Teaching and Learning in Medicine最新文献

Prosocial behavior, a cornerstone of effective healthcare, is crucial for positive doctor-patient relationships and ethical medical practice. However, cultivating prosociality in medical students, particularly within diverse cultural contexts, presents a significant challenge. While mindfulness interventions show promise, the underlying mechanisms, especially the role of self-construal, remain underexplored. This study addresses this gap by investigating the effects of a seven-day online mindfulness program on prosocial behavior among Chinese medical students and the mediating role of self-construal, a culturally contingent framework. Divergent from Western research suggesting mindfulness promotes prosociality via interdependent self-construal, we explored a potentially distinct dynamic in a collectivist setting. In 2023, we randomly assigned 64 medical students without prior mindfulness experience to a mindfulness practice group (n = 33) or a control group (n = 31). Pre- and post-intervention assessments included trait mindfulness, self-construal, and prosocial behavior, using validated Chinese instruments. The mindfulness intervention significantly increased prosocial behavior and both independent and interdependent self-construal. However, mediation analysis revealed that only independent self-construal significantly mediated the mindfulness-prosociality link; interdependent self-construal showed no significant mediating effect. This unexpected finding highlights the cultural plasticity of self-construal theory, suggesting mindfulness in collectivist contexts may facilitate prosociality by activating individual agency and autonomy-a pathway diverging from Western observations. These findings have substantial implications for adapting mindfulness interventions in global medical education, advocating for culturally informed designs that leverage the dynamic interplay between mindfulness, self-construal, and prosocial development. This research refines the theoretical understanding of self-construal and offers a novel perspective on cultivating essential prosocial attributes in future healthcare professionals. Furthermore, this work suggests practical strategies for integrating mindfulness training into medical curricula, potentially enhancing student well-being, ethical decision-making, and patient-centered care.

Background: This study investigated the views and experiences of students, teachers, and administrators regarding educational ethics to gain a deeper understanding of the role educational ethics can play in medical education. This research contributes to a deeper understanding of ethical issues related to increasingly complex medical education and may encourage all stakeholders in the field of medical education to reflect on these issues. Method: In this qualitative study, we conducted 29 individual interviews with medical teachers and medical school administrators and seven focus group interviews with 45 medical students. Interviews took place in 2020 at seven medical schools with different qualifications in Türkiye. We examined the interview data using thematic content analysis. Findings: We developed six themes: 1) fundamental ethical values in medical education, 2) responsibilities of medical students, 3) responsibilities of medical teachers, 4) responsibilities of medical school administrators, 5) ethical problems experienced in learning-teaching processes, and 6) suggestions for solutions to ethical problems in teaching processes. Conclusion: Our findings provide a basic rationale for considering educational ethics in medical education. Educational ethics appear to be important in creating an academic climate in which human values are protected, thus promoting professional identity formation and internalization of the medical profession's ethical values. Medical schools should be encouraged to prepare position statements as a sign of ethical sensitivity to maintain and enhance the value of trust in medicine among both the public and members of the medical community.

During my first year as a resident physician, I was confronted with the collision of physician identity and personal loss after the sudden death of my father. This essay presents first-hand experiences and examines how doctoring roles and newly developed clinical habits can be misapplied to personal grief. What is discovered is that these misapplications can both distort the grief process and erode self- and patient-level compassion. In particular, I reveal how existing frameworks exclusively prepare trainees for professional grief and prioritize professional composure over authentic mourning. For example, I recall an initial guilt-laden impulse to medicalize and restrain. Drawing on narrative reflection, clinical encounters, and engagement with grief literature and religious practice, the essay traces my evolving understanding of my identities. As both doctor and son, my two roles coexist in an intimate experience of loss. It is clear that when left unexamined, obstinate persistence in the doctoring role-searching for signs, explanations, or missed interventions-risks contorting grief into a problem to solve rather than a reality to humanely endure and from which to grow. Ultimately, I argue that medical education must intentionally support trainees' personal grief, not only for their own well-being but to preserve the empathy and humanity essential to patient care.

