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This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the challenges in proofreading a manuscript. Emerging researchers might think that someone in the production team will catch any errors. This may not always be the case. We emphasize the importance of guiding mentees to take the process of preparing a manuscript for submission seriously.

Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the question of co-first authorship bearing in mind the why, when and how of this consideration as well as the potential consequences. This guidance should help authors and mentors when this situation arises.

There is increasing interest in the use of ethnography as a qualitative research approach to explore, in depth, issues of culture in health professions education (HPE). Our specific focus in this article is incorporating the digital into ethnography. Digital technologies are pervasively and increasingly shaping the way we interact, behave, think, and communicate as health professions educators and learners. Understanding the contemporary culture(s) of HPE thus means paying attention to what goes on in digital spaces. In this paper, we critically consider some of the potential issues when the field of ethnography exists outside the space time continuum, including the need to engage with theory in research about technology and digital spaces in HPE. After a very brief review of the few HPE studies that have used digital ethnography, we scrutinize what can be gained when ethnography encompasses the digital world, particularly in relation to untangling sociomaterial aspects of HPE. We chart the shifts inherent in conducting ethnographic research within the digital landscape, specifically those related to research field, the role of the researcher and ethical issues. We then use two examples to illustrate possible HPE research questions and potential strategies for using digital ethnography to answer those questions: using digital tools in the conduct of an ethnographic study and how to conduct an ethnography of a digital space. We conclude that acknowledging the pervasiveness of technologies in the design, delivery and experiences of HPE opens up new research questions which can be addressed by embracing the digital in ethnography.

INTRODUCTION:Two developing forces have achieved prominence in medical education: the advent of competency-based assessments and a growing commitment to expand access to medicine for a broader range of learners with a wider array of preparation. Remediation is intended to support all learners to achieve sufficient competence. Therefore, it is timely to provide practical guidelines for remediation in medical education that clarify best practices, practices to avoid, and areas requiring further research, in order to guide work with both individual struggling learners and development of training program policies. METHODS:Collectively, we generated an initial list of Do's, Don'ts, and Don't Knows for remediation in medical education, which was then iteratively refined through discussions and additional evidence-gathering. The final guidelines were then graded for the strength of the evidence by consensus. RESULTS:We present 26 guidelines: two groupings of Do's (systems-level interventions and recommendations for individual learners), along with short lists of Don'ts and Don't Knows, and our interpretation of the strength of current evidence for each guideline. CONCLUSIONS:Remediation is a high-stakes, highly complex process involving learners, faculty, systems, and societal factors. Our synthesis resulted in a list of guidelines that summarize the current state of educational theory and empirical evidence that can improve remediation processes at individual and institutional levels. Important unanswered questions remain; ongoing research can further improve remediation practices to ensure the appropriate support for learners, institutions, and society.

Medical schools worldwide undertake widening access (WA) initiatives (e.g. pipeline, outreach and academic enrichment programmes) to support pupils from high schools which do not traditionally send high numbers of applicants to medicine. UK literature indicates that pupils in these schools feel that their teachers are ill-equipped, cautious or even discouraging towards their aspiration and/or application to medicine. This study aimed to explore teachers' perspectives and practices to include their voice in discussions and consider how medical schools might best engage with them to facilitate WA. Interviews were conducted with high school teachers in three UK regions, working in schools targeted by WA initiatives. Data were analysed thematically using template analysis, using a largely data-driven approach. Findings showed that although medicine was largely seen as a prestigious and worthwhile career, teachers held reservations about advocating this above other choices. Teachers saw it as their role to encourage pupils to educate themselves about medicine, but to ultimately allow pupils to make their own decisions. Their attitudes were influenced by material constraints in their schools, and the perception of daunting, long and emotionally difficult admissions requirements, with low chances of success. Medical schools may wish to work with teachers to understand their hesitations and help them develop the mindset required to advocate a challenging and unfamiliar career, emphasising that this encouragement can further the shared goal of empowering and preparing pupils to feel capable of choosing medicine. Reciprocally, medical schools should ensure pupils have fair opportunities for access, should they choose to apply.

