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Drawing Connections between four papers, the authors explore how recent writing demonstrates various ways of conceptualizing globalisation in our field, begging the question of "where next for globalization research in #MedEd?" [ABSTRACT FROM AUTHOR]

Context: There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo‐sociocultural pattern during undergraduate medical training. Methods: Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross‐sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations. Results: The studies reviewed indicate similar patterns of empathy change within approximate geo‐sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course. Conclusions: These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct. Does empathy change during medical school? The authors review the literature and report an emerging geo‐sociocultural pattern across different parts of the world. [ABSTRACT FROM AUTHOR]

An opinion piece is presented in which the authors discuss an article in the issue on attitudes expressed by Taiwanese medical students towards gender in their online discussions. Topics discussed include the so-called hidden curriculum in medical education, institutional culture at medical schools, and the ways in which discourses of gender impact who has power in a social context.

Context Ethnic minority students find that their ethnicity negatively affects the evaluation of their capacities and their feelings in medical school. This study tests whether ethnic minority and majority students differ in their 'self‐regulatory focus' in clinical training, that is, their ways to approach goals, due to differences in social learning experiences. Self‐regulatory focus consists of a promotion and prevention focus. People who are prone to stereotypes and unfair treatments are more likely to have a prevention focus and conceal certain identity aspects. The objectives of the study are to test whether ethnic minority students, as compared with ethnic majority students, are equally likely to have a promotion focus, but more likely to have a prevention focus in clinical training due to more negative social learning experiences (Hypothesis 1), and whether the relationship between student ethnicity and clinical evaluations can be explained by students' gender, social learning experiences, self‐regulatory focus and impression management (Hypothesis 2). Methods: Survey and clinical evaluation data of 312 (71.2% female) clerks were collected and grouped into 215 ethnic majority (69.4%) and 95 ethnic minority students (30.6%). Students' social learning experiences were measured as perceptions of unfair treatment, trust in supervisors and social academic fit. Self‐regulatory focus (general and work specific) and impression management were also measured. A parallel mediation model (Hypothesis 1) and hierarchical multiple regression analyses were used (Hypothesis 2). Results: Ethnic minority students had higher perceptions of unfair treatment and lower trust in their supervisors in clinical training. They were more prevention focused in clinical training, but this was not mediated by having more negative social learning experiences. Lower clinical evaluations for ethnic minority students were unexplained. Promotion focus in clinical training and trust in supervisors positively relate to clinical grades. Conclusion: Student ethnicity predicts social learning experiences, self‐regulatory focus and grades in clinical training. The hidden curriculum plausibly plays a role here. van Andel et al. demonstrate that systematic differences between ethnic minority and majority students can be predicted based on social learning experiences, self‐regulatory focus and clinical grades. [ABSTRACT FROM AUTHOR]

Context: Gender inequality remains prevalent worldwide in academic medicine. A closer look into women physicians’ gendered experiences through the lens of culture is necessary to advance understanding of gender inequality in this context. Relatively few studies, however, have investigated how social and cultural practices implicitly yet significantly affect gender inequality throughout women physicians’ careers. Objectives: This study aimed to investigate the lived experiences of South Korean women physicians working in academic medicine and to focus on social and cultural influences on the gendered process of their career journeys. The study will extend our understanding of gender inequality in academic medicine through an in‐depth analysis of social and cultural practices that affect the phenomenon. Methods: We conducted a qualitative study utilising a grounded theory approach. Twenty‐one women physicians participated in semi‐structured interviews. Data were recorded, transcribed and analysed through a process of constant comparison using grounded theory to extract themes. Results: Junior women physicians were more vulnerable to gender discrimination and channelled to ‘ghettos’ through the seniority‐based, patriarchal, collectivist and business hospital culture in South Korea. Under pressure to excel at work, they had no work–family balance and experienced identity crises as competent doctors and mothers. They felt themselves to be ‘othered’ in multiple cultural contexts, including school ties, rankism and a culture of after‐work gatherings. Minimal levels of leadership aspiration created a vicious cycle of a lack of social networking and mentoring. Pursuing individual excellence, they attributed their struggles to personal choices and rarely sought organisational support. Conclusions: The dynamics of cultural and social practices constantly and implicitly recreate mechanisms to maintain gender inequality in academic medicine in South Korea. Planned culture changes at individual, organisational and national levels are imperative to discontinue the vicious cycle that exists in the labyrinth of women physicians’ career development in academic medicine. [ABSTRACT FROM AUTHOR]

