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Context: Realist evaluation is increasingly employed in health professions education research (HPER) because it can unpack the extent to which complex educational interventions work (or not), for whom under what circumstances and how. While realist evaluation is not wedded to particular methods, realist interviews are commonly the primary, if not only, data collection method in realist evaluations. While qualitative interviewing from an interpretivist standpoint has been well‐articulated in the HPER literature, realist interviewing differs substantially. The former elicits participants' views and experiences of a topic of inquiry, whereas realist interviewing focuses on building, testing and/or refining programme theory. Therefore, this article aims to help readers better understand, conduct, report and critique realist interviews as part of realist evaluations. Methods: In this paper, we describe what realist approaches are, what realist interviewing is and why realist interviewing matters. We outline five stages to realist interviewing (developing initial programme theory, realist sampling/samples, the interview itself, realist analysis and reporting realist interviews), drawing on two illustrative cases from our own realist evaluations employing interviewing to bring theory to life. We provide a critical analysis of 12 realist evaluations employing interviewing in the HPER literature. Alongside reporting standards, and our own realist interviewing experiences, this critical analysis of published articles serves to foreground our recommendations for realist interviewing. Conclusions: We encourage HPE researchers to consider realist interviews as part of realist evaluations of complex interventions. Our critical analysis reveals that realist interviews can provide unique insights into HPE, but authors now need to report their sampling approach, type of interviewing and interview questions more explicitly. Studies should also more explicitly draw on existing realist interviewing literature and follow reporting guidelines for realist evaluations. We hope this paper provides a useful roadmap to conducting, reporting and critically appraising realist interviews in HPER. Realist interviews are increasing in #MedEd #HPE but how can we better understand, conduct, report & critique them? This work teaches us that @charlreessidhu @KarenMattick @VanNBNguyen @crndvs [ABSTRACT FROM AUTHOR]

Although health sciences programmes continue to value non-cognitive variables such as interpersonal skills and professionalism, it is not clear that current admissions tools like the personal interview are capable of assessing ability in these domains. Hypothesising that many of the problems with the personal interview might be explained, at least in part, by it being yet another measurement tool that is plagued by context specificity, we have attempted to develop a multiple sample approach to the personal interview. A group of 117 applicants to the undergraduate MD programme at McMaster University participated in a multiple mini-interview (MMI), consisting of 10 short objective structured clinical examination (OSCE)-style stations, in which they were presented with scenarios that required them to discuss a health-related issue (e.g. the use of placebos) with an interviewer, interact with a standardised confederate while an examiner observed the interpersonal skills displayed, or answer traditional interview questions. The reliability of the MMI was observed to be 0.65. Furthermore, the hypothesis that context specificity might reduce the validity of traditional interviews was supported by the finding that the variance component attributable to candidate–station interaction was greater than that attributable to candidate. Both applicants and examiners were positive about the experience and the potential for this protocol. The principles used in developing this new admissions instrument, the flexibility inherent in the multiple mini-interview, and its feasibility and cost-effectiveness are discussed. [ABSTRACT FROM AUTHOR]

Background: Transitions are critical periods that can lead to growth and, or, distress. Transitions are a sociocultural process, yet most approaches to transitions in practice and research do not explore the social or developmental aspects of entering a new training phase. Wenger reminds us that identity development is crucial when newcomers navigate change. In this paper, we use Wenger's modes of identification: engagement, imagination and alignment to explore students' identity development (as a student and professional) during the transition from pre‐clinical to clinical training. Methods: We enrolled nine 2nd‐year medical students who generated 61 entries comprising audio diary (or typed) reflections over 9 months (starting 3 months before clinical clerkships began) and interviewed them twice. We used research poems (transcripts reframed as poetry) to help construct a meaningful, emotive elicitation of our longitudinal data and analysed data using sensitising concepts from Wenger's modes of identification. Results: Students described their transition as a journey filled with positive and negative emotions and uncertainty about their current and future careers. Students navigated the transition using three mechanisms: (1) becoming more engaged through taking charge, (2) shaping their image of self through engagement and finding role models and (3) learning to flexibly adapt to clerkship norms by managing expectations and adopting a journey mindset. Conclusions: We successfully narrated students' identity formation during their transition to clinical training. We learned that students became more engaged over time by learning to take charge. They shaped their image of self by engaging in team activities and reflecting on role models. They learnt to adapt flexibly to clerkship norms by managing expectations and adopting a journey mindset. We suggest that institutions provide a safe opportunity for medical students to reflect, allowing students' transition periods to be lived, reflected on and supported. The authors showcase Wenger's three modes of identification (engagement, imagination, and alignment) as medical students transition to clinical training using longitudinal qualitative methods and research poetry. [ABSTRACT FROM AUTHOR]

Introduction: Many medical schools have well‐established admission pathways and programming to support Indigenous medical workforce development. Ideally, these efforts should contribute to attracting highly qualified Indigenous applicants which, in turn, may improve accessible, quality care for Indigenous people. However, it is difficult to evolve and tailor these approaches without a situated understanding of Indigenous learners' experiences. In this paper, we focus on the Canadian context, sharing Indigenous learners' stories about their journey towards and throughout medical training. Methods: The conceptual underpinnings of narrative inquiry and key principles from Indigenous methodologies were drawn upon throughout both data collection and analysis. Participants were Indigenous learners (medical students and residents) and a recently graduated physician (n = 5) from one Canadian medical school. Both spoken (formal recorded interviews) and visual (photographs) texts were used to make meaning of participants' experiences. Results: Participants' experiences during medical training showed a striking resemblance at three points in their transition to, and progression through, medical education: preparing for and applying to medical school, completing undergraduate medical training and determining specialty choice. Participants' stories revealed a tug‐of‐war between their identities as an Indigenous person and as a medical trainee, with these tensions sometimes compromising their perceived sense of belonging within both Indigenous and academic circles, creating, at times, a heavy burden to shoulder. Conclusion: Meaningful representation of Indigenous people in the medical workforce is about more than training additional health care providers; it requires understanding Indigenous learners and recently graduated physicians' experiences as they enter and navigate the medical profession. By amplifying their voices, we stand to gain a more holistic representation of the factors that contribute to and potentially impede the recruitment and retention of Indigenous people into the medical profession. By blending narrative and Indigenous research approaches, the authors explore Indigenous learners' motivations for pursuing a career in medicine, the barriers and enablers they encounter, and their future aspirations. [ABSTRACT FROM AUTHOR]

Introduction: In light of reforms demanding increased transparency of student performance assessments, this study offers an in‐depth perspective of how teachers develop their assessment practice. Much is known about factors that influence assessments, and different solutions claim to improve the validity and reliability of assessments of students' clinical competency. However, little is known about how teachers go about improving their assessment practices. This study aims to contribute empirical findings about how teachers' assessment practice may change when shared criteria for assessing students' clinical competency are developed and implemented. Methods: Using a narrative‐in‐action research approach grounded in narrative theory about human sense‐making, one group including nine health professions teachers was studied over a period of 1 year. Drawing upon data from observations, interviews, formal documents and written reflections from these teachers, we performed a narrative analysis to reveal how these teachers made sense of experiences associated with the development and implementation of joint grading criteria for assessing students' clinical performances. Results: The findings present a narrative showing how a shared assessment practice took years to develop and was based on the teachers changed approach to scrutiny. The teachers became highly motivated to use grading criteria to ensure fairness in assessments, but more importantly, to fulfil their moral obligation towards patients. The narrative also demonstrates how these teachers reasoned about dilemmas that arose when they applied standardised assessment criteria. Discussion The narrative analysis shows clearly how teachers' development and application of assessment standards are embedded in local practices. Our findings highlight the importance of teachers' joint discussions on how to interpret criteria applied in formative and summative assessments of students' performances. In particular, teachers' different approaches to assessing 'pieces of skills' versus making holistic judgements on students' performances, regardless of whether the grading criteria are clear and well‐articulated on paper, should be acknowledged. Understanding the journey that these teachers made gives new perspectives as to how faculty can be supported when assessments of professionalism and clinical competency are developed. This study demonstrates how assessment practices change when performance criteria are developed. The findings highlight the importance of joint conversations between teachers and how their grading rationale shifts. [ABSTRACT FROM AUTHOR]

