Teaching and Learning in Medicine最新文献

Professional identity formation (PIF) is the developmental process through which medical trainees transition from laypersons to physicians. While recent scholarship has explored the challenges of a dominant standard influencing the PIF of minoritized students, much of this research employs a single-axis lens, focusing on race/ethnicity or gender in isolation. This study investigates how the intersection of race/ethnicity, immigrant status, and non-English language skills influences PIF among 1.5-generation immigrant medical students and second-generation children of immigrants in the US. This qualitative study was designed using a constructivist grounded theory approach to data collection and analysis. We recruited nine East Asian, 10 South Asian, six Black, and seven Latinx immigrant students in their third and fourth years of medical school. Participants were either foreign-born students who migrated to the US during childhood or adolescence and completed formative schooling in the US or US-born children of immigrants. We interviewed them about their PIF experiences and then analyzed the data iteratively using an intersectional lens. Using open, focused, and theoretical coding, we analyzed each group's PIF experiences then moved to constant comparative analysis to identify themes that cut across groups. Using re-storying, we incorporated common plot points from all four groups to create a collective narrative. Across participants, the dominant narrative reflected experiences of conditional belonging, in which students could be welcomed into medicine when their identities and language skills served institutional needs, but those same identities could also be used to perceive them as less competent, less professional, or less fully belonging. Perceived foreign accents, non-standard English communication styles, and distinct cultural frames of reference were treated as a deficit. However, students also found that their multilinguistic and cultural knowledge, often developed through their immigrant family experiences, were powerful assets in patient care. These assets could also become liabilities when students were pushed into unpaid labor for the institution and their communities. By adopting a multi-axis lens, this study shows conditional belonging is a common narrative that transcends individual racial/ethnic categories, while still taking different forms across groups. Non-English language skills are a core issue used to justify inadequate patient care and question competence across all groups. This key mechanism of marginalization for immigrant students adds nuance not thoroughly addressed in single-axis studies.

US medical school admissions have been under increasing pressure from state and federal governments, while contending with the implications of the 2023 US Supreme Court decision that ended race-conscious admissions. Change is necessary, but few have offered ideas for how best to proceed. In this article, we first review past eras of US medical school admissions. We describe the establishment of standardized admissions processes, which maintained a largely uniform medical student demographic of more than 90% white men through the first half of the 20th century. Subsequent changes in US society and federal government policies began to push for demographic diversity in medical schools in the 1960s. While the language used to describe the diversity focus shifted from affirmative action to race-conscious admissions to holistic review, the goals remained the same and have not been achieved to date. We then consider the future of medical school admissions as guided by the concept of human flourishing, based on Aristotle's depiction of eudaimonia as the highest human good. Flourishing has been gaining momentum and relevance globally in education and healthcare. Flourishing-guided admissions may offer a new paradigm that enables medicine to proactively define its admissions policies rather than deferring to US federal and state policies. Flourishing is an integrative concept that emphasizes relationships between individuals and communities; it can reduce emphasis on individual and institutional competition to better align admissions practices with system and societal needs. We suggest options for implementing flourishing-guided principles at the levels of admissions committees, institutional structures, and broader partnerships. Re-orienting medical school admissions toward human flourishing could link ageless ideas with contemporary needs.

Competency-based medical education (CBME) aims to deliver individualized, outcome-oriented training. However, implementing entrustable professional activities (EPAs) across diverse institutional and healthcare environments remains challenging. Taiwan's nationwide implementation of the medical radiation technologist (MRT) EPA framework across 122 teaching hospitals provides an opportunity to examine how educational goals intersect with institutional constraints. Using data from the national "Emyway" e-portfolio system for the first implementation year (January to December 2024), we analyzed EPA implementation patterns for MRTs in three subspecialties: diagnostic radiology, radiation therapy, and nuclear medicine. At the institutional level, 81 (66.4%) of the 122 accredited teaching hospitals registered on Emyway. Of the 81 registered hospitals, 52 (64.2%) documented EPA training. Registration rates differed significantly by hospital tier (medical centers 100% vs. regional/district hospitals 57.3%, p < 0.001), although documentation rates did not differ significantly (73.1% vs. 60.0%, p = 0.25). At the trainee level, 340 MRT trainees were registered on the platform, of whom 186 (54.7%) had at least one documented workplace-based EPA assessment; 49 (14.4% of registered trainees) progressed to summative Clinical Competency Committee entrustment decisions. We also identified three EPAs with very low assessment documentation during the first implementation year. These patterns of EPA engagement could potentially be interpreted as typical implementation challenges but may also point to structural barriers of various types. Given one year of descriptive data, they should be read as a hypothesis of misalignment between standardized frameworks and local clinical realities requiring further study rather than as established structural barriers. Taiwan's experience suggests that national CBME frameworks may benefit from differentiating between universally attainable competencies and context-dependent activities and from incorporating flexible EPA portfolios and tier-sensitive expectations to promote both assessment validity and educational equity across heterogeneous training environments.