Background: Effective pain management is essential to high-quality dental care, and its inclusion in dental curricula is vital to ensure future professionals are adequately trained. In Brazil, however, little is known about how pain-related content is integrated into undergraduate dental education. This study aimed to¹ identify whether pain curricula are present in Brazilian undergraduate dentistry programs and² analyze the content covered in these curricula, using international recommendations as a benchmark. Methods: We examined all accredited dental education programs (DEPs) in Brazil and analyzed their curricular content based on guidelines from the International Association for the Study of Pain (IASP) and the American Dental Association (ADA). Results: Among 274 DEPs analyzed, only 50 (18.2%) included a dedicated pain curriculum. Regional distribution varied, with 91 programs (25.1%) in the Northeast, 141 (38.8%) in the Southeast, 43 (11.8%) in the Midwest, 26 (7.2%) in the North, and 62 (17.1%) in the South. Among the 17 programs with curricula fully available, the most frequently covered topics were related to pharmacological management, such as local anesthetics (70.6%), airway anatomy and physiology (64.7%), and drug administration routes, analgesics, and antagonists (52.9%). In contrast, topics such as pain definitions and orofacial pain conditions (23.5%), orofacial malignancies (41.2%), and pain and anxiety control (11.8%) were less frequent. Notably, non-pharmacological approaches and drug abuse prevention were almost entirely absent. Conclusion: Brazilian dental education programs fall short of meeting the IASP and ADA recommendations for pain education, particularly regarding non-pharmacological content and substance misuse. These findings highlight significant curricular gaps that may affect dental students' training and preparedness. Our results can support curriculum planners and academic leaders in identifying regional disparities and thematic omissions, ultimately guiding improvements in pain education within undergraduate dental programs.

The complex skill of prescribing often fails to translate effectively from basic medical training into clinical practice, leading to poor patient management and medication errors. Previous research has demonstrated that learners face substantial challenges in achieving the threshold of integrated understanding and decision-making required for rational prescribing in different contexts. These challenges stem from the fact that learning to prescribe remains an implicit experience. Students tend to imitate physicians' prescribing patterns without understanding how the expert's cognitive schema operates, making it difficult to transfer this skill to new or diverse situations. While several interventions have been introduced, the challenge in transferring this skill may lie in the educational strategies for prescribing, further compounded by the complex web of underlying concepts inherent to the task. To address this, we explore the Four Component Instructional Design (4 C/ID) model, integrated with cognitive load theory. The 4 C/ID model posits that complex skills training requires a combination of learning tasks, supportive information, procedural information, and part-task practice. This integration aims to develop the knowledge, skills, and attitudes necessary for complex tasks and enhance knowledge transfer without overloading cognitive abilities. To illustrate this integration, we present a blueprint for an antimicrobial module spanning pre-clinical to clinical years, focusing on identified threshold concepts of pharmacology and fostering the practice of both routine and non-routine prescribing skills. Students engage in whole-task activities, supported by mental models, procedural knowledge, and repetitive practice. We recommend a blended learning approach for this module, using successful strategies from other domains. In traditional curricula, our module can be introduced during clinical rotations and culminate as a capstone course. This module offers a promising solution to current challenges in teaching and practicing prescribing.

Student professionalism is a complex construct that intersects with individual behaviour, relationships, and politics and social discourse. A small number of authors have previously commented on the importance of aesthetics for understanding how professionalism is assessed in medical education. This paper develops a preliminary account of precisely what types of sensible responses occur when assessing one aspect of student professionalism. It argues that positive and negative evaluations of student appearance involve two fundamentally different subjective phenomena - Kant's judgments of agreeableness and mere feelings of displeasure. These different processes mean that positive, but not negative, evaluations can claim a degree of generality and objectivity. Because negative evaluations involve weaker and more subjective responses, they have the potential to be unjust. The potentially wider implications of this argument for assessing student professionalism are also considered.

Problem-Based Learning (PBL) is widely implemented in health professions education (HPE). Small-group knowledge construction plays an essential role in trainees' learning from PBL tutorials. However, there is a dearth of systematic reviews to unpack the black box of the PBL knowledge construction process. The current review tackles this gap by identifying (1) the perspectives and methods adopted to directly assess the PBL knowledge construction process and (2) the factors in group interaction processes that impact PBL knowledge construction. We conducted a systematic search of multiple databases in November 2023 and identified original studies analyzing PBL interaction processes in HPE. Two reviewers conducted a thematic synthesis of the findings. Of 2,691 citations identified, 60 empirical studies (2.2%) from 16 countries and covering eight health professions met the inclusion criteria. Most investigations adopted a social constructivist perspective to analyze recordings, observations, and digital trace data of group interactions, often triangulating with other data for deeper insights. A wide range of qualitative, quantitative, and mixed methods was used to analyze interaction processes. Our synthesis identified a series of intertwined factors that influence knowledge construction: cultural influences and linguistic strategies; interprofessional dynamics, curriculum and assessment practices; learning task design, including technology affordance; tutor facilitation; learner prior knowledge and experience; and team learning behaviors and interaction patterns, such as learner directedness, social-cognitive exchange, group climate, and group interaction patterns. Our review highlighted the complexity of PBL knowledge construction by revealing the interrelated impact of various factors. Future studies should adopt a sociocultural perspective, employ the Design-Based Research approach, and integrate multiple methods and levels of analysis to unravel the dynamic interplay of these factors. Future research directions include exploring new analytics techniques, leveraging AI to develop data-driven interventions, and enhancing the inclusivity of collaborative learning environments.