Introduction: The experience of remediation in practising physicians has not been widely studied. Remediatees frequently present negative emotions, but observers can only infer the underlying reasons behind these. Understanding remediatees' perspectives may help those mandating and organising remediation to structure the process in ways that improve the experience for all concerned parties and maximise chances of a successful outcome for remediatees. Methods: Seventeen physicians who had undergone remediation for clinical competence concerns were interviewed via telephone. Participant data were first iteratively analysed thematically and then reanalysed using a narrative mode of analysis for each participant in order to understand the stories as wholes. Figured worlds (FW) theory was used as a lens for analysing the data for this constructivist research study. Results: Participants entering the FW of remediation perceived that their position as a 'good doctor' was threatened. Lacking experience with this world and with little available support to help them navigate it, participants used their agency to draw on various discursive threads within the FW to construct a narrative account of their remediation. In their narratives, participants tended to position themselves either as victims of regulatory bodies or as resilient individuals who could make the best of a difficult situation. In both cases, the chosen discursive threads enabled them to maintain their self‐identity as 'good doctor'. Conclusion: Remediation poses a threat to a physician's professional and personal identity. Focusing mainly on the educational aspect of remediation—that is, the improvement in knowledge and skills—risks missing its impact on physician identity. We need to ensure not only that we support physicians in dealing with this identity threat but that our assessment and remediation processes do not inadvertently encourage remediatees to draw on discursive threads that lead them to see themselves as victims. Practising physicians undergoing remediation are shown in this paper to adapt to threatening situations by constructing narrative that enables them to maintain the self‐identity of 'good doctor'. [ABSTRACT FROM AUTHOR]

Introduction: There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work‐based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher–learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery. Methods: This was a secondary analysis of a large dataset, comprising field notes, participant interviews, images and video‐recordings gathered in an ethnographic study. The lead author embedded himself in four clinical teams (two surgical and two medical) in two different hospitals. The authors undertook a critical reanalysis of the observational dataset, using Dialogism and Figured Worlds theory to identify how teachers and postgraduate learners figured and authored their professional identities in the specialty‐specific cultural worlds of surgery and internal medicine. Results: Surgery and internal medicine privileged different ways of being, knowing and talking in formal and informal settings, where trainees authored themselves as capable practitioners. The discourse of surgical education constructed proximal coaching relationships in which trainees placed themselves at reputational risk in a closely observed, embodied practice. Internal medicine constructed more distal educational relationships, in which trainees negotiated abstract representations of patients' presentations, which aligned to a greater or lesser degree with supervisors' representations. Conclusions: Our research suggests that clinical education and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties. Attempts to change work‐based learning should be founded on situated knowledge of specialty‐specific clinical workplace cultures and should be done in collaboration with the people who work there, the clinicians. Cantillon et al. explore how clinical teaching and learning are uniquely shaped by the specialty‐specific cultures of postgraduate training. [ABSTRACT FROM AUTHOR]

Introduction: 'Fit' refers to an applicants' perceived compatibility to a residency programme. A variety of structural, identity‐related and relational factors contribute to self‐assessments of fit. The 2021 residency recruitment cycle in the USA was performed virtually due to the COVID‐19 pandemic. Little is known about how video‐interviewing may affect residency applicants' ability to gauge fit. Methods: A multidisciplinary, anonymous survey was distributed to applicants at a large academic institution between rank order list (ROL) certification deadline and Match Day 2021. Using Likert‐type scales, applicants rated factors for importance to 'fit' and their ease of assessment through video‐interviewing. Applicants also self‐assigned fit scores to the top‐ranked programme in their ROL using Likert‐type scales with pairs of anchoring statements. Results: Four hundred seventy‐three applicants responded to the survey (25.7% response rate). The three most important factors to applicants for assessment of fit (how much the programme seemed to care, how satisfied residents seem with their programme and how well the residents get along) were also the factors with the greatest discrepancy between importance and ease of assessment through video‐interviewing. Diversity‐related factors were more important to female applicants compared with males and to non‐White applicants compared with White applicants. Furthermore, White male applicants self‐assigned higher fit scores compared with other demographic groups. Conclusion: There is a marked discrepancy between the most important factors to applicants for fit and their ability to assess those factors virtually. Minoritised trainees self‐assigned lower fit scores to their top‐ranked programme, which should raise concern amongst medical educators and highlights the importance of expanding current diversity, equity and inclusion efforts in academic medicine. This paper offers examination of how residency applicants assess fit to the programs at which they interview during the virtual recruitment era, showing that female and minority applicants perceive poorer fit. [ABSTRACT FROM AUTHOR]

Introduction: Longitudinal Integrated Clerkships (LICs) have demonstrated benefits for students' learning and development in medical education globally. The model emphasises importance with respect to continuity and time in the workplace for learners. There is a need to explore how LICs become a viable training model for learners. An amalgamative LIC model was drawn upon to inform the design of a placement for trainee pharmacists on a hospital ward. This study sought to determine the local viability of a longitudinal placement for trainee pharmacists, using communities of practice learning theory to interpret findings. Methods: A design‐based research approach informed study design. A longitudinal placement was implemented on two hospital wards for 13 weeks. Trainees (n = 3) were interviewed four times over a 14‐week period. Ward staff (n = 14) were interviewed at week 14. Interviews were transcribed verbatim. Qualitative longitudinal analysis, using the trajectory approach, was conducted using abductive analysis. The coded data were organised into a framework and subthemes were created. Results: Trainees acquired membership within the multi‐disciplinary ward team over time. This led to an enriched learning experience and the trainee's professional development improved as they attained more responsibilities. This enabled them to make a greater contribution to patient care; more medication consultations occurred, and discharge times improved. Discussion The local viability of the longitudinal placement appears to be linked to the trainee's ability to acquire membership within the ward community of practice. Membership gave trainee's access to learning opportunities, supporting their development, and they earnt the trust of staff, leading to more responsibilities for providing patient care. Further research into developing longitudinal placements that support trainee healthcare professionals to acquire membership within communities of practice is warranted. This paper highlights the importance of healthcare trainees acquiring membership within healthcare teams to enhance their learning experience, advance their professional development and improve patient care. [ABSTRACT FROM AUTHOR]

Introduction: The OSCE is a sociomaterial assemblage—a meshing together of human and material components producing multiple effects. Materials matter because they shape candidate performance, with potentially calamitous career consequences if materials influence performance unjustly. Although the OSCE literature refers to materials, few papers study the sociomateriality of OSCEs. Therefore, we explored OSCE stakeholders' talk about sociomaterial assemblages to better understand their importance for candidate performance. Methods: We conducted 15 focus groups with OSCE candidates (n = 42), examiners (n = 20) and simulated patients (n = 17) after an Australian postgraduate nursing OSCE. Sociomateriality informed our team‐based framework analysis of data. Results: Participants identified a multiplicity of OSCE materials (objects, technologies and spaces) thought to matter for candidate performance. Candidates' unfamiliarity with materials and missing or malfunctioning materials were reported to yield numerous negative impacts (eg cognitive overload, negative affect, time‐wasting), thereby adversely affecting candidate performance. Both examiners and candidates made micro‐adjustments to sociomaterial assemblages during the OSCE in order to make it work (eg candidates saying what they would do rather than doing it). Sometimes, such tinkering extended so far that sociomaterial assemblages were ruptured (eg examiners ignoring rubrics to help pass candidates), potentially influencing OSCE standardisation. Discussion: Our novel empirical study extends previous conceptual work by illustrating wide‐ranging sociomaterial assemblages influencing OSCE candidate performance. Further research is now needed employing sociomaterial approaches to further elucidate sociomaterial entanglements in diverse OSCEs. We encourage OSCE stakeholders to become more attuned to the productive nature of materials within all stages of OSCE design and implementation. The authors demonstrate the extent to which materials really matter in shaping candidate performance in OSCEs [ABSTRACT FROM AUTHOR]

Introduction: Students from low‐income backgrounds (LIB) have been under‐represented in Canadian medical schools for over fifty years. Despite our awareness of this problem, little is known about the experiences of aspiring physicians from LIB in Canada who are working towards medical school admission. Consequently, we have little insight into the barriers and facilitators that may be used to increase the representation of students from LIB in Canadian medical schools. Methods: This paper describes a qualitative description interview study aimed at understanding the experiences of aspiring physicians from LIB as they attempt to gain entry to medical school. We conducted semi‐structured interviews with 21 participants at different stages of their undergraduate, master's, and non‐medical professional education, and used the theories of intersectionality and identity capital as a theoretical framework for identifying barriers and facilitators to a career in medicine. Results: Participants experienced social, identity‐related, economic, structural and informational barriers to a career in medicine. Intrinsic facilitators included motivation, self‐confidence, attitude, strategy, information‐seeking and sorting, and financial literacy and increasing income. Extrinsic facilitators were social, informational, financial and institutional in nature. Conclusion: This study fills existing knowledge gaps in the literature by identifying the pre‐admissions barriers and facilitators encountered by aspiring physicians from LIB in Canada. The barriers and facilitators outlined in this study offer a framework for identifying target areas in developing support for admitting medical students from LIB. Given that medical students from LIB are more likely to serve underserved populations, our study is relevant to Canadian medical schools' social accountability commitment to producing physicians that meet the health needs of marginalised and vulnerable patients. Out of concern for socioeconomic diversity, the authors apply an intersectional approach to examine the barriers and facilitators faced by aspiring physicians from low‐income backgrounds. [ABSTRACT FROM AUTHOR]

