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Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents' workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.

Education in Doctor of Medicine programs has moved towards an emphasis on clinical competency, with entrustable professional activities providing a framework of learning objectives and outcomes to be assessed within the clinical environment. While the identification and structured definition of objectives and outcomes have evolved, many methods employed to assess clerkship students' clinical skills remain relatively unchanged. There is a paucity of medical education research applying advanced statistical design and analytic techniques to investigate the validity of clinical skills assessment. One robust statistical method, multitrait-multimethod matrix analysis, can be applied to investigate construct validity across multiple assessment instruments and settings. Four traits were operationalized to represent the construct of critical clinical skills (professionalism, data gathering, data synthesis, and data delivery). The traits were assessed using three methods (direct observations by faculty coaches, clinical workplace-based evaluations, and objective structured clinical examination type clinical practice examinations). The four traits and three methods were intercorrelated for the multitrait-multimethod matrix analysis. The results indicated reliability values in the adequate to good range across the three methods with the majority of the validity coefficients demonstrating statistical significance. The clearest evidence for convergent and divergent validity was with the professionalism trait. The correlations on the same method/different traits analyses indicated substantial method effect; particularly on clinical workplace-based assessments. The multitrait-multimethod matrix approach, currently underutilized in medical education, could be employed to explore validity evidence of complex constructs such as clinical skills. These results can inform faculty development programs to improve the reliability and validity of assessments within the clinical environment.

The maldistribution of family physicians challenges equitable primary care access in Canada. The "Theory of Social Attachment" suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.

This study aims to analyze the impact of intern physicians' social interaction during teamwork, their cognitive flexibility and academic achievement on clinical reasoning. The study, designed through sequential exploratory mixed method, was carried out with 20 intern physicians working in 4 teams. The process of how they approach to the case was recorded. The verbal interactions made during the discussions in the teams were analyzed, the discourses obtained from the videos were coded and modelled by regression. In addition, the cognitive flexibility and academic achievement levels of intern physicians were also included in the regression modelling. The results showed that, according to the initial signs and symptoms of the first period of the case (when uncertainty was high), the team members informing each other resulted in success in clinical reasoning. Although guiding in the first period was not very effective, excessive guiding in the second period played a negative role in clinical reasoning. In the second period, ignoring, reminding, and suggesting had a negative impact on clinical reasoning. Our study demonstrated that academic achievement and cognitive flexibility levels of the students in teamwork has a positive impact on the quality of clinical reasoning. Moreover, for effective clinical reasoning, the quality of discourses in the team is more important than how many discourses are created during the discussions.

Anatomy is an essential component of clinical anesthesiology. The use of simulated patients and alternative materials, including embalmed human bodies, have become increasingly common during resident physician training due to the deemphasis on anatomical education during undergraduate medical training. In this report, the need for a more extensive review of relevant anatomy for the practice of anesthesiology was addressed by the design, evaluation, and dissemination of a human dissection course for procedural training of anesthesiology residents. The course utilized "freedom art" embalmed human bodies that allowed trainees to perform ultrasound-based regional and neuraxial techniques followed by detailed dissections of critical anatomy. One hundred and four residents participated in workshops and small group discussions and were evaluated using pre- and post-course assessments. A variety of clinical techniques were performed on the bodies, including regional blocks and neuraxial catheter placement. Insertion of peripheral/neuraxial catheters was successful, with dissections demonstrating the expected placement. Assessment scores improved following the course (pre-course mean 52.7%, standard deviation ([delta]) 13.1%; post-course mean 72.2%, [delta] 11.6%; t-test p < 0.0001) and feedback highlighted the usefulness and clinical relevance of course content. The ability to correlate ultrasound imaging with subsequent dissections of the "blocked" area and visualization of dye staining was extremely relevant for spatial understanding of the anatomy relevant for the clinical practice of these techniques. This manuscript demonstrates successful implementation of a comprehensive course for anesthesiology resident physicians to address gaps in undergraduate anatomical education and suggests that broader adoption of dissection courses may be beneficial for training anesthesiologists.

Kansas City University offers a Clinical Anatomy Fellowship which enrolls nine medical students during each academic year and provides training in research, teaching, and advanced anatomical topics. The Fellows practice as novice educators, working alongside Anatomy faculty to teach medical students in the Gross Anatomy laboratory. However, little has been reported related to Fellowship participation and success outcomes. This survey-based study was designed to explore (1) student motivation(s) for pursuing the Fellowship, (2) benefits of participation, and (3) the perceived impact on residency applications and career success. Three unique populations were surveyed. The most important factors driving application to the Fellowship were a desire to increase competitiveness in the residency application process (Likert mean score 4.7-5.0) and a passion for Anatomy (Likert mean score 4.3-4.7). Taking a year away from the College of Osteopathic Medicine curriculum (Likert mean score 4.4) and delaying clinical exposure (Likert mean score 4.2) were the most important deterrents to application. The most reported benefits after program completion included opportunities to build a strong residency application (44% and 50% of Fellows), conduct research (44% and 45% of Fellows), and participate in teaching (11% and 50% of Fellows). 73% of past Fellows matched into their top specialty of choice. Flexibility in the program allows participants to individualize their Fellowship experience to address their personal goals related to residency applications and careers as future physicians. As the results suggest, the Clinical Anatomy Fellowship benefits Fellows, signaling other medical institutions to consider adopting a similar program.

The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.