For-profit, English-speaking Caribbean medical schools have enrolled thousands of US citizens over the past 50 years. While successful graduates have gone on to make substantial contributions to the US physician workforce, many students have not completed their programs and instead been left with debt and no degree. The US government first attempted to regulate quality in Caribbean medical schools when it established the National Committee on Foreign Medical Education Accreditation in 1994, which led to the first medical school accreditor working in the Caribbean in 1995. Persistent concerns about quality prompted the Educational Commission for Foreign Medical Graduates to create a new requirement in 2010 to have accreditors evaluated by the World Federation for Medical Education (WFME) and "recognized" if they met WFME's criteria. As of 2026, six WFME-recognized accreditors were operating in the Caribbean; two located in the Caribbean, the others based in Ireland, Netherlands, Kazakhstan, and Kyrgyzstan. There is evidence that some schools have begun to avoid stringent standards by switching to more favorable terms offered by a different accreditor. There is also evidence that accreditors have tolerated high rates of attrition and student debt among accredited schools. The Caribbean medical education market has expanded beyond medical schools to include a market for accreditors. It challenges the traditional assumptions that medical schools' primary purpose is to produce a physician workforce for their national population and that accreditors serve public interests by monitoring school quality. Incentives in the Caribbean instead favor schools functioning primarily as a source of foreign income for their governments and encourage accreditors to cater to school interests. As the globalization of medical education and accreditation continues, the Caribbean market may serve as a cautionary tale, where ineffective regulation can leave medical students vulnerable to the motivations of profit-oriented medical schools.

Undergraduate research training is a fundamental component of health professions education, intended to develop critical thinking and scientific inquiry. However, systematic evidence regarding the scope and alignment of student research topics with disciplinary expectations and educational program objectives remains limited. This study examined patterns in undergraduate thesis topics within a Chinese medical university context, using a computational framework to assess their alignment with institutional positioning, established disciplinary research, and peer-recognized undergraduate achievement. A total of 392 undergraduate theses from an applied psychology program (2022-2025) at a Chinese medical university were analyzed using a combination of expert evaluation and BERTopic modeling. To benchmark the currency and diversity of these topics, student work was mapped against a joint model of 2,790 peer-reviewed psychology journal articles and award-winning theses from Chinese peer institutions. The findings indicate a pronounced misalignment between the clinical resources available at the institution and the research practices reflected in student theses; despite the university's positioning as an academic medical center, fewer than 3% of student theses recruited patient populations, while 81% relied on convenience sampling of fellow students via questionnaires. Topic modeling further showed substantial concentration, with 69% of theses clustering into just four narrow domains that occupy only 30% of the available disciplinary topic space. This pattern reflects limited engagement with methodologically demanding, experimentally oriented topics that characterize much of the published disciplinary research. This concentration was associated with organizational dynamics; specifically, a 51% decline in faculty availability and the departure of medical specialists from the institution coincided with students clustering into low-resource, supervisor-centric research domains. These findings illustrate how institutional positioning and faculty constraints can create self-reinforcing bottlenecks that limit student exposure to clinical environments, even in the presence of formal goals for clinical research productivity. This study offers a scalable computational framework for examining research training and highlights the need for programs to structurally align their clinical assets with undergraduate curricular pathways.