Context: Transitions in medical education are dynamic, emotional and complex yet, unavoidable. Relationships matter, especially in times of transition. Using qualitative, social network research methods, we explored social relationships and social support as medical students transitioned from pre‐clinical to clinical training. Methods: Eight medical students completed a social network map during a semi‐structured interview within two weeks of beginning their clinical clerkships (T0) and then again four months later (T1). They indicated meaningful interactions that influenced their transition from pre‐clinical to clinical training and discussed how these relationshipsimpacted their transition. We conducted mixed‐methods analysis on this data. Results: At T0, eight participants described the influence of 128 people in their social support networks; this marginally increased to 134 at T1. People from within and beyond the clinical space made up participants' social networks. As new relationships were created (eg with peers and doctors), old relationships were kept (eg with doctors and family) or dissolved over time (eg with near‐peers and nurses). Participants deliberately created, kept or dissolved relationships over time dependent on whether they provided emotional support (eg they could trust them) or instrumental support (eg they provided academic guidance). Conclusions: This is the first social networks analysis paper to explore social networks in transitioning students in medicine. We found that undergraduate medical students' social support networks were diverse, dynamic and deliberate as they transitioned to clerkships. Participants created and kept relationships with those they trusted and who provided emotional or instrumental support and dissolved relationships that did not provide these functions. It is well‐established that relationships are crucial to effective education. Here Atherley et al. explore how relationships change as students transition into clinical training. [ABSTRACT FROM AUTHOR]

Background: Objective structured clinical examinations (OSCEs) are commonly used to assess the clinical skills of health professional students. Examiner judgement is one acknowledged source of variation in candidate marks. This paper reports an exploration of examiner decision making to better characterise the cognitive processes and workload associated with making judgements of clinical performance in exit‐level OSCEs. Methods: Fifty‐five examiners for exit‐level OSCEs at five Australian medical schools completed a NASA Task Load Index (TLX) measure of cognitive load and participated in focus group interviews immediately after the OSCE session. Discussions focused on how decisions were made for borderline and clear pass candidates. Interviews were transcribed, coded and thematically analysed. NASA TLX results were quantitatively analysed. Results: Examiners self‐reported higher cognitive workload levels when assessing a borderline candidate in comparison with a clear pass candidate. Further analysis revealed five major themes considered by examiners when marking candidate performance in an OSCE: (a) use of marking criteria as a source of reassurance; (b) difficulty adhering to the marking sheet under certain conditions; (c) demeanour of candidates; (d) patient safety, and (e) calibration using a mental construct of the 'mythical [prototypical] intern'. Examiners demonstrated particularly higher mental demand when assessing borderline compared to clear pass candidates. Conclusions: Examiners demonstrate that judging candidate performance is a complex, cognitively difficult task, particularly when performance is of borderline or lower standard. At programme exit level, examiners intuitively want to rate candidates against a construct of a prototypical graduate when marking criteria appear not to describe both what and how a passing candidate should demonstrate when completing clinical tasks. This construct should be shared, agreed upon and aligned with marking criteria to best guide examiner training and calibration. Achieving this integration may improve the accuracy and consistency of examiner judgements and reduce cognitive workload. Ever wonder what's going on in the mind of OSCE examiners? This study explores that 'black box' and highlights why the evaluation of borderline candidates is particularly taxing. [ABSTRACT FROM AUTHOR]

Objectives: In clinical reasoning, clinicians need to switch between automatic and effortful reasoning to solve both routine and non‐routine problems. This requires the ability to recognise when a problem is non‐routine and adapt one's reasoning mode accordingly, that is to 'slow down' the reasoning process. In the current study, we explored the process of these transitions between automatic and effortful reasoning by radiologists who performed ultrasound examinations during consultations at the polyclinic. Methods: Manifestations of slowing down in clinical reasoning were explored in 41 out‐patient consultations performed by five radiologists. Interviews before and after the consultations were combined with observations during the consultations to obtain proactively planned triggers, slowing down manifestations and situationally responsive initiators. Transcripts of the interviews and field notes of the observations were coded. The constant comparative method was used to classify slowing down manifestations. Results: In thirteen of the 41 consultations, slowing down moments were observed. Four manifestations of slowing down were identified: shifting, checking, searching and focusing. These manifestations mainly differed in how long radiologists maintained effortful reasoning, varying from very short periods (shifting and checking) to sustained periods (searching and focusing). Unexpected patient statements and ambiguous ultrasound images initiated the slowing down moments. Discussion: The results from this study contribute to understanding how clinicians transition from automatic to effortful reasoning. Also, this study revealed two sources of initiators of this transition in radiologists' consultations: statements made by the patient and conflicting or ambiguous visual information, in this case from ultrasound images. Natural variations in patient statements and visual information can be used as input of what might be meaningful variation in the domain of radiology education to support expertise development. In this paper, Groenier et al. demonstrate how radiologists transition from near‐automatic to effortful reasoning to illustrate how clinicians 'slow down' the reasoning process. [ABSTRACT FROM AUTHOR]

Context: Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians’ activities in practice as they sought follow‐up information about patients. Methods: Using a constructivist grounded theory approach, semi‐structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants’ strategies when deliberately conducting follow‐up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow‐up. Results: The authors identified three themes related to follow‐up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow‐up. Analysis of participants' follow‐up processes as an activity system highlighted key tensions in the system and participants’ work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients’ outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients’ health information (rules) led to rule‐breaking or abandoning activities of locating information. Finding time to conduct desired follow‐up produced tension between this and other activity systems. Conclusion: In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow‐up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians’ skill development in developing and maintaining tracking systems for follow‐up; (iii) dedicate time in physicians’ work schedules for conducting follow‐up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians’ learning and respect patients’ privacy. [ABSTRACT FROM AUTHOR]

Objectives: Although there is much evidence to support the use of simulation‐based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes. Methods: Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens. Findings: A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy‐in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE. Conclusions: Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised. Although "validity" is a central concept for educators, this research outlining the conversion of outcome frameworks to assessment practice illustrates that the concept can easily get lost in translation. [ABSTRACT FROM AUTHOR]

Context: Understanding self‐regulated learning (SRL) is complicated due to the different measures used to identify the key SRL processes. There is a growing trend in applying event measures of SRL (microanalysis and trace) but aptitude measures (questionnaires) continue to be widely used in medical education. A major concern is whether aptitude measures are a valid approach to capture the dimensions of SRL processes. This study examined correlations between SRL microanalysis, SRL trace and the Motivated Strategies for Learning Questionnaire (MSLQ) and how these measures were associated with biomedical science performance. Methods: An SRL microanalysis assessment interview was administered to 76 first‐year medical students individually when performing a biomedical science learning task. All written materials by students were collected for further trace analysis. Students completed an MSLQ 2 weeks before completing their biomedical science course. Correlation analyses were used to determine the correlations between the three SRL assessment measures. Bivariate and multiple analyses were conducted to compare students on different course or task performance using the three SRL assessment measures. Results: Microanalytic metacognitive monitoring (κ = 0.30, P <.001) and causal attributions (κ = 0.17, P =.009) had statistically significant correlations with use of the SRL trace strategy. MSLQ self‐efficacy correlated with microanalytic self‐efficacy (r =.39, P =.001). Bivariate tests showed that microanalytic metacognitive monitoring, causal attributions and adaptive inferences, and SRL trace strategy use had significant associations with task performance (P <.05). Microanalytic self‐efficacy, metacognitive monitoring and causal attributions, SRL trace strategy use and MSLQ self‐efficacy had significant associations with course performance (P <.05). Measures of use of the SRL trace strategy and MSLQ subscales did not show significant associations with task and course outcomes in multiple analyses (P >.05). Conclusions: Event measures, specifically SRL microanalysis, had greater associations with both task and course outcomes compared with the MSLQ measure. The SRL microanalysis is recommended for the assessment of SRL in biomedical science learning. However, to fully understand medical students' SRL a multidimensional assessment approach that combines event and aptitude measures should be used. Trying to measure engagement in self‐regulated learning? This paper stresses the value of prioritizing microanalysis given relationships with biomedical science learning outcomes. [ABSTRACT FROM AUTHOR]