Context: Single‐best‐answer questions (SBAQs) have been widely used to test knowledge because they are easy to mark and demonstrate high reliability. However, SBAQs have been criticised for being subject to cueing. Objectives: We used a novel assessment tool that facilitates efficient marking of open‐ended very‐short‐answer questions (VSAQs). We compared VSAQs with SBAQs with regard to reliability, discrimination and student performance, and evaluated the acceptability of VSAQs. Methods: Medical students were randomised to sit a 60‐question assessment administered in either VSAQ and then SBAQ format (Group 1, n = 155) or the reverse (Group 2, n = 144). The VSAQs were delivered on a tablet; responses were computer‐marked and subsequently reviewed by two examiners. The standard error of measurement (SEM) across the ability spectrum was estimated using item response theory. Results: The review of machine‐marked questions took an average of 1 minute, 36 seconds per question for all students. The VSAQs had high reliability (alpha: 0.91), a significantly lower SEM than the SBAQs (p < 0.001) and higher mean item–total point biserial correlations (p < 0.001). The VSAQ scores were significantly lower than the SBAQ scores (p < 0.001). The difference in scores between VSAQs and SBAQs was attenuated in Group 2. Although 80.4% of students found the VSAQs more difficult, 69.2% found them more authentic. Conclusions: The VSAQ format demonstrated high reliability and discrimination and items were perceived as more authentic. The SBAQ format was associated with significant cueing. The present results suggest the VSAQ format has a higher degree of validity. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Why Women Go to Medical College But Fail to Practise Medicine: Perspectives From the Islamic Republic of Pakistan" by F. Moazam and S. Shekhani. They discuss the impact of sociocultural mores, values and gender norms on the ability of women to practice medicine. They explain the need of medical educators and other stakeholders to ensure that measures are put in place to enable women in medicine to maximize their potential.

Medical Education 2012: 46: 887-893 Objectives In this qualitative study we examine how teachers' egalitarian or discriminatory behaviours and values at odds with those of the individual learner or the institution are perceived and absorbed by students, and how this hidden curriculum shapes the doctors students become. Methods During 2011, a total of 120 randomly selected medical students from each class at three Canadian medical schools were electronically asked for examples of teachers' words, attitudes or behaviours that discriminated against or promoted equality towards a group or groups of doctors or patients. We examined the content of participants' examples of unexpected messages and their reactions to these. Responses were aggregated, sorted and coded for conceptual themes. An independent qualitative researcher repeated the analytic process and then engaged in discussion with us to reach consensus on themes and meanings. Results The 76 (63%) respondents noted that attitudes in keeping with universally held, institutional values of equality towards, for example, homosexuals or marginalised populations were expressed, but also described role-modelling at odds with this. Patient characteristics such as obesity, drug abuse, mental illness and poverty were presented as signs of individual weakness or moral failing. Some teachers assumed immigrant status based on a student's or patient's skin colour or last name. Respondents described how women in medicine were maligned as potential surgeons and were expected to put family before career. Teachers denigrated doctors from specialties other than their own. Students reacted to discordant role-modelling by challenging, dissociating themselves, with silence or with confusion followed by attempts at individual transformation to realign careers and behaviours with those of teachers. Conclusions When teaching contradicts institutional or learners' values, or is particularly inspiring, students notice and may be influenced to the extent that they rethink personal beliefs and plans to fit their future doctor selves to these models. [ABSTRACT FROM AUTHOR]

Background Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education. Framework and practice paradoxes We offer a framework for an explicit education of perceptual discrimination in the visual domain as a form of practice ‘artistry’, turning a surface ‘looking’ into a deeper ‘seeing’. Such an education, however, raises certain paradoxes. While novices typically ‘see’ what they expect to see in visual images (sign and symptom), experts also make similar errors. Further, experts become familiar with the use of visual heuristics in diagnosis, such as vivid natural referents to aid in rapid pattern recognition in an encompassing diagnostic ‘glance’, yet this appears to defeat the first principle of describing what you see. Employing a model of imagination as a tacit form of knowing that ‘prepares’ and enhances perception, we suggest, however, that the judicious use of such heuristics can be positive. Moreover, the mechanics of the process of clinical judgement in visual domains can be detailed to inform educational agendas. A further paradox is that of experts using both idiosyncratic heuristics and protocol-driven practices, where these seem to offer contradictory approaches to gaining knowledge. We recognise this as a facet of medicine's inherent uncertainty, in the face of complex, ambiguous and unique material, that must be addressed through clinical education. Conclusion We equate ‘aesthetics’ with ‘sensibility’ and describe clinical expertise as ‘connoisseurship’ of informational images. Such connoisseurship, a particular form of knowing, can, in turn, be defined as an aesthetic sensibility informing practice artistry. It can be articulated and analysed to provide a basis for educational enhancement. Connoisseurship is not a technical-rational procedure but is inherently paradoxical and such paradox may be valued as an educational resource, rather than seen as a hindrance. [ABSTRACT FROM AUTHOR]

The article highlights evidence and experiences as the indicators of knowledge which should be integrated with empathy and integrity in order to achieve best outcomes. It states that knowledge compensate for poor communication skills which acknowledges clinical errors. It also offers information on hidden curriculum and its role in shaping learning rather than the institutional values.