Teaching and Learning in Medicine最新文献

Competency-Based Education (CBE) has become the dominant paradigm for structuring medical training worldwide. Yet its foundational constructs (e.g., Entrustable Professional Activities (EPAs), milestones, and competencies) were conceived within resource-rich, institutionally stable, and culturally specific contexts. Their diffusion across global landscapes has not been neutral. When such frameworks travel, they carry embedded assumptions, epistemic values, and implicit universalizing authority. This article describes how The East, Central, and Southern Africa College of Paediatrics and Child Health (ECSAPACH), in partnership with the Center for Research, Innovation, and Scholarship in Health Professions Education (CRIS) at Baylor College of Medicine, reimagined CBE for African pediatric training through a process guided by design justice and implemented using knowledge brokering. Anchored in Homi Bhabha's concept of the Third Space and Culture's In-Between, we argue that the translation of CBE into new contexts is not merely a technical or linguistic act but an ethical, dialectical, and generative one. ECSAPACH's translation process demonstrates that when frameworks encounter contextual resistance and epistemic contestation, they can be reconstituted into hybrid forms that unsettle universality while deepening both global and local understanding. The resulting hybrid framework represents not a replication or simple adaptation of imported theory but a co-created, contextually anchored model for pediatric education that emerges from ongoing negotiation under conditions of asymmetrical power. We position this work as an instance of hybrid knowledge production in Bhabha's Third Space, offering lessons for equitable global partnerships and for the future evolution of CBE as a living, revisable theory.

In this narrative recounting of a Malaysian academic medical department's mystery-seed project, lecturers reflect on the parallels between cultivating plants and supervising students. As the seeds grow, struggle, or fail to germinate, the participants examine how patience, intervention, adaptability, and environmental conditions influence development. Through experimentation and shared reflection, they discover that effective supervision requires recognizing individual needs, responding creatively to setbacks, and providing the conditions in which growth can occur.

Background: Problem-based learning (PBL) is globally accepted for promoting critical thinking and interpersonal communication skills, yet evidence among first-year medical students in resource-constrained settings remains limited. The current study assessed the effects of an eight-month PBL exposure on first-year medical students' self-reported critical thinking, perceived interpersonal communication competence, and satisfaction with PBL in Ghana. Methods: We employed a pretest-posttest design. Students completed the Critical Thinking Questionnaire and the Interpersonal Communication Competence Scale at baseline and follow-up and a locally-developed post-PBL satisfaction survey. The questionnaires were administered through Google form. We analyzed data using standard statistical software (SPSS version 26.0) and non-parametric tests, where normality assumptions were not met. We conducted the study between April and May 2025. Results: Out of 110 participating students, 88.1% (n = 97) and 84.5% (n = 93) completed critical thinking communication assessments at pretest and posttest, respectively. All participants completed the satisfaction survey. Critical thinking scores did not change from pre- to post-test. Interpersonal communication competence also remained stable, except for perceived supportiveness, which declined significantly (Z = -2.16, p = .031, r = .22). The majority of participants (n = 80, 72.8%) reported being satisfied or very satisfied with PBL, with male students reportedly being more satisfied than female students (χ² (1, N = 110) = 7.06, p = .008)). Discussion: Whereas first-year medical students in this setting (particularly males) were generally satisfied with PBL, we found no significant changes in self-reported critical thinking or perceived competence in interpersonal communication, except for a significant decrease in perceived supportiveness of others. The findings suggest a need for better scaffolding, intentional communication skills intervention, and gender-sensitive approaches in PBL.

Obesity is a leading public health concern in the United States, yet medical education continues to inadequately prepare future providers to manage it as a complex, chronic disease. Compounding this issue is the pervasive presence of weight bias in healthcare, which contributes to poorer patient outcomes, diminished quality of care, and reduced patient engagement. Despite growing awareness, obesity and weight bias education remain inconsistently integrated into medical curricula, often lacking structured, longitudinal, and competency-based approaches. While frameworks such as those developed by the Obesity Medicine Education Collaborative have advanced obesity-related competencies, weight bias remains underrepresented, with few formalized competencies guiding its instruction or assessment. Current efforts to reduce weight bias among medical school students are fragmented and often short-term. Interventions such as didactic modules, simulation-based experiences, and reflective exercises have shown promise in improving attitudes, yet most lack explicit mapping to weight bias competencies and fail to assess observable clinical behaviors. Weight bias education is rarely positioned as a core clinical skill, and standardized methods for competency assessment are virtually absent. In this article, we first review the current state of obesity and weight bias education in medical education and, second, reflect on experiences in developing the Weight of Words educational model, rooted in competency-based assessment and using our original instrument, the Weight Sensitivity Instrument (WSI©). We propose a theory-based approach informed by best practices, called the Weight of Words model, for weight bias education. The four-part educational model includes: (1) content delivery; (2) experiential learning; (3) reflection; and (4) competency assessment. The model represents a novel contribution to medical education by operationalizing weight bias competencies within a scalable, pedagogically rigorous framework and thus has far-reaching implications for medical practice. Without adequate training, future providers may unknowingly perpetuate stigma, erode patient trust, and compromise care quality. Addressing weight bias is essential for improving individual patient-provider interactions and for advancing health equity across the healthcare system.