Context: The electronic health record (EHR) has been identified as a potential site for gathering data about trainees' clinical performance, but these data are not collected or organised for this purpose. Therefore, a careful and rigorous approach is required to explore how EHR data could be meaningfully used for assessment purposes. The purpose of this study was to identify EHR performance metrics that represent both the independent and interdependent clinical performance of emergency medicine (EM) trainees and explore how they might be meaningfully used for assessment and feedback. Methods: Using constructivist grounded theory, we conducted 21 semi‐structured interviews with EM faculty members and residents. Participants were asked to identify the clinical actions of trainees that would be valuable for assessment and feedback and describe how those activities are represented in the EHR. Data collection and analysis, which consisted of three stages of coding, occurred iteratively. Results: When faculty members and trainees in EM were asked to reflect on the usefulness of using EHR performance metrics for resident assessment and feedback they expressed both widespread support for the idea in principle and hesitation that aspects of clinical performance captured in the data would not be representative of residents' individual performance, but would rather reflect their interdependence with other team members and the systems in which they work. We highlight three categorisations of system‐level interdependence ‐ medical directives, technological systems and organisational systems ‐ identified by our participants, and discuss strategies participants employed to navigate these forms of interdependence within the health care system. Conclusions: System‐level interdependence shapes physicians' performances, and yet, this impact is rarely corrected for or noted within clinical performance data. Educators have a responsibility to recognise system‐level interdependence when teaching and consider system‐level interdependence when assessing the performance of trainees in order to most effectively and fairly utilise the EHR as a source of assessment data. In this paper, the authors highlight factors that contribute to system‐level interdependence and discuss the implications these factors have for resident assessment. [ABSTRACT FROM AUTHOR]

Context: Teaching intimate examinations to medical students has been recognised as difficult because of the anxious feelings that the students may experience. For their professional development, previously incorporated understandings need to be relearned: how to transgress boundaries that regulate intimacy and physical closeness, learning to examine and touch other peoples' bodies, and talking about things that are otherwise taboo. Objectives: This paper compares how students learn to perform two intimate examinations: (i) the digital rectal examination (DRE) of the prostate, and (ii) the bimanual pelvic examination (PE) and analyses how norms and expectations affect how students learn to approach them. Methods: This study is based on ethnographic work: in‐depth qualitative interviews with two urologists and nine medical students in semesters four, eight and 11 of a medical education programme in Sweden, observations of three learning sessions where 16 students performed the PE on professional patients, and 2 days of observations at a urology outpatient clinic. Results: The educational approach to the PE and DRE differ. The PE is taught as sensitive and to be handled with care, using a well‐documented learning concept including interpersonal and technical skills. The patient's exposed position in the gynaecological chair, possible previous negative experiences of PE or sexual exploitation are taken into account. In contrast, there is no educational concept for teaching the DRE. The students perform their first DRE on a clinical patient. The DRE is also handled with care, but with less sensitivity. The patients' possible previous negative experiences are not discussed and are thus made invisible. Conclusions: Well‐established routines in performing the PE help doctors and students to be attentive to patients' emotions and previous experiences, and remind them to perceive the examination as sensitive. Aligning the teaching of the DRE with that of the PE will improve how the male prostate patient is approached. The authors demonstrate that when comparing the digital rectal exam (DRE) with the bimanual pelvic exam (PE), the lack of articulated routines for teaching the DRE becomes apparent. Aligning the teaching of the DRE with that of the PE will improve how the male patient is cared for. [ABSTRACT FROM AUTHOR]

Context: Studies about the impact of global health electives on host institutions are scarce and often made from the perspective of institutions that send students. The present research examined the impact of short‐term electives in global health (STEGHs) from the under‐represented perspective of host institutions in Benin. Methods: The authors conducted 30 semi‐structured interviews from a convenience sample of Beninese health care professionals who had hosted Canadian medical students. Interviewees had previously supervised STEGHs in one of the five different institutions. A subsequent qualitative thematic analysis methodology was used to compilate codes and generate themes. Results: Hosting STEGH students motivated respondents to increase their medical knowledge through self‐driven learning. They perceived an improvement in the quality of their care and felt a negligible impact on patient safety. They negatively commented on the lack of clear pedagogic objectives that they could rely on. Interviewees think current STEGH partnerships do not advantage them because institutions that send students offer little support during the electives. Furthermore, sending institutions do not offer the same opportunity for local medical students or professionals to take part in such electives outside of Benin. Conclusions: Although host health care professionals evaluated global health electives positively overall, specific improvements could mitigate their negative impacts and help create a more balanced partnership between sending and host institutions. Sending institutions could involve host institutions in curriculum planning. They could invest in building reciprocal elective programmes to receive students from elsewhere. Meanwhile they can maximise the transfer of relevant medical knowledge, and provide expertise, resources and support during the electives. International electives in Global Health offer valuable learning. However, benefits and problems must be considered, a ratio that can be inequitable. This paper highlights host institution perspectives to help bring such opportunities into balance. [ABSTRACT FROM AUTHOR]

Context: Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end‐of‐life care. In previous research, medical learners have reported insufficient training and emotional distress about end‐of‐life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. Methods: Using purposive sampling at one Canadian medical school, individual semi‐structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. Results: Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. Conclusions: GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively. The research described in this paper illustrates how leading goals‐of‐care discussions as a very junior learner can lead to emotional distress and have negative impacts on professional identity development. [ABSTRACT FROM AUTHOR]

Context: Competency‐based medical education has spurred the implementation of longitudinal workplace‐based assessment (WBA) programmes to track learners' development of competencies. These hinge on the appropriate use of assessment instruments by assessors. This study aimed to validate our assessment programme and specifically to explore whether assessors' beliefs and behaviours rendered the detection of progress possible. Methods: We implemented a longitudinal WBA programme in the third year of a primarily rotation‐based clerkship. The programme used the professionalism mini‐evaluation exercise (P‐MEX) to detect progress in generic competencies. We used mixed methods: a retrospective psychometric examination of student assessment data in one academic year, and a prospective focus group and interview study of assessors' beliefs and reported behaviours related to the assessment. Results: We analysed 1662 assessment forms for 186 students. We conducted interviews and focus groups with 21 assessors from different professions and disciplines. Scores were excellent from the outset (3.5–3.7/4), with no meaningful increase across blocks (average overall scores: 3.6 in block 1 versus 3.7 in blocks 2 and 3; F = 8.310, d.f. 2, p < 0.001). The main source of variance was the forms (47%) and only 1% of variance was attributable to students, which led to low generalisability across forms (Eρ2 = 0.18). Assessors reported using multiple observations to produce their assessments and were reluctant to harm students by consigning anything negative to writing. They justified the use of a consistent benchmark across time by citing the basic nature of the form or a belief that the 'competencies' assessed were in fact fixed attributes that were unlikely to change. Conclusions: Assessors may purposefully deviate from instructions in order to meet their ethical standards of good assessment. Furthermore, generic competencies may be viewed as intrinsic and fixed rather than as learnable. Implementing a longitudinal WBA programme is complex and requires careful consideration of assessors' beliefs and values. Are assessment practices ethical? This paper shows that longitudinal assessment of competencies may be complicated by assessors' beliefs [ABSTRACT FROM AUTHOR]

