autonomy levels (Levels 3-4) were assigned mainly to communication, patient-centered care, and professionalism outcomes. Greater variability was observed for higher-risk procedural activities, including episiotomy repair, neonatal resuscitation, and perineal assessment, for which no single supervision level reached consensus. These outcomes were therefore considered areas where expectations of student autonomy remained uncertain. Inter-rater agreement strengthened progressively across the three rounds, confirming iterative convergence. Conclusions: This study offers a consensus-based interprofessional framework that defines learning outcomes and supervision expectations for midwife-led labor ward teaching. The predominance of direct supervision highlights the safety-sensitive nature of labor ward learning. The model is intended to support structured and collaborative clinical education in the labor ward and should be interpreted in relation to this setting. Nevertheless, it may offer analytically transferable insights to comparable interprofessional clinical learning environments.

Teaching and learning are often positioned as secondary to patient care, research, and leadership. In non-academic medical centres (NAMCs), this can make it difficult to justify investments in faculty development, as educational activities may be perceived as peripheral, even disruptive, to patient care. Although academic medical centres face similar challenges, far less is known about how they manifest in non-academic contexts. In 2020, East Tallinn Central Hospital, a secondary care NAMC in Estonia, took deliberate steps to rethink teaching and learning as central to quality patient care. A key innovation was the clinician educator (CE) career track, designed to provide healthcare professionals with the resources, skills, and support needed to fulfil their educational roles. We designed and implemented the CE career track using the social practice theory to translate and adapt contemporary academic faculty development practices to a non-academic setting. In this traveling concept, we first describe the CE career track as the contextualized application of faculty development practices using the social practice theory, illustrating its applicability for translating and adapting faculty development to non-academic contexts. Second, we reflect on the CE career track's implementation to derive five key lessons from "importing" faculty development to non-academic settings: (1) time allocated to teaching needs to be collaborative and visible; (2) teaching skills are transferable across patient care; (3) developing specific, shared educational expertise early is a priority; (4) reflection is key to meaningful and purposeful collaborations; and (5) teaching and learning are inherent to patient care. Together, these insights suggest the social practices approach to faculty development can help reposition teaching and learning within NAMCs as integral to patient care.

Health professions education increasingly addresses social inequities, cultivating student awareness of structured power relations. Yet such teaching is met with resistance, with students prioritizing "hard" sciences and demanding immediate relevance and clinical application for everything taught. Sociological teaching and pedagogies are too often dismissed as "fluffy" and "wasting time." In Canada, professional competencies in occupational therapy now require practitioners to engage in anti-oppressive practice, which means education programs need to teach those skills. This article employs an autoethnographic approach to critically reflect on 25 years of teaching about social inequities in occupational therapy. Four challenges arise: 1. Epistemological dissonance, with objectivity and individualism deeply unsettled by sociological thinking; 2. Insistence on immediate relevance and application, which can lead to a problematic reliance on first-voices guests; 3. Simultaneous privilege and absence-of-privilege in the classroom, alongside a "charitable model" rescuing stance; and 4. The importance of emotion in learning difficult topics. A pedagogy of discomfort invites learners to stay present to the unsettling emotions that may arise as they confront systemic social power relations. This means moving away from notions of "safe" classrooms toward emphasizing courage in the face of complex feelings. Helplessness and powerlessness may be countered through cultivating critical hope, as a necessary step toward social change.

Surveys of medical trainees have found that while students agree on the importance of understanding clinical care of people with disabilities, the majority of medical students do not feel competent treating these populations. The purpose of this descriptive mixed-methods study was to better characterize efforts in a non-random sample of US medical and dental schools to include material about intellectual and developmental disabilities (IDDs) in their curricula, with particular attention to the meaningful involvement of people with IDD in curriculum development and delivery. This study consisted of a 36-item, electronically delivered survey (N = 38 respondents from 24 institutions) of medical and dental school students, faculty, and administrators, including people with IDD, who were involved with inclusive IDD curricula design and implementation. This was followed by two focus groups (N = 13) with people with IDD who had been involved in medical or dental school curriculum design, implementation, and/or evaluation. While people with IDD were commonly involved in curriculum delivery, goal-setting and evaluation were two phases where people with IDD were included the least. While most schools provided content on the social and medical model of disability and basic knowledge and context about IDD, less than half included gender and sexuality/reproductive health or diagnostics in topics covered. Focus group findings from people with IDD found varied levels of meaningful engagement. Moving forward, a continued push to increase inclusive IDD-related content in medical and dental schools should include people with IDD at the forefront, from goal setting to curriculum evaluation, and integrate intersectional topics such as sexual health. Collaborative efforts are needed to ensure researchers, educators, clinicians, and medical students are collectively increasing IDD-focused training for future healthcare providers.

Adults with intellectual disabilities are at increased risk of experiencing unmet health needs, underscoring the importance of improving healthcare professionals' preparedness to respond to such needs. Direct contact between healthcare professionals and patients with intellectual disabilities appears to be associated with lower social distance and more inclusive care practices. Therefore, simulation-based education involving people with intellectual disabilities may offer a promising way to prepare future professionals. Little is known, however, about how adults with intellectual disabilities can be trained to act as expert patients in such simulations. A mixed-methods study was therefore conducted to evaluate a four-session training programme in Belgium designed to prepare adults with mild-to-moderate intellectual disabilities for the expert-patient role in healthcare simulations. Quantitative measures assessed changes in participants' comfort, self-confidence, scenario-related knowledge, and role-play quality across sessions. Qualitative data were collected to explore the experiences of people with mild-to-moderate intellectual disabilities participating as expert patients in simulation-based education. Eleven participants were trained. They reported gaining confidence and feeling more comfortable in their roles as expert patients. Researcher observation corroborated these improvements, showing improvements in participants' simulation skills at the end of the training. However, knowledge of the scenario during the sessions did not improve. The qualitative results highlight four main categories: sustaining engagement in simulation-based student training, the simulation experience, the debriefing experience, and learning through repetition. These findings support the feasibility and relevance of simulated patient training for adults with mild-to-moderate intellectual disabilities. They also contribute to the scholarly documentation of this approach, which can be used to guide future initiatives aimed at training healthcare professionals.

I describe three phases of a physician-scientist's writing career: solitary writing, human collaboration, and engagement with generative artificial intelligence (AI) based on large language models. I use these phases to argue that academic medicine should rethink how it supports scholarly work. The central claim, offered from a single case as hypothesis rather than proof, is that a significant obstacle to scholarly productivity can be structural rather than cognitive: the unavailability of appropriate intellectual companionship at the moment of need. In the first phase, characterized by productive solitude, I built an original scholarly voice, but it led, over time, to epistemic loneliness and exhaustion. In the second phase, collaboration with a scientific editor restored my energy, but our interaction was constrained by scheduled availability. The third phase introduced generative AI as an unusually accessible intellectual companion that allowed me to engage at the moment of curiosity, bridged clinical science and the medical humanities, and made it less costly to admit uncertainty. I describe concrete examples in the text and in a supplementary appendix that serves as an extended disclosure of AI use. I argue that generative AI, grounded in deep research, teaching, and clinical experience, extends rather than replaces human thought and that the experience likely speaks to hybrid scholars of many kinds, not to physician-scientists alone. This essay draws implications for faculty development, equitable access, responsible AI use, and the formation of scholarly voice among learners and identifies research questions for the field.