Health professions education (HPE) in the US is facing a critical disparity between the diversity of students enrolled in health professions programs and the diversity of US society. This disparity has downstream impacts on the healthcare workforce and patient care. The problem is created partly by social determinants of learning (SDOL), which are nonacademic, contextual conditions that impact students' ability to optimally participate in their education. SDOL can be facilitators or barriers and often have disproportionate effects on individuals from underrepresented backgrounds and identities. This article explores these nonacademic factors, the lack of student diversity in HPE, the resulting societal impacts, and offers practical recommendations for individuals and institutions.

Background: Clinical education and healthcare work occur within their own complex sociocultural contexts, where interactions can be emotionally intense. Scholars have begun to conceptualize emotional experiences using a socio-cultural lens, examining emotions within their own complexity and contextuality. To better understand and help providers process the intense emotional experiences inherent to clinical education and work, it is important to analyze them from a socio-cultural perspective. Objective: This study aimed to identify the emotional experiences of clinical providers engaged in healthcare work and to determine the value of adopting a reflective approach to processing intense emotions. Our research questions were (1) What clinical activities prompt emotional response among providers, and how does context (system, socio-cultural, political, etc.) shape these experiences? (2) How does providers' reflectivity about their emotional experiences in context affect their understanding and outcomes? Method: The study was conducted between 12 July 2021 and 07 January 2022 at a university hospital's general surgery clinic in the Eastern Anatolia Region of Türkiye. This narrative, ethnographic study analyzed the emotional narratives embedded in clinical work. The participant group consisted of 31 volunteers from a single clinical team: five faculty members, five residents, six nurses, 15 sixth-year medical students (interns). We analyzed narratives generated from participant observation and narrative interviewing using the "Three Stage Contextual Theme Analysis Framework" model. Findings: We created a tripartite conceptual framework to convey (a) the multi-level context in which emotional experiences occur, (b) providers' reflection on emotional experiences in context, and (c) the consequences of contextual, reflective emotional experiences. Our analysis revealed two main contexts in which emotional experiences take place: "institutional and clinical context" and "national and local context." The institutional and clinical context consists of "social, emotional," "physical," and "institutional and clinical system" subcontexts, while the national and local context consists of "health system" and "socio-cultural life" subcontexts. Conclusion: Given the consequences of intense emotional experiences in clinical education and healthcare work, it is important to understand them in context, using a reflective narrative approach. This approach allows educators to reframe both clinical education and healthcare work in a more humane and socioculturally sensitive manner.

Through a Critical Whiteness lens, we examined the extent to which the measures developed, or selected, to evaluate the effectiveness of the antiracist curricula also reflected a commitment to (or understanding of the importance of) disrupting white supremacist norms with respect to what and how measures should be used. We were curious to understand if development teams critically audited the content of their measures, scoring rubrics, and/or feedback loops for embedded norms associated with whiteness, ensuring that even the measures (beyond the interventions themselves) served justice rather than reinforcing whiteness as the invisible standard. Findings revealed that while measurement is happening, it is (a) often limited in psychometric rigor (i.e., validity and reliability evidence); (b) infrequently includes any actual behavioral changes (12% of studies); (c) rarely includes the input of patients in the development process; and (d) is absent of any critical theoretical orientation. In fact, the dominant patterns in measure development and use across the antiracist medical education interventions we identified revealed a persistent centering of whiteness-visible in the prioritization of white normative standards, the marginalization of minorized voices in design and validation, the absence of explicit justice-oriented theoretical frameworks, and outcome measurement focused on institutional and professional comfort. To ensure our measurement processes have the same justice-orientation as our interventions, we propose three principles, or guidelines, for measure design/development (critical theory integration, centering rights-holders with marginalized identities, and justice-aligned validity evidence).