Recent commentaries have urged reconsideration of the shift away from tiered grading in US medical schools and the removal of numerical scores on the US Medical Licensing Exam Step 1 examination. They suggest the move to pass/fail may negatively impact decision-making, especially affecting residency selection. By arguing for the need for data to help residency programs stratify applicants, they risk overstating the objectivity of "hard data" and overlooking the long-term goal of educating future doctors. We examine the history of tiered grading and explore the evidence that led to shifts away from such grading formats. Tiered systems often rely on multiple-choice question assessments that introduce bias and assess only medical knowledge. They show extreme variability and grade inflation, and studies have consistently demonstrated racial and gender disparities. Moreover, Step 1, which was never designed to stratify students' performances, has not been shown to predict future physician clinical success in any significant way. Claims that the shift away from tiered grading has resulted in detrimental student behaviors or bias against students from specific schools are unsubstantiated. In contrast, pass/fail grading leads to improved student well-being, intrinsic motivation, and mastery-oriented learning environments. Returning to competitive assessment, which stratifies residency applications, prioritizes a comfortable system over one with substantial validity evidence. Our efforts are better spent on developing new programmatic systems that incorporate holistic data, leverage artificial intelligence, and combine narrative feedback to assess our learners and prepare them to be competent physicians. We should strive to link assessments to long-term outcomes before using them to determine students' fates. We should not return to familiar data because they help residency programs stratify learners at the expense of their learning.

Rooted in spiritual energy and centered in Black liberation, Afrofuturism, and feminism, Hersey's "Rest is Resistance" framework encourages deliberate rest practices as a personal necessity and a form of political resistance. Inspired by her work, we are a group of health professions education scholars from minoritized backgrounds using our lived experiences to illustrate the application of our "Rest is Resistance" framework. The demands of academic medicine, defined by productivity in clinical, scholarly, and educational domains, combined with personal obligations, run counter to rest. Enduring long hours and pushing oneself to exhaustion imply that needing to rest is a sign of weakness, and this so-called "grind culture" in medicine is pervasive. The expectations of a culture of self-sacrifice and dedication come at a cost to mental health and self-care. Minoritized faculty and trainees disproportionately experience the negative consequences of these expectations, including mental and racial battle fatigue. We introduce "Rest is Resistance"-a deliberate and necessary act of self-preservation against capitalism and structural injustices-and offer practices for individuals in the health professions to consider. The call for rest is not relegated to just physically resting our bodies. Rather, our call for rest is used metaphorically as a form of political, spiritual, and cultural resistance against oppressive systems, particularly capitalism and white supremacy, to promote a conscious slowing to reclaim individual agency and humanity. We hope that introducing "Rest is Resistance" as a framework in health professions education will promote well-being and support minoritized health care professionals and trainees, in particular, so that they can be fully present and create a sustainable healthcare culture that values everyone.

Healthcare systems worldwide face escalating complexity driven by workforce shortages, increasing patient acuity, interprofessional practice demands, and rapid technological transformation, including artificial intelligence. These pressures require leadership capacity across all levels of healthcare, yet leadership development within healthcare curricula remains inconsistent, fragmented, and variably aligned with clinical realities. Although numerous national and professional frameworks provide leadership competencies, significant heterogeneity persists in how leadership is conceptualized, implemented, and evaluated. To examine the current landscape and identify priorities for advancement, the International Leadership Association convened an interdisciplinary working group at the 2024 Healthcare Leadership Conference. Working group members represented multiple health professions, countries, and leadership development traditions. Through facilitated dialogue and collective synthesis, the group examined shared opportunities, persistent implementation challenges, and future directions for healthcare leadership education. Across contexts, working group members identified common cross-cutting themes essential to effective leadership development. Despite growing consensus regarding these domains, significant challenges limit progress, including curricular constraints, limited faculty expertise, cultural hierarchies, fragmented assessment approaches, inequitable resource distribution, and lack of consensus on meaningful outcome measures. Acknowledging gaps in knowledge and workplace constraints, our working group constructed a consensus vision for the future of leadership development for healthcare providers. This vision emphasizes leadership as a core professional value for all healthcare providers; longitudinal, developmentally aligned curricula; explicit integration of followership; systems thinking and change leadership; preparedness for digital transformation; and creation of psychologically safe organizational learning environments. The group further proposes a corresponding research and development agenda prioritizing standardized competencies, longitudinal evaluation strategies, culturally responsive leadership models, and strengthened international collaboration. Advancing leadership development across healthcare providers requires coordinated multinational efforts, evidence-informed program design, and shared success metrics.