Context As electronic health records ( EHRs) are adopted by teaching hospitals, educators must examine how this change impacts trainee development. Objectives We investigate this influence by studying clinician experiences of a hospital's move from paper charts to an EHR. We ask: how does each chart modality present conceptions of time and data interconnections? How do these conceptions affect clinical reasoning? Methods This two-phase, longitudinal study employed constructivist grounded theory. Data were collected at a paediatric teaching hospital before (Phase 1), during and after (Phase 2) the transition from a paper chart to an EHR system. Data collection consisted of field observations (146 hours involving 300 health care providers, 22 patients and 32 patient family members), think-aloud ( n = 13) and think-after ( n = 11) sessions, interviews ( n = 39) and document retrieval ( n = 392). Theories of rhetorical genre studies and visual rhetoric informed analysis. Results In the paper flowsheet, clinicians recorded and viewed patient data in chronologically organised displays that emphasised data interconnections. In the EHR flowsheet, clinicians viewed and recorded individual data points that were largely chronologically and contextually isolated. Clinicians reported that this change resulted in: (i) not knowing the patient's evolving status; (ii) increased cognitive workload, and (iii) loss of clinical reasoning support mechanisms. Conclusions Understanding how patient data are interconnected is essential to clinical reasoning. The use of EHRs supports this goal because the EHR is a tool for collecting dispersed data; however, these collections often deconstruct data interconnections. Where the paper flowsheet emphasises chronology and interconnectedness, the EHR flowsheet emphasises individual data values that are largely independent of time and other patient data. To prepare trainees to work with EHRs, the ways of thinking and acting that were implicitly learned through the use of paper charts must be made explicit. To support clinical reasoning, medical educators should provide lessons in connectivity - the chronologically framed data interconnections upon which clinicians rely to provide patient care. [ABSTRACT FROM AUTHOR]

Objectives: Visual interpretation is essential in many fields of health care. Although diagnostic competency can be measured as an educational outcome, few accounts have addressed tacit aspects of visual interpretation in clinical training; these include the disciplining of the trainee's attentions and the trainee's acculturation into expected styles of communicating visual interpretations to others. This paper describes values and dispositions that are taught to ophthalmology trainees as they learn to reason through visual information, and explores how these qualities are evaluated during residency training. Methods: The project was based on 6 months of ethnographic participant observation and interviews in an ophthalmology residency programme. Observational notes and interview transcripts pertaining to visual interpretation were isolated for qualitative analysis in the tradition of sociocultural anthropology, guided by literature on communication in medical education and the socialisation of health professionals. Results: Residents and faculty members identified visual interpretation as one of the most challenging skills expected of ophthalmology trainees. They expressed a belief that ‘systematic’ approaches, where visual information is parsed in a stepwise fashion, reduce the chance of trainees overlooking or misinterpreting key diagnostic features. This sensory discipline was represented in narrative form when faculty members asked residents to interpret images aloud, as residents were expected to follow prescribed sequences for describing the content of images before commenting on possible diagnoses. Conclusions: Sensory processing is ordinarily opaque to outside observers, but the ritual of describing images in highly regimented narratives allows residents to demonstrate how they gather and reason through visual information. The form of these narratives reflects values that residents are expected to embody during their training, such as being thorough and methodical; it may also serve a pedagogical function by entrenching those values. Further research is needed to characterise how the performance of speech genres shapes the interpretive skills of medical trainees. [ABSTRACT FROM AUTHOR]

Context Health care organisations are increasingly conceptualised as complex, indivisible entities made up of web-like networks of staff that connect to each other in changeable ways. This study draws on the theoretical framework of activity theory and the concept of knotworking to illustrate how health professionals improvise collaboratively to negotiate everyday challenges and contribute positively to patients' health priorities. Objectives The aim of this paper is to contribute to evolving ideas about collective learning, change and improvement in secondary care by exploring how health professionals work and learn together and how this compares with earlier findings from primary care. Methods This study applied a constructionist methodology within the research paradigm of interpretivism. Qualitative data were gathered through 26 hours of observations and 17 field interviews within the natural environment of a working hospital over a 3-month period. The research site encompassed a medical receiving ward, a chronic ward, an out-patient clinic and the connecting corridors. Staff participants included a range of clinical, nursing, ancillary and clerical staff. Results The study found a recurring pattern of spontaneous team forming and interprofessional shared learning to respond to care needs within the hospital as they arise. These are presented in four analytical themes: motion, flux and the unpredictability of 'team spirit'; adaptive, responsive learning through seeing, doing and asking questions; the collective learning gap between doctors and other staff; and frustration, compassion and the desire for improvement. Conclusions Health care professionals in the hospital setting both create and experience complex inclusion and exclusion behaviours that define who is empowered to act with professional authority in any given moment of care. This paper discusses issues of power, the particular exclusion of doctors from interprofessional knotworking, and the greater emphasis on questions as the pivotal aspect of shared collective learning when compared with primary care. [ABSTRACT FROM AUTHOR]

Context We teach judgement in pieces; that is, we talk about each aspect separately (patient, plan, resources, technique, etc.). We also let trainees figure out how to put the pieces together. In complex situations, this might be problematic. Using data from a drawing-based study on surgeons' experiences with complex situations, we explore the notion of 'problem definition' in real-world clinical judgement using the theoretical lens of systems engineering. Methods 'Emergence', the sensitising concept for analysis, is rooted in two key systems premises: that person and context are inseparable and that what emerges is an act of choice. Via a 'gallery walk' we used these premises to perform analysis on individual drawings as well as cross-comparisons of multiple drawings. Our focus was to understand similarities and differences among the vantage points used by multiple surgeons. Results In this paper we challenge two assumptions from current models of clinical judgement: that experts hold a fixed and static definition of the problem and that consequently the focus of the expert's work is on solving the problem. Each situation described by our participants revealed different but complementary perspectives of what a surgical problem might come to be: from concerns about ensuring standard of care, to balancing personal emotions versus care choices, to coordinating resources, and to maintaining control while in the midst of personality clashes. Conclusion We suggest that it is only at the situation and system level, not at the individual level, that we are able to appreciate the nuances of defining the problem when experts make judgements during real-world complex situations. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 455-463 This paper aims to consider why general practitioners (GPs) teach, in particular by defining the longitudinal supervisory relationships between rural clinician-preceptors and students. A total of 41 individual semi-structured interviews were conducted with GPs, practice managers and students. All interviews were audiotaped, transcribed and analysed for emergent themes. In this study preceptors identified many ways in which precepting added value to their roles. However, themes relating to the doctor-student relationship were central to GP preceptors' experiences. These developed in chronological order and resulted in changes in the triangular relationship between doctor, patient and student in the consultation. Interpretive findings identify that the motivators for precepting represent a group of constantly changing interconnected factors that contribute to the defining of preceptors as central members of their professional community of practice. This critical finding challenges the simplistic organisational concept that universities can recruit and retain GPs by offering increased rewards. This paper introduces four clinical preceptor models, which involve the roles of, respectively: the student-observer; the teacher-healer; the doctor-orchestrator, and the doctor-advisor. Symbiosis between student learning and patient care was found to occur in the doctor-orchestrator model. The evolution of doctor-student relationships in long-term student placements explains how students become more useful over the academic year and sheds light on how GPs are changed through precepting as part of the complex process by which they come to recognise themselves as central members of the rural generalist community. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 95-106 One hundred years after the Flexner report remade medical education in North America, many countries are reviewing the purpose and organisation of medical education. In Canada, a national study is being undertaken to define important issues and challenges for the future of medical education. The objectives of this paper are to describe the process of conducting an empirical environmental scan at a national level, and to present the research findings of this scan. Thirty national key informant interviews were conducted, transcribed and coded to identify key themes. Interview data were triangulated with data sourced from 34 commissioned literature reviews and a series of national focus groups. Ten key issues or priorities were identified and used to generate detailed review papers used by the Association of Faculties of Medicine of Canada to create a blueprint for the evolution of medical education. The new priorities have major implications for areas ranging from admissions, curriculum content, educational process and the need to articulate the purpose and responsibilities of medical schools in society. This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44: 864–873 Objectives Ethical reasoning in medicine is not well understood and medical educators often find it difficult to justify what and how they teach and assess in medical ethics. To facilitate the development of moral values and professional conduct, a model of ethical reasoning was created. The purposes of this paper are to describe the ethical reasoning model and to indicate how it can be used to foster moral and ethical behaviours. Methods The ethical reasoning model was created from information derived from two sources: (i) an examination of different ethical models described in the literature, and (ii) think-aloud interviews with ethical experts in Taiwan and Canada. All the components and cognitive steps used by experts in ethical decision making were extracted and categorised. Interview subjects consisted of 16 voluntary ethics experts. The ethical reasoning models reported in the literature were divided into two groups according to whether they were justification-based or task-based models. Neither of the two types represented the ‘whole picture’ of ethical reasoning in medicine. This analysis enabled us to identify five universal cognitive steps and the gaps between ‘logical decision’ and ‘action’. Results The think-aloud interviews verified the multi-dimensional components or steps used by experts when resolving ethical problems. The resulting model, designated the Medical Ethical Reasoning (MER) Model, reflects interactions within three domains: medical and ethical knowledge; cognitive reasoning processes, and attitude. Conclusions The MER Model accurately reflects how doctors resolve ethical dilemmas and is seen to be helpful in identifying what and how educators should teach and assess in ethical reasoning. The model can also serve as a communication framework for curricular design. A ‘humane’ doctor is competent in providing quality, ethical patient care. Making an appropriate ethical decision is the foundation for subsequent ethical behaviours. By contrast with the abundant evidence cited in previous research describing how doctors solve medical problems, there is little empirical evidence indicating how doctors make appropriate ethical decisions. Thus, the cognition of ethical reasoning in medicine is not well understood. This paper represents a step towards overcoming this problem. [ABSTRACT FROM AUTHOR]