Introduction: Discourse analysis has been used as an approach to conducting research in health professions education (HPE) for many years. However, because there is no one 'right' interpretation of or approach to it, quite what discourse analysis is, how it could or should be used, and how it can be appraised are unclear. This ambiguity risks undermining the trustworthiness and coherence of the methodology and any findings it produces. Method: A meta‐study review was conducted to explore the current state of discourse analysis in HPE, to guide researchers engaging using the methodology and to improving methodological, analytical and reporting rigour. Structured searches were conducted, returns were filtered for inclusion and 124 articles critically analysed. Results: Of 124 included articles, 64 were from medical education, 51 from nursing and 9 were mutli‐disciplinary or from other HPE disciplines. Of 119 articles reporting some sort of data, 50 used documents/written text as the sole data source, while 27 were solely based on interview data. Foucault was the most commonly cited theorist (n = 47), particularly in medical education articles. The quality of articles varied: many did not provide a clear articulation what was meant by discourse, definitions and methodological choices were often misaligned, there was a lack of detail regarding data collection and analysis, and positionality statements and critiques were often underdeveloped or absent. Discussion: Seeking to address these many lacunae, the authors present a framework to facilitate rigorous discourse analysis research and transparent, complete and accurate reporting of the same, to help readers assess the trustworthiness of the findings from discourse analysis in HPE. Scholars are encouraged to reflect more deeply on the applications and practices of discourse analysis, with the ultimate aim of ensuring more breadth and depth when using discourse analysis for understanding and constructing meaning in our field. Discourse analysis in #HPE lacks clarity and consistency, risking its trustworthiness. This meta‐study revealed quality and methodological misalignments, leading to a framework to enhance rigor and transparency. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion The medical school selection literature comes mostly from a few countries in the Global North and offers little opportunity to consider different ways of thinking and doing. Our aim, therefore, was to critically consider selection practices and their sociohistorical influences in our respective countries (Brazil, China, Singapore, South Africa and the UK), including how any perceived inequalities are addressed.This paper summarises many constructive dialogues grounded in the idea of he er butong (和而不同) (harmony with diversity), learning about and from each other.Some practices were similar across the five countries, but there were differences in precise practices, attitudes and sociohistorical influences thereon. For example, in Brazil, South Africa and the UK, there is public and political acknowledgement that attainment is linked to systemic and social factors such as socio‐economic status and/or race. Selecting for medical school solely on prior attainment is recognised as unfair to less privileged societal groups. Conversely, selection via examination performance is seen as fair and promoting equality in China and Singapore, although the historical context underpinning this value differs across the two countries. The five countries differ in respect of their actions towards addressing inequality. Quotas are used to ensure the representation of certain groups in Brazil and regional representation in China. Quotas are illegal in the UK, and South Africa does not impose them, leading to the use of various, compensatory ‘workarounds’ to address inequality. Singapore does not take action to address inequality because all people are considered equal constitutionally.In conclusion, medical school selection practices are firmly embedded in history, values, societal expectations and stakeholder beliefs, which vary by context. More comparisons, working from the position of acknowledging and respecting differences, would extend knowledge further and enable consideration of what permits and hinders change in different contexts. [ABSTRACT FROM AUTHOR]

Aim: Surgeon personality is a factor influencing rectal anastomotic decision‐making. However, it is unclear how or why this may be the case, or what aspects of personality are involved. The aim of this study was to investigate the views of colorectal surgeons on how their individual personality may influence variation in anastomotic decision‐making. Method: Purposive sampling was used to invite certified UK‐based colorectal surgeons to participate, with individual interviews used for data collection. Participants were recruited until ongoing data review indicated no new codes were generated (i.e. data sufficiency). Data were analysed thematically following Braun and Clarke's six‐step framework. Results: Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes relating to personality and decision‐making were identified: (1) surgeon development and training and (2) patient–surgeon interactions, each with relevant subthemes. Surgeons described how their personality may influence patients' postoperative outcomes (e.g. decision‐making, team working and communication) and potential mechanisms for how their personality may influence operative risk‐taking. Following anastomotic leakage, surgeons described a disproportionate sense of guilt and responsibility. There appears to be a significant transition in responsibility from trainee to newly appointed consultant, which may be part of the 'hidden curriculum' of surgical training. Conclusion: Colorectal surgeons have described their perceptions of how personality traits may impact variation in decision‐making and patient outcomes for the first time. Early career surgeons felt ill‐prepared for the level of guilt experienced when managing complications. Surgeons appear open to personality assessment if this was through an educational lens, with the aim of improving decision‐making following complications and overall performance. [ABSTRACT FROM AUTHOR]