Adaptability is an essential element of professional healthcare practice, yet little is known about how medical students understand and engage with adaptability during their preclinical training. Insight into these early experiences can help uncover the fundamentals of later adaptive expertise. This study explored how preclinical medical students perceive their own adaptability in the context of their academic work. From December 2024 to January 2025, seventeen third-year medical students from three universities in Belgium, the Netherlands, and Portugal participated in semi-structured interviews. We conducted interviews in person or online and recorded, transcribed verbatim, and analyzed them using thematic analysis. A constructivist orientation informed the approach to data collection and interpretation. Coding was iterative and supported by regular team discussions and memo writing. Students described adaptability in two distinct but related ways. The first theme, refining, occurred in situations that were different but came with clear expectations, such as examinations, course structures, or explicit or inferred teacher requirements. In these situations, students described adaptability as adjusting established study strategies and seeking guidance from peers to meet goals they could define clearly. Their actions were cautious and deliberate, influenced by a desire to avoid failure and remain within a context that felt manageable. The second theme, looking for gaps, reflected experiences in situations that were unfamiliar or ambiguous, including early clinical encounters or unexpected challenges. In these situations, students realized their usual strategies were insufficient and described adaptability as stepping back, observing before acting, and asking targeted questions to understand how to proceed. Although these situations often prompted significant learning, students also reported discomfort, uncertainty, and vulnerability, which sometimes led to hesitation or avoidance. These findings highlight the importance of educational environments that acknowledge adaptability as part of learning and provide structured support to help students navigate less predictable situations. Such environments may encourage students to move beyond optimizing familiar strategies and toward the forms of adaptability that underpin the development of adaptive expertise.

Financial hardship is a significant but underexplored challenge for medical students from lower socioeconomic backgrounds. While the financial barriers to medical school admissions are well-documented, there is limited research on the nuanced financial struggles these students face after matriculation. Traditional qualitative data collection methods often limit students' disclosure of these sensitive experiences. To uncover deeper insights into the experiences of financially disadvantaged medical students, a thematic analysis was conducted in February 2024 using comments from Reddit (r/medicalschool) (from February 2019-2024), a platform that offers anonymous and candid discussions. Three researchers analyzed threads discussing financial burdens in medical training through an inductive coding process. From 9,590 comments across 144 threads, we identified four key themes: personal costs, institutional and systemic barriers, social isolation and peer comparisons, and career trade-offs and professional development. Students described extreme budgeting measures that often led to compromises on basic needs such as food and healthcare. The emotional toll of financial stress was evident in widespread mental health concerns, with many students feeling anxious and inadequate compared to their wealthier peers. Financial disparities also contributed to social isolation and envy, while the need to manage debt heavily shaped career decisions, with many prioritizing high-earning specialties or loan forgiveness opportunities. Interpreted through the complementary frameworks of Bourdieu and Freidson, the findings suggest that financial hardship operates not only as an individual challenge but as a pattern shaped by the institutional organization of medical training. The findings highlight the pervasive financial challenges faced by low-income medical students. Addressing these issues will require greater transparency around the hidden costs of medical education, more comprehensive financial support, and increased institutional empathy toward students' financial difficulties.

Recent discussions of abolition have highlighted its promise in addressing many of the most pressing social inequalities of modern times. Yet, medicine and the medical education system remain ambivalent about the potential of incorporating abolitionist principles and praxis. Here, we draw from our lived experiences within the current US medical education system to 1) expand on existing definitions of abolition medicine, 2) highlight how educational approaches could incorporate abolitionist praxis into training healthcare workers, and 3) call for institutional investments in abolition medicine as both a discipline and practice. This work contributes to ongoing efforts to transform the medical education system and empower medicine to advance health justice.