Objective The focus of simulation-based education ( SBE) research has been limited to outcome and effectiveness studies. The effect of social and cultural influences on SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical boot camp ( BC). Methods A rapid ethnographic study, employing the theoretical lenses of complexity and activity theory and Bourdieu's concept of 'capital', to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with faculty members ( n = 10, including the lead faculty member, session leaders and junior faculty members) and participants ( n = 19 core surgical trainees and early-stage residents). Results Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytical themes. First, the complexity of the surgical training system and wider health care education context, and how this influenced the development of the BC. Second, participants' views of the BC as a vehicle not just for learning skills but for gaining 'insider information' on how best to progress in surgical training. Finally, the explicit aim of faculty members to use the Scottish Surgical Bootcamp to welcome trainees and residents into the world of surgery, and how this occurred. Conclusions To the best of our knowledge, this is the first empirical study of a surgical BC that takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that a BC is as much about social and cultural processes as it is about individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research. [ABSTRACT FROM AUTHOR]

Context This paper describes the transition processes experienced by Year 3 medical students during their longitudinal integrated clerkship ( LIC). The authors conceptualise the stages that encompass the transition through a LIC. Objectives The purpose of this study was to understand the perspectives of 12 Northern Ontario School of Medicine ( NOSM) Year 3 medical students about their transition process. Methods Data were collected longitudinally through three conversational interviews with each of these students, occurring before, during and after the clerkship. The authors used a guided walk methodology to explore students' everyday lives and elicit insights about the transition process, prompted by the locations and clinical settings in which the clerkship occurred. Results Participants identified three interconnected stages in the transition process: (i) shifting from classroom to clinical learning; (ii) dealing with disorientation and restoring balance, and (iii) seeing oneself as a physician. Interview data provided evidence for the adaptive strategies the participants developed in response to these stages. Conclusions Based on these findings, the transition process during a LIC can be characterised as one of entering the unfamiliar, with few forewarnings about the changes, of experiencing moments of confusion and burnout, and of eventual gains in confidence and competence in the clinical roles of a physician. Recommendations are made regarding future research opportunities to further scholarship on transitions. [ABSTRACT FROM AUTHOR]

Context Health advocacy is often framed as an activity that physicians do for others. A physician uses her expertise to identify and address the health needs of patients or communities on their behalves. As part of a larger study, we uncovered data to suggest that effective health advocates work not just for but often with others to understand and address their health needs. Objectives This paper explores and elaborates the important distinction between advocating with and for others. Methods We interviewed 10 physicians, identified by others as successful health advocates, about their advocacy activities. Informed by constructivist grounded theory, we gathered and evaluated data iteratively, continually revising the interview outline and concurrently refining our evolving themes. Once it had stabilised, the coding scheme was applied to the full set of transcripts. Results Health advocacy was framed by participants as an activity that was more often done with others, than for others. This manifested in two ways: (i) joining other voices: rather than always feeling a need to plan and act alone, our participants often described making efforts to find and join existing initiatives and to work collaboratively, and (ii) amplifying other voices: rather than authoritatively determining needs and enacting solutions on behalf of others, our participants often described making efforts to empower others to find their own voices, thereby fostering autonomy rather than reliance. Participants described factors and mechanisms that enabled them to approach advocacy in this manner. Conclusions Successful health advocates often enact health advocacy with others, rather than exclusively for them. This partnership-based facilitative approach enables them to better appreciate the needs of those requiring support, and to ask: 'How can I help?' If this approach were more effectively reflected in formal constructions of the process, health advocacy might not only be practised more effectively, but might also be perceived as more achievable by trainees and physicians. [ABSTRACT FROM AUTHOR]

Context The purpose of this paper is to provide a critical analysis of a mobile research method, the guided walk, and its potential suitability in medical education research. Methods The Northern Ontario School of Medicine's ( NOSM) longitudinal integrated clerkship served as the research context in which the guided walk method was used to explore the lived experiences of 12 Year 3 medical students undertaking their clerkship in one of eight different communities across Northern Ontario, Canada. Informed by the social constructivist research paradigm, the guided walk method was employed to answer the research question: how do Year 3 medical students at NOSM describe their clerkship experiences as encountered in their placement and living contexts? Through an inductive thematic analysis of the data, the findings provided a rich description of the guided walk from the participants' and the researcher's perspectives. Results There were significant advantages to using the guided walk rather than other types of qualitative research approaches. The guided walk made it easier for participants to take part in the study, provided context-rich research interactions, and led to serendipitous encounters for both participants and the first author. There were also challenges and limitations associated with the guided walk method. For example, this method carries inherent challenges with reference to the safeguarding of confidentiality and anonymity for both participants and those encountered during the walk. Conclusions The guided walk method is promising within medical education, particularly for researchers seeking to gain participants' stories in the contexts to which they refer. This method may be appropriate for use in medical education research in areas such as the evaluation and assessment of a student's clinical decision-making skills and competency development, as well as the consolidation of strategies to manage ethical and professional dilemmas. [ABSTRACT FROM AUTHOR]

Context This paper explores how structured feedback and other features of workplace-based assessment ( WBA) impact on medical students' learning in the context of an evaluation of a workplace-based performance assessment: the teamwork mini-clinical evaluation exercise ( T- MEX). The T- MEX enables observation-based measurement of and feedback on the behaviours required to collaborate effectively as a junior doctor within the health care team. The instrument is based on the mini-clinical evaluation exercise (mini- CEX) format and focuses on clinical encounters such as consultations with medical and allied health professionals, discharge plan preparation, handovers and team meetings. Methods The assessment was implemented during a 6-week period in 2010 with 25 medical students during their final clinical rotation. Content analysis was conducted on the written feedback provided by 23 assessors and the written reflections and action plans proposed by the 25 student participants (in 88 T- MEX forms). Semi-structured interviews with seven assessors and three focus groups with 14 student participants were conducted and the educational impact was explored through thematic analysis. Results The study enabled the identification of features of WBA that promote the development of collaborative competencies. The focus of the assessment on clinical encounters and behaviours important for collaboration provided opportunities for students to engage with the health care team and highlighted the role of teamwork in these encounters. The focus on specific behaviours and a stage-appropriate response scale helped students identify learning goals and facilitated the provision of focused feedback. Incorporating these features within an established format helped students and supervisors to engage with the instrument. Extending the format to include structured reflection enabled students to self-evaluate and develop plans for improvement. Conclusions The findings illuminate the mechanisms by which WBA facilitates learning. The educational features highlighted include effectively structured feedback processes, support for situated learning, a positive backwash (facilitation of learning through preparation for the assessment), and facilitation of informed self-assessment. [ABSTRACT FROM AUTHOR]

Objectives There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement. Methods Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs). Results In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity. Conclusions Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning. [ABSTRACT FROM AUTHOR]

Context Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research. Methods This paper introduces phenomenography as a viable qualitative approach for use in medical education research. Results A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education. Conclusion We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change. [ABSTRACT FROM AUTHOR]

Introduction Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and human-material interaction. Methods A qualitative design was adopted employing video- and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short individual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted. Results Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical/health belief talk. With reference to para-language, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope. Conclusions Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student-patient-doctor relationship within bedside teaching. [ABSTRACT FROM AUTHOR]