Medical school selection is currently in the paradoxical situation in which selection tools may predict study outcomes, but which constructs are actually doing the predicting is unknown (the 'black box of selection'). Therefore, our research focused on those constructs, answering the question: do the internal structures of the tests in an outcome-based selection procedure reflect the content that was intended to be measured? Downing's validity framework was applied to organize evidence for construct validity, focusing on evidence related to content and internal structure. The applied selection procedure was a multi-tool, CanMEDS-based procedure comprised of a video-based situational judgement test (focused on (inter)personal competencies), and a written aptitude test (reflecting a broader array of CanMEDS competencies). First, we examined content-related evidence pertaining to the creation and application of the competency-based selection blueprint and found that the set-up of the selection procedure was a robust, transparent and replicable process. Second, the internal structure of the selection tests was investigated by connecting applicants' performance on the selection tests to the predetermined blueprint using cognitive diagnostic modeling. The data indicate 89% overlap between the expected and measured constructs. Our results support the notion that the focus placed on creating the right content and following a competency-blueprint was effective in terms of internal structure: most items measured what they were intended to measure. This way of linking a predetermined blueprint to the applicants' results sheds light into the 'black box of selection' and can be used to support the construct validity of selection procedures.

Introduction Methods Results Discussion Increasing the diversity of medical students, or widening participation (WP), is critical for social justice and healthcare delivery, and many governments are setting policies to encourage WP. However, establishing policy is only the first step in an educational change process: we also need to know “how” policy is enacted or how medical schools interpret and put into practice WP policy. Addressing this gap, the aim of this study was to examine policy enactment in six new UK medical schools with an explicit WP mandate.This qualitative study, underpinned by social constructivism, used semi‐structured interviews to explore the experiences of key actors (6 Deans and 14 Admissions staff) of putting policy into practice when setting up a new medical school. Data coding and analysis were initially inductive, using thematic analysis. We then applied Ball's theory of policy enactment to organise the data into four contextual dimensions of ‘situation’, ‘professional’, ‘material’ and ‘external’.On the surface, there were many similarities across the six schools in terms of the four dimensions. However, how these dimensions interacted illuminated tensions and differences. For example, some schools found themselves increasingly subjected to local and extra‐local rule systems, including pressure to follow host university norms and hosts struggling to accept that medical schools are heavily regulated. There were also tensions between the new medical schools and the medical education “establishment”, including lack of power and being judged by overly narrow outcomes.Different contexts seem to influence the enactment of WP to medicine in different places, even in the same country, even in medical schools established at the same time. That policy enactment is a complex, non‐linear process of enactment is important to acknowledge: context is critical. Our findings will inform future policies and practices that aim to increase WP in medicine. [ABSTRACT FROM AUTHOR]

Aim: When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision‐making and experience of complications. Method: This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK‐based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six‐step framework. Results: Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision‐making (e.g. demographics, personality) and (2) the influence of complications on decision‐making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision‐making and is associated with changes in practice even when a technical error is not identified. Conclusion: Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes. [ABSTRACT FROM AUTHOR]

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors focus on how to help mentees take an analytic approach to improve their mixed methods work. Mixed methods research has increased in popularity and with that comes both strengths and weaknesses in these studies. We suggest key elements to look for when reading a mixed methods research paper. We also provide guidance around weaknesses we have noticed in reporting. [ABSTRACT FROM AUTHOR]