Health professions education is increasingly called upon to prepare clinicians to provide equitable, patient-centered care; yet transgender and gender-diverse (TGD) health remains inconsistently integrated into formal curricula. Despite growing clinical literature, including evidence related to cardiovascular outcomes, educational integration of TGD health content remains limited across residency training programs. This disconnect between emerging evidence and curricular uptake raises questions about structural barriers that shape what is considered "core" knowledge. This study explored academic faculty perspectives on barriers to integrating TGD health content into residency curricula, using cardiovascular health as an illustrative case within Internal Medicine (IM) training. Drawing on a descriptive qualitative approach informed by Queer Theory, we conducted semi-structured interviews with 10 IM faculty members involved in curriculum development and teaching at a large Canadian academic institution. We purposively sampled participants to capture diversity in gender identity, academic rank, and clinical interest. We transcribed and analyzed interviews using NVivo. We performed a thematic analysis framed through a Queer Theory lens to identify how educational exclusion might reflect broader patterns of institutional cisnormativity. We constructed six themes from the data. While some participants cited lack of expertise or clinical exposure, others described structural forces-such as hierarchy-driven curriculum design, perceived niche status, and binary medical frameworks-that shape broader patterns of curricular inclusion and exclusion. When viewed through Queer Theory, these findings illustrate how the cisnormative image of the "default patient" renders some bodies and topics invisible to the curriculum, even when evidence and clinical need are well established. This exclusion of TGD health content, illustrated here through cardiovascular care, reflects cisnormative assumptions embedded within medical education. Just as the field has challenged the normative image of the physician, this study argues for a parallel interrogation of the patient. The same worldview that shapes which bodies clinicians are prepared to see also shapes what educators recognize as core content. Queer Theory exposes these exclusions and points toward structural work in curriculum design, faculty development, and institutional leadership required to address them.

Simulation-based healthcare education presents complex sensory, social, and cognitive demands that may systematically disadvantage autistic learners. Although contemporary research acknowledges autistic professionals' presence in healthcare practice, the literature remains conspicuously silent on how autistic learners actually experience simulation-based environments. Without understanding these lived experiences, we risk perpetuating educational practices that exclude neurodivergent talent and missing insights that could improve simulation design for all learners. This study aimed to explore the lived experiences of autistic healthcare learners in simulation-based education and understand how they make sense of these experiences. This interpretative phenomenological analysis explored the lived experiences of seven autistic healthcare learners from the UK and Europe. Participants included medical students and qualified doctors with simulation experiences spanning undergraduate curriculum-based training, postgraduate education, and professional development activities. We conducted semi-structured online interviews lasting approximately 60 minutes between February and May 2025, with interviews progressing from descriptive accounts to reflective consideration of ideal simulation experiences. Data analysis followed established interpretive phenomenological analysis (IPA) procedures, developing emergent themes and identifying patterns across participants whilst preserving individual voices. We developed four interconnected themes from participants' accounts. First, "Navigating Artificial Realities" captured how participants developed strategic, performance-based approaches to simulation's predictable structure, often prioritising technical success over genuine skill development. Second, "The Social Minefield of Group Learning" revealed how group composition and social dynamics served as gatekeepers to meaningful engagement. Third, "The Cognitive Burden of Dual Processing" described participants' exhausting experience of simultaneously managing clinical learning and social monitoring, with educational engagement competing against social performance demands. Fourth, "Communication as a Structural Barrier" highlighted participants' need for clear, direct instruction and feedback across all simulation phases. Our findings suggest that autistic learners may experience well-documented challenges in simulation-based healthcare education with particular intensity, revealing how simulation learning environments that appear inclusive may present challenges for autistic learners through design failures rather than learners' individual limitations.

This article explores the role of comics as a sustained pedagogical practice within medical education, presenting findings from a longitudinal qualitative study conducted at Penn State College of Medicine, United States. Over two pre-clinical years, a self-selected group of medical students-known as the Comics Cohort-were given comics-making assignments to integrate into their required Humanities curriculum. Through focus groups, individual interviews, and visual narrative analysis of students' drawings, the study investigated how engaging with comics over time shaped medical students' ways of seeing, learning, and becoming. We identified three main thematic domains: 1) students learn more deeply when they engage visually; 2) the personal reflection and vulnerability that arise from making comics can be challenging but are also tools for growth; and 3) making and sharing comics creates community and connection. Building on participants' accounts of repeated comics-based practices, this article conceptualizes drawing as a form of reflective engagement that shapes how students attend to clinical encounters. The act of drawing-repetitive, situated, and open-ended-functioned as a reflective tool through which students developed what we conceptualize as visual attunement: an ethically engaged perceptual stance that integrates attention to bodies, silences, emotions, and context. Rather than using art as an occasional creative supplement, this study found that drawing comics can serve as both a medium and method through which students cultivate professional identity, visual thinking, and critical reflection.