Context Authentic early experience (AEE) describes experiences provided to new medical students to undertake 'human contact' to enhance learning. Although the concept of AEE is not new, and was commonplace prior to the Flexner Report of 1910, little is known about how or why meaning and knowledge are constructed through early student placements in medical, social and voluntary workplaces. Variance among settings means AEE is a collection of non-uniform, complex educational interventions which require students to make repeated transitions between different workplaces and their university institution. The purpose of this paper is to develop theory in this context. Methods We report on a study undertaken in a UK medical school using interviews and discussion groups to generate data from students, workplace supervisors and school faculty staff. We used narrative analysis to access knowledge and meaning construction, in combination with analytic tools drawn from thematic and interpretative approaches to phenomena. We sought to refine theoretical understanding through the application of mētis, a socio-cultural theory novel to the field of medical education. Results Scott's concept of mētis provides a useful theoretical framework for understanding how AEE works for students in terms of their creation of meaning and how they choose to use it in relation to formally recognised knowledge. Knowledge and meaning, generated as a consequence of AEE, contained dichotomies and paradoxes. Students improvised, in the face of unpredictability and uncertainty, to create a form of mētis that allowed them to handle the perceived competing demands of AEE settings and the medical school. Discussion We demonstrate how meaning making can be conceived of as student mētis arising from social processes in students' learning interactions. We suggest that the development of collaborative working with students could potentiate positive forms of student mētis, thereby maximising desirable educational consequences. Further work is required to establish effective ways to do this. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 953-962 Objectives Affective organisation commitment, which refers to a psychological attachment to, and involvement with, an employing institution, is regarded as important because of its effects on employee identification with the employer and its causal effects on work effort and staff retention. This paper explores the experiences of casual tutors facilitating problem-based learning (PBL) tutorials and aims to identify aspects of their role that strengthen and detract from employee job satisfaction and affective commitment. Methods Qualitative data were gathered from first- and second-year tutors ( N = 13) through 2 focus groups. Both clinicians and non-clinicians were recruited, including highly experienced staff and those with < 12 months of tutoring experience. Results Four main themes arose from inductive analysis of data: job-related factors; job-involvement characteristics; professional challenges and responsibilities, and mentoring for learning and support. The first 2 themes are congruent with previous literature on organisation commitment; novel findings include the supportive and compensatory nature of the collegial relationships formed between casual tutors. Role attenuation, a job-related factor, was a predominant perception as it related to dysfunctional groups and increasing student disengagement with PBL. Conclusions Within the unique learning environment of PBL, positive factors relating to job satisfaction may have an important role to play in improving tutors' commitment to their employing organisation. Aspects of the role which are viewed most negatively and relate most significantly to affective commitment need to be addressed promptly. Attention should be directed to supporting tutors to maximise the perceived benefits and providing professional development and improved communication to better address issues associated with difficult or disengaged students as well as isolation from decision-makers. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 869-877 Objectives In order to be relevant and impactful, our research into health care teamwork needs to better reflect the complexity inherent to this area. This study explored the complexity of collaborative practice on a distributed transplant team. We employed the theoretical lenses of activity theory to better understand the nature of collaborative complexity and its implications for current approaches to interprofessional collaboration (IPC) and interprofessional education (IPE). Methods Over 4 months, two trained observers conducted 162 hours of observation, 30 field interviews and 17 formal interviews with 39 members of a solid organ transplant team in a Canadian teaching hospital. Participants included consultant medical and surgical staff and postgraduate trainees, the team nurse practitioner, social worker, dietician, pharmacist, physical therapist, bedside nurses, organ donor coordinators and organ recipient coordinators. Data collection and inductive analysis for emergent themes proceeded iteratively. Results Daily collaborative practice involves improvisation in the face of recurring challenges on a distributed team. This paper focuses on the theme of 'interservice' challenges, which represent instances in which the 'core' transplant team (those providing daily care for transplant patients) work to engage the expertise and resources of other services in the hospital, such as those of radiology and pathology departments. We examine a single story of the core team's collaboration with cardiology, anaesthesiology and radiology services to decide whether a patient is appropriate for transplantation and use this story to consider the team's strategies in the face of conflicting expectations and preferences among these services. Conclusions This story of collaboration in a distributed team calls into question two premises underpinning current models of IPC and IPE: the notion that stable professional roles exist, and the ideal of a unifying objective of 'caring for the patient'. We suggest important elaborations to these premises as they are used to conceptualise and teach IPC in order to better represent the intricacy of everyday collaborative work in health care. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 748-756 Context Capacity-building programmes in low-income countries (LICs) are subject to a tension between the requirement to best train workers to fulfil national needs and the requirement to meet international expectations of their students, academics and institutions. This paper presents a theoretical framework developed from a case study of an undergraduate degree programme in Malawi and explores how national needs and international expectations can be managed in health profession settings in LICs to ensure successful curriculum development. Methods An inductive qualitative methodology, grounded theory, combined with open-ended interviews with students, graduates, tutors and external stakeholders in the programme, was used to develop a theoretical framework. Results A total of 22 interviews were performed; their analysis conceptualised the tension between national needs and international expectations, and resulted in 12 codes, in four categories: competing and advancing agendas; processes of collaboration; developing a programme or professional identity, and perceptions of programme change. Conclusions This study describes a conceptual framework highlighting three particular areas for analysis to aid in understanding how to best manage competing agendas. These areas refer to, respectively, the significance of international expectations, the organisational climate, and the development of a professional identity. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1251-1261 Objectives Professional status and working arrangements can inhibit doctors from acknowledging and seeking care for their own ill health. Research identifies that a culture of immunity to illness within the medical profession takes root during training. What happens when trainee doctors become unwell during their formative period of education and training? What support do they receive and how do they perceive that the experience of ill health affects their training trajectory? These research questions were developed by a multidisciplinary team of researchers and health professionals, who adopted a qualitative approach to investigate the experiences of personal illness among trainees in their Foundation Programme (FP) years. Methods Semi-structured interviews were conducted with eight FP trainees from the Severn Deanery in southwest England who had experienced significant illness. Interpretative phenomenological analysis was used to conduct and analyse the interviews, resulting in a comprehensive list of master themes. This paper reports an interpretative analysis of the themes of Support, Illness Experience, Crossing the Line, Medical Culture, Stigma and Disclosure. Results Ineffective communication within the medical education and employment system underpins many of the difficulties encountered by trainees who are unwell. Coping style plays a key role in predicting how trainees experience support during and after their illness, although this may be influenced by their particular diagnoses. The barriers to disclosure of their illnesses are discussed within the context of mobilising and maintaining support. Concern about the impact of missing training as a result of ill health appears to be significant in the transmitting of an ethos of invulnerability within the medical culture. Conclusions Suggestions to improve support procedures for trainees who are unwell include the provision of greater flexibility within the rotation system along with independent pastoral support. Promoting the importance of disclosing significant illness as early as possible might go some way towards challenging the culture of invulnerability to illness that prevails among doctors. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1041-1047 Context UK medical school traditional selection processes are faltering in their ability to distinguish among highly qualified candidates. New methods of selection, including the UK Clinical Aptitude Test (UKCAT), herald a new era in which candidates are selected on aptitude and also aim to widen participation. However, the predictive validity of UKCAT and its role in the selection process are yet to be defined. This paper examines current selection practices and questions the role that such an aptitude test may take. Objective This study is intended to determine whether UKCAT can select suitable candidates for interview. Methods The study was designed to determine whether selectors rejected fewer candidates with high rather than low UKCAT scores using routine selection techniques. Selector rejection rates for 812 candidates with high UKCAT scores and 200 candidates with low UKCAT scores were compared. Additionally, any relationships among UKCAT and subsequent interview performance scores were explored by examining the correlation coefficients between overall and component UKCAT and interview scores for 637 candidates with high UKCAT scores. Results The rejection rate before interview of candidates with low UKCAT scores was 2.7 times that of candidates with high UKCAT scores. However, no relationship between overall UKCAT score and overall interview score existed within a pre-selected cohort of applicants with high UKCAT scores (Kendall's correlation coefficient, tau b = − 0.004; p = 0.88). Conclusions UKCAT can facilitate the independent selection of appropriate candidates for interview when used as described. However, UKCAT is not predictive of success at interview. The long-term predictive validity of UKCAT is currently under investigation. Therefore, we conclude that UKCAT is best viewed as a useful adjunct to current selection processes. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 995-1005 Context A particularly onerous aspect of the transition from medical student to practising doctor concerns the necessity to be able to rapidly identify acutely unwell patients and initiate appropriate resuscitation. These are skills in which many graduates feel poorly prepared and are considered by some to be best learned on the job. This constructivist study investigated the factors that influence the behaviour of junior doctors in this context and initiated the development of a framework that promotes understanding of this important area. Methods Focus groups involving 36 clinicians with a variety of clinical experience were conducted and analysed using a qualitative, grounded theory approach. The complex relationships between emergent themes guided the development of a framework that was refined and validated by further interviews with participants. Results Six main themes, grouped under three broad headings, emerged from the data: 'transferring knowledge into practice' and 'decision making and uncertainty' (cognitive challenges); 'acts and omissions' and 'identity and expectations' (roles and responsibilities), and, finally, 'the medical hierarchy' and 'performing under stress' (environmental factors). The framework presented within this paper illustrates the complex relationships between these factors. Conclusions Although the potential of metacognitive strategies to reduce medical error is acknowledged, the framework promotes looking beyond the individual to consider the contributions to patient safety of identity issues, role uncertainty and the hierarchical clinical environment. A more distributed approach to situation awareness may help junior doctors to better tolerate complexity and uncertainty. The efficacy of simulation as an educational strategy may be improved by finding ways to recreate the hierarchical and stressful environment in which junior doctors practise. Junior doctors should be aware of the impact of affect and emotion on behaviour, and clinical supervisors should strive to ensure that roles and responsibilities are explicitly discussed. [ABSTRACT FROM AUTHOR]