This editorial discusses the importance of constructive dialogue and exploring cross-cultural differences in the field of medical education. The authors curated a special issue that highlights different perspectives on health professions education from authors across the globe. The papers in the issue cover a range of topics, including the establishment of new medical schools, online learning, inclusive assessments, interprofessional education, workplace learning, and cultural dynamics in clinical reasoning skills. The authors emphasize the need for diverse voices and ideas in the field and challenge the dominance of Westernized systems of knowledge production. [Extracted from the article]

Despite repeated calls for change, the problem of widening access (WA) to medicine persists globally. One factor which may be operating to maintain social exclusion is the language used in representing WA applicants and students by the gatekeepers and representatives of medical schools, Admissions Deans. We therefore examined the institutional discourse of UK Medical Admissions Deans in order to determine how values regarding WA are communicated and presented in this context. We conducted a linguistic analysis of qualitative interviews with Admissions Deans and/or Staff from 24 of 32 UK medical schools. Corpus Linguistics data analysis determined broad patterns of frequency and word lists. This informed a critical discourse analysis of the data using an "othering" lens to explore and understand the judgements made of WA students by Admissions Deans, and the practices to which these judgments give rise. Representations of WA students highlighted existing divides and preconceptions in relation to WA programmes and students. Through using discourse that can be considered othering and divisive, issues of social divide and lack of integration in medicine were highlighted. Language served to reinforce pre-existing stereotypes and a significant 'us' and 'them' rhetoric exists in medical education. Even with drivers to achieve diversity and equality in medical education, existing social structures and preconceptions still influence the representations of applicants and students from outside the 'traditional' medical education model in the UK. Acknowledging this is a crucial step for medical schools wishing to address barriers to the perceived challenges to diversity.

Current theoretical thinking asserts that leadership should be distributed across many levels of healthcare organisations to improve the patient experience and staff morale. However, much healthcare leadership education focusses on the training and competence of individuals and little attention is paid to the interprofessional workplace and how its inherent complexities might contribute to the emergence of leadership. Underpinned by complexity theory, this research aimed to explore how interprofessional healthcare teams enact leadership at a micro-level through influential acts of organising. A whole (interprofessional) team workplace-based study utilising video-reflexive ethnography occurred in two UK clinical sites. Thematic framework analyses of the video data (video-observation and video-reflexivity sessions) were undertaken, followed by in-depth analyses of human-human and human-material interactions. Data analysis revealed a complex interprofessional environment where leadership is a dynamic process, negotiated and renegotiated in various ways throughout interactions (both formal and informal). Being able to "see" themselves at work gave participants the opportunity to discuss and analyse their everyday leadership practices and challenge some of their sometimes deeply entrenched values, beliefs, practices and assumptions about healthcare leadership. These study findings therefore indicate a need to redefine the way that medical and healthcare educators facilitate leadership development and argue for new approaches to research which shifts the focus from "leaders" to "leadership."

Changes in digital technology, increasing volume of data collection, and advances in methods have the potential to unleash the value of big data generated through the education of health professionals. Coupled with this potential are legitimate concerns about how data can be used or misused in ways that limit autonomy, equity, or harm stakeholders. This consensus statement is intended to address these issues by foregrounding the ethical imperatives for engaging with big data as well as the potential risks and challenges. Recognizing the wide and ever evolving scope of big data scholarship, we focus on foundational issues for framing and engaging in research. We ground our recommendations in the context of big data created through data sharing across and within the stages of the continuum of the education and training of health professionals. Ultimately, the goal of this statement is to support a culture of trust and quality for big data research to deliver on its promises for health professions education (HPE) and the health of society. Based on expert consensus and review of the literature, we report 19 recommendations in (1) framing scholarship and research through research, (2) considering unique ethical practices, (3) governance of data sharing collaborations that engage stakeholders, (4) data sharing processes best practices, (5) the importance of knowledge translation, and (6) advancing the quality of scholarship through multidisciplinary collaboration. The recommendations were modified and refined based on feedback from the 2022 Ottawa Conference attendees and subsequent public engagement. Adoption of these recommendations can help HPE scholars share data ethically and engage in high impact big data scholarship, which in turn can help the field meet the ultimate goal: high-quality education that leads to high-quality healthcare. [ABSTRACT FROM AUTHOR]

