Teaching and Learning in Medicine最新文献

Moral distress has been linked to burnout, emotional exhaustion, and intention to leave medicine. Although it has been widely studied in other health professionals, research into the experience of resident physicians, who work in unique sociocultural environments, is in the early stages. The objective of this scoping review is to identify, examine, and summarize the literature on moral distress in residents. Using the methodology described by Arksey & O'Malley, we queried five databases and screened and analyzed 2,991 articles. In the 36 included articles, authors' definitions of moral distress varied; however, external constraint was emphasized as a core feature. An analysis of quantitative, qualitative, and theoretical or commentary articles produced several key findings. First, conditions contributing to moral distress included tensions surrounding end-of-life care, hierarchical cultural norms, ambiguities associated with work-based learning, and structural factors in healthcare delivery. Second, frequency and intensity of moral distress were inconsistent across studies. Third, impacts of moral distress included callousness, burnout, depersonalization, and attrition. Fourth, residents employed a range of coping mechanisms such as seeking peer support, engaging in meaning-making, going above and beyond expectations, internalizing thoughts and emotions, or employing detachment and cynicism. Finally, suggested mitigation strategies included debriefing and reflection, culture change initiatives, and educational programming. The findings offer a unique analysis of how moral distress is defined in residency education and illuminate the interplay of relational, systemic, and sociocultural factors shaping residents' experiences. Further, the results provide a meaningful overview of the literature and identify important directions for future inquiry. .

Introduction: Clinically significant adverse events (CSAE) place medical students at risk for secondary traumatic stress, feelings of guilt, anxiety, failure, decreased confidence, and alterations of career trajectories and specialty choice. The CSAE literature focuses on clinicians or nursing students, leaving medical students relatively understudied. Understanding medical students' CSAE experiences, within the context of their role as a learner, is important because students may be uniquely vulnerable due to their relative lack of experience with adverse events, lower position in the medical hierarchy, and absence of formalized CSAE curricular or co-curricular support. Thus, the purpose of this study is to explore medical students' experience of CSAE and identify ways to support learning during the recovery process. Methods: We used a constructivist narrative approach to explore medical students' stories of CSAE holistically. From December 2024 through February 2025, we conducted semi-structured interviews with 16 second- through fourth-year civilian and military medical students in the United States. This study is constructivist in that both the authors' and the participants' experiences of CSAE are contextually specific realities where meaning is relational and often co-created. We elected to use a narrative approach, which is a story-centered methodology, because CSAE is a chronological phenomenon and stories are one way that humans make sense of traumatic events. We followed a chronological approach to develop the interview protocol and used narrative analysis to interpret the data. The Institutional Review Board at the Uniformed Services University of the Health Sciences in Bethesda, MD approved this research (DBS.2024.783). Results: Narratives highlighted intense emotional responses to CSAEs, including helplessness, guilt, fear, and grief, shaped by their limited power, inexperience, and pressure to perform. Their role as learners often left them excluded from care decisions, debriefings, and formal support, leading to feelings of invisibility within the medical hierarchy. While emotional and social support from faculty and residents was often absent, students sought help from peers, therapists, or medically trained family members. Informational and esteem support, especially when faculty explained clinical reasoning, helped students process events and regain a sense of competence. Conclusion: Medical students often feel unprepared for the emotional impact of CSAEs and face barriers to seeking support due to hierarchy and fear of negative evaluation. Participants described experiences of isolation, emotional distress, and invisibility within clinical teams but also identified moments of growth when supported by faculty and peers. These findings highlight the need for curricula that prioritize emotional preparedness and social support.

Purpose: Enabling undergraduate medical trainees to develop professional identities consistent with their consciousness of inequities in healthcare and their obligation to provide just healthcare is a pressing challenge. Except as a duty not to discriminate, the positive obligations of a physician's commitment to social justice in the clinic can be unclear, including for educators seeking to empower learners to incorporate such commitments into their developing identities. This study explored the pedagogical value of allyship-to be in supportive association with a marginalized or mistreated group-seeking to understand the allyship issues students in clinical training reflect on as noteworthy and how they assess allyship-related encounters with respect to their professional identity. Method: We conducted a qualitative content analysis of 110 vignettes and reflections that students doing their clerkships as acting interns submitted as part of a required ethics course at a US allopathic medical school in 2020-21. Independent coders followed an inductive, iterative process to code the submissions. Results: Students reflected on demonstrated acts of allyship in 65.5% of cases, and in 34.5% of cases, students described situations in which allyship was warranted but lacking. Students most frequently reflected on the allyship needs of those who were racially minoritized, identified as LGBTQ+, were perceived as "difficult," and had complex care needs, and they specified issues like disparaging remarks, implicit bias, ignored patient needs, and treatment refusals as calling for allyship. The highlighted issues reflected their salience in contemporary social justice discourses in medicine. All analyzed submissions also featured meaningful reflections on at least one demonstrated act of allyship or failure thereof. Students discussed these acts' significance by connecting them to a constellation of professional values, such as the obligation to treat the whole person, be inclusive, be fair, and advocate. Conclusions: This study's results show allyship can be a pedagogically useful concept with which students can reflect on and raise their consciousness of vulnerable patients and populations, what acts of allyship can look like at the bedside, and how their commitment to allyship connects with and is reinforced by other professional values.

Phenomenon: Increasingly, peer feedback and assessment exercises are being introduced into health professional degree programs with many proposed benefits including the unique feedback received from peers and development of clinical education skills. However, studies investigating the bidirectional significance of peer feedback in workplace-based assessments (WBAs) are limited. The peer assessed mini-clinical evaluation exercise (peer mini-CEX) is a WBA conducted as part of The University of Melbourne Doctor of Medicine course, which involves peers assessing one another in a clinical setting. Approach: This research investigated students' perceptions of the bidirectional effects of peer feedback on medical students undertaking peer mini-CEXs. Between August and October 2023, we conducted semi-structured interviews of penultimate and final year medical students. We undertook an exploratory qualitative study based on social constructivist theory. We transcribed the interviews and analyzed them via inductive thematic analysis, which led to the development of themes and the thematic map. Findings: Fourteen students, including eight third-year and six fourth-year students, participated in the study. Students appeared to engage in two general approaches to the peer mini-CEX: a mastery approach or a compliance approach. These themes encapsulated a tension between the desire to achieve deeper learning versus a strategic approach to assessment. When students took a mastery approach, perceived bidirectional benefits clustered around improvements in feedback provision and reception, more intentional observation and reflection leading to enhanced clinical skills, and development of professional communication skills. If students took a compliance approach, the reported outcomes were limited or undesirable with students viewing the assessment as a tick box exercise and identifying the limitations of peer feedback. A third theme, the social milieu, illustrated the influence of the social context on peer interactions and whether a mastery or compliance approach was undertaken. Insights: This study is the first to explore students' perceptions of the nuanced bidirectional effects of peer feedback in a WBA. Participants report benefits of the peer mini-CEX in domains such as clinical skills, professionalism, communication, and feedback provision and reception. However, even engaged students often described adopting a superficial approach to the peer mini-CEX, resulting in minimal learning. Our findings indicate the influence of the social milieu on peer assessment and feedback processes. With contemporaneous feedback training and priming, peer assessment and feedback can be a valuable exercise for medical students. Further research into peer feedback in WBAs is required.