Medical Education 2011:: 748-755 Research activity is not a mandatory component of medical education in many developing countries, including Brazil, although such experiences can have a positive impact on the quality of medical education. The interest and involvement of medical students in research and the barriers they face in accessing research training in developing countries have not been adequately addressed. We sought to assess the availability of scientific training programmes in Brazilian medical schools, the degree of involvement of medical students in these programmes, the main barriers to student involvement in research and possible reasons for the lack of scientific training programmes. This study examined 13 medical programmes conducted in six Brazilian states. A total of 1004 medical students were interviewed. We evaluated the availability of scientific training in the institutions attended by these students, the participation of the students in such activities and students' reasons for not joining such programmes based on student answers to our questionnaire. Although only 7% of the medical students expressed no interest in research, only 60% of them were involved in research training. Students regarded a lack of institutional incentive as the most significant barrier to their participation in research activities. Other significant barriers included defective infrastructure and insufficient time available for professors to mentor undergraduate students. According to the feedback from the students, eight of the 13 schools investigated featured structured programmes for scientific training. However, a mean of only 47% of students participated in scientific training programmes on their campuses and 13% of students were compelled to pursue such activities off-campus. Although scientific training during medical education in Brazil is still less frequent than expected, most of the students were interested in research activities. The barriers to undergraduate scientific training described in this paper may help the Brazilian government improve research training in medical schools. These issues might also be explored in other developing countries. [ABSTRACT FROM AUTHOR]

Medical Education 2011; : 585-602 Rather than merely acting professionally, medical students are expected to become professionals. Developing an embodied professional persona is not straightforward as there is no single perspective of what medical professionalism comprises. In the context of this confusion, medical educationalists have been charged with developing a professionalism curriculum that emphasises, supports and measures students' professionalism. This paper focuses on medical students' discourses of medical professionalism in order to understand the means through which students conceptualise professionalism. Discourse analysis was undertaken. Two hundred students from three medical schools (in England, Australia and Wales) participated in 32 group and 22 individual interviews. Students' explicit definitions of professionalism were inductively coded according to the dimensions of professionalism they identified ( n = 19) and the discourses of professionalism they used ( individual, collective, interpersonal, complexity). Connections were explored between pre-clinical and clinical students' understandings of professionalism across the schools and the respective policies, documents and teaching opportunities available to them. Understandings of professionalism differed between pre-clinical and clinical students and between schools with different approaches to professionalism education. Students who experienced early patient interaction and opportunities to engage in conversations about professionalism within clinician-led small groups demonstrated complex, embodied understandings of professionalism, drawing on all four discourses. Students who learned predominately through lectures used a restricted range of discourses and focused on dressing or acting like a professional. Providing students with opportunities to engage in active sense-making activities within the formal professional curriculum can encourage an embodied and sophisticated understanding of professionalism. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44: 1095-1104 Objectives Comprehensive programme evaluation frameworks are increasingly important to inform the development of sophisticated programmes that educate the next generation of health professions education researchers. This paper highlights an innovative process undertaken by the Wilson Centre for Research in Education to evaluate its fellowship programme. This process incorporates the principles of programme theory and a framework drawn from the field of organisational development. Methods During the iterative and dynamic process of articulating the programme's theory, a hidden tension between structured and unstructured components of the fellowship programme was unearthed. This necessitated a secondary process beyond traditional programme evaluations involving the use of a method called 'Polarity Management®'. Results The use of this model allowed the team to identify priority actions for balancing both the structured and unstructured components, along with indicators which can serve as an early warning system to alert observers to any imbalance between the components. Discussion Lessons learned and implications for other health education programming and the practice of programme evaluation are discussed. [ABSTRACT FROM AUTHOR]

Context The McGill University Faculty of Medicine undertook a pilot, simulation-based multiple mini-interview (MMI) for medical school applicant selection, which ran simultaneously with traditional unstructured interviews (all applicants underwent both processes). This paper examines major stakeholder (applicants and evaluators) opinions towards the MMI compared with traditional interviews, including perceptions about the feasibility and utility of the MMI. Methods A total of 100 candidates applying to McGill University Medical School were enrolled in the pilot comparison of the MMI with the traditional, unstructured interview. Applicants’ opinions were obtained by questionnaire shortly after the process (for all applicants) and approximately 6 months after the interviews (for non-accepted applicants). Evaluators’ perceptions were also surveyed. Questionnaires contained both quantitative items and space for qualitative impressions. Descriptive statistics, repeated measures analysis of variance (manova) and analysis of the topics raised in written comments were conducted. Results Univariate analyses of response scores revealed statistically significant differences, with the MMI rated more highly than the traditional interview on fairness, imposition of stress and effectiveness as a measurement tool. Compared with the traditional interview, applicants also felt the MMI: (i) allowed them to be competitive; (ii) was enjoyable, and (iii) was often a favourite part of their interview experience. It should be noted that applicants were aware that their MMI score would be included in their overall interview rating. Written comments were positive with regard to, for example, fairness, the provision of opportunities to show one’s strengths, and appreciation of the fidelity of the simulations. Evaluators’ responses were in agreement with applicants’ responses, albeit that overall they expressed more caution about the MMI. Conclusions Results suggest the MMI is a promising selection tool from the point of view of both applicants and evaluators. Both groups expressed concerns, but overall the response was favourable for the MMI in comparison with traditional interviews, and the MMI has been adopted by McGill University’s medical school. [ABSTRACT FROM AUTHOR]

Context The multiple mini-interview (MMI) was used to measure professionalism in international medical graduate (IMG) applicants for family medicine residency in Alberta for positions accessed through the Alberta International Medical Graduate (AIMG) Program. This paper assesses the evidence for the MMI’s reliability and validity in this context. Methods A group of 71 IMGs participated in our 12-station MMI designed to assess professionalism competency. A 10-point scale evaluated applicants on ability to address the objectives of the situation, interpersonal skills, suitability for a residency and for family medicine, and overall performance. We conducted generalisability and decision studies to assess the reliability of MMI scores. We assessed the validity by examining the differences in MMI scores associated with session, track and socio-demographic characteristics of applicants and by measuring the correlations between MMI scores and scores on compulsory examinations, including the AIMG objective structured clinical examination, the Medical Council of Canada Evaluating Examination (MCCEE) and the Medical Council of Canada Qualifying Examination Part I (MCCQE I). We measured the correlation between MMI and non-requisite MCCQE Part II (MCCQE II) scores that were provided. Results The reliability as indicated by the generalisability coefficient associated with average station scores was 0.70 with one interviewer per station. There were no statistically significant differences in total MMI scores or mean station sum scores based on session, track, applicant age, gender, years since medical school completion, or language of medical school. There were low, non-significant correlations with OSCE overall ( r = 0.15), MCCEE ( r = 0.01) and MCCQE I ( r = 0.06) scores and a higher non-significant correlation with MCCQE II scores ( r = 0.33). Conclusions There is evidence that the MMI offers a reliable and valid assessment of professionalism in IMG doctors applying for Canadian family medicine residencies and that this clinically situated MMI assessed facets of competency other than those assessed by the OSCE. [ABSTRACT FROM AUTHOR]

The article discusses the paper by DiCicco-Bloom and Crabtree which provides a valuable overview of the methodological advantages of employing qualitative interviews as an approach to data collection. The authors suggest that qualitative interviews are important in generating rich, in-depth data that promote understanding of complex social, behavioral and educational issues. The paper and other contributions in the "Making Sense of Qualitative Research" series show the growing use and acceptability of qualitative methodologies within the medical education community.