Introduction: The slow pace of change in respect of increasing the diversity of medical students suggests powerful actors are reproducing practices to support the status quo. Opening up medicine to embrace diversity thus requires the deconstruction of entrenched processes and practices. The first step in doing so is to understand how the actor‐network of widening participation and access to medicine (WP/WA) is constructed. Thus, here we examine how the connections among actors in WP/WA in two different networks are assembled. Methods: A comparative case study using documents (n = 7) and interviews with staff and students (n = 45) from two medical schools, one United Kingdom and one Australian, was used. We used Callon's moments of translation (problematisation, interessement/operationalisation, enrolment, mobilisation) to map the network of actors as they are assembled in relation to one another. Our main actant was institutional WP to medicine policy (actor‐as‐policy). Results: Our actor‐as‐policy introduced five other actors: the medical school, medical profession, high schools, applicants and medical school staff. In terms of problematisation, academic excellence holds firm as the obligatory passage point and focal challenge for all actors in both countries. The networks are operationalised via activities such as outreach and admissions policy (e.g., affirmative action is apparent in Australia but not the UK). High schools play (at best) a passive role, but directed by the policy, the medical schools and applicants work hard to achieve WP/WA to medicine. In both contexts, staff are key mobilisers of WP/WA, but with little guidance in how to enact policy. In Australia, policy drivers plus associated entry structures mean the medical profession exerts significant influence. Conclusions: Keeping academic excellence as the obligatory passage point to medical school shapes the whole network of WP/WA and perpetuates inequality. Only by addressing this can the network reconfigure. Treating policy as an actor in UK and Australian medical schools, Coyle et al. were enabled to conduct unique comparisons between Widening Practice networks that shine light on how staff, students and policies navigate equity and excellence in medicine. [ABSTRACT FROM AUTHOR]

The article discusses the necessity of a deliberate approach to integrating artificial intelligence (AI) into medical school curricula, emphasizing the metaphor of 'slowing down when you should' from surgical decision-making literature. Topics include the potential pitfalls of rushing AI implementation, the need for ethical considerations, and the application of Implementation Science frameworks to guide successful integration while considering patient safety.

Introduction: The Objective Structured Clinical Examination (OSCE) is a key feature of healthcare education assessment. Many aspects of the OSCE are well‐investigated, but not so its sociomaterial assemblage. The Covid‐19 pandemic provided a unique opportunity to (re)consider taken‐for‐granted OSCE practices. Drawing on Law's modes of ordering, our aim was to demonstrate the 'mangle of practice' between space and people; the spatialised and spatialising processes of an OSCE. Methods: We used a case study approach to critically examine a redesigned final year MBChB OSCE held during the pandemic. We used multiple sources of data to attune to human and non‐human actors: OSCE documentation, photographs, field notes and semi‐structured interviews with OSCE staff/organisers. Law's modes of ordering was used as an analytical lens to critically consider how people and things flowed through the adapted OSCE. Findings: The overarching ordering was the delivery of a 'pandemic safe' OSCE. This necessitated reordering of 'usual' process to deliver a socially distanced, safe flow of human and non‐human actors through the assessment space. Each change had material and social 'knock on' effects. We identified three main interrelated orderings: Substituting technologies for bodies: Disembodied and dehumanised but feasible; Flow through space: Architectural affordances and one‐way traffic; Barriers to flow: Time and technology. Discussion Looking at the OSCE through a sociomaterial lens allows us to critically examine the OSCE's essential and complex processes and the restrictions and affordances of the spaces and props within the OSCE. In doing so, we open the possibility of considering alternative ways of doing OSCEs in the future. Moreover, conceptualising the OSCE as a living set of socially (human) and materially (nonhuman) enacted processes changes the social perception of the OSCE and highlights that an OSCE has agency on people, places and things. Brown et al. offer a #sociomaterial investigation of a pandemic disrupted #OSCE, describing it as disembodied and dehumanised but safe and feasible, while offering insights into virtual assessment's strengths and limitations. [ABSTRACT FROM AUTHOR]