Intrinsic inequity in assessment refers to sources of harmful discrimination inherent in the design of assessment tools and systems. This study seeks to understand intrinsic inequity in assessment systems by studying assessment policies and associated procedures in residency training, using general pediatrics as a discourse case study. Foucauldian discourse analysis (FDA) was conducted on assessment policy and procedure documents. Two authors independently prepared structured analytic notes using guiding questions. Documents and respective analytic notes were subsequently reviewed independently by all authors. Each author prepared further unstructured analytic notes on the documents' discourse. The authors then compared notes and constructed truth statements (i.e., interpretations of what the discourse establishes as true about the construct under study) and sub-strands (i.e., themes) that were repeated and legitimized across the documents via iterative discussion. Based on analysis, the authors constructed two truth statements. These truth statements, "good assessment is equitable assessment," and "everyone is responsible for inequity," conceptualized inequity in assessment as an isolated or individual-level aberration in an otherwise effective or neutral system. Closer examination of the truth statements and sub-strands in the discourse presented an alternative view, suggesting that inequity may in fact not be an aberration but rather an inherent feature of assessment systems.

Diagnostic errors are a major, largely preventable, patient safety concern. Error interventions cannot feasibly be implemented for every patient that is seen. To identify cases at high risk of error, clinicians should have a good calibration between their perceived and actual accuracy. This experiment studied the impact of feedback on medical interns' calibration and diagnostic process. In a two-phase experiment, 125 medical interns from Dutch University Medical Centers were randomized to receive no feedback (control), feedback on their accuracy (performance feedback), or feedback with additional information on why a certain diagnosis was correct (information feedback) on 20 chest X-rays they diagnosed in a feedback phase. A test phase immediately followed this phase and had all interns diagnose an additional 10 X-rays without feedback. Outcome measures were confidence--accuracy calibration, diagnostic accuracy, confidence, and time to diagnose. Both feedback types improved overall confidence--accuracy calibration (R[superscript 2][subscript]No Feedback = 0.05, R[superscript 2][subscript]Performance Feedback = 0.12, R[superscript 2][subscript]Information Feedback = 0.19), in line with the individual improvements in diagnostic accuracy and confidence. We also report secondary analyses to examine how case difficulty affected calibration. Time to diagnose did not differ between conditions. Feedback improved interns' calibration. However, it is unclear whether this improvement reflects better confidence estimates or an improvement in accuracy. Future research should examine more experienced participants and non-visual specialties. Our results suggest that feedback is an effective intervention that could be beneficial as a tool to improve calibration, especially in cases that are not too difficult for learners.

Background: Concussions are a public health concern. Underdiagnosis and mismanagement negatively impact patients, risking in persistent symptoms and permanent disability. Objective: This scoping review consolidates the heterogeneous and inconsistent concussion research and identifies key areas for medical education curriculum design to focus on for effective knowledge acquisition and bolstering competency in family physician residency. We analyze the literature on concussion education spanning various healthcare disciplines in North America. Methods: PRISMA-Sc was followed and MEDLINE and EMBASE Classic + EMBASE in the OvidSP search platform were used to find terms for brain concussion AND medical education OR specific education until 2021. Results: There are significant knowledge gaps about concussions, increased clinical exposure is required for competency which bolster physical examination skills and streamlined concussion guidelines are required for family medicine specialists that filter undifferentiated symptoms 25% of participants improved adherence to concussion guidelines after an educational intervention and knowledge increased after concussion workshop and clinics. Conclusions: Multifaceted teaching improves concussion diagnosis and management. More research is needed to examine concussion competency and, more importantly, whether these interventions improve patient outcomes.

In the last two decades, India has seen a massive rise in the number of medical schools. As a result, numerous issues, including the availability of qualified teachers, have made medical education in India challenging. Faculty development (FD) has gained significant attention because of its importance in educational capacity building. FD programs help faculty become more aware of their professional responsibilities. Medical education units can play a vital role in FD and thus improve the quality of medical training by training the teachers. The National Teacher Training Centre (NTTC), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, was the first center established by the Ministry of Health and Family Welfare, Government of India in 1975, with the assistance of the World Health Organization, to promote the training of health professionals in educational science and technology, including educational planning and research. This article describes the profile of activities of NTTC, which is functioning under the aegis of the Department of Medical Education (DME), JIPMER, and lists the outcomes that contributed to the success of DME with particular reference to the last decade. The establishment of DME is seen to affect the medical school positively.

This study aims to investigate the effectiveness of flipped learning in surgical education in trauma. The participants were 15 first-year general surgery residents in Shiraz medical school. After completing a pre-test, the participants received the learning content in interactive multimedia, podcasts, movies, and books. One month later, they had a face-to-face class based on case-based discussions. An early post-test was performed immediately after the class, and a late post-test was performed one month later. In these tests, the residents' problem-solving abilities were assessed using multiple-choice questions. A semi-structured phone interview was used to measure their attitude towards the learning program. The results showed a significant difference between pre-test and early post-test scores and between pre-test and late post-test scores. However, there was no significant difference between early and late post-test scores. The residents were satisfied with the program's overall usefulness for junior residents. The participants tended to use podcasts more than other materials. They mentioned that the videos and books helped more to foster theoretical knowledge. The case-based discussion makes them more confident in dealing with patients in daily encounters.

Career selection in medicine is a complex and underexplored process. Most medical career studies performed in the U.S. focused on the effect of demographic variables and medical education debt on career choice. Considering ongoing U.S. physician workforce shortages and the trilateral adaptive model of career decision making, a robust assessment of professional attitudes and work-life preferences is necessary. The objective of this study was to explore and define the dominant viewpoints related to career choice selection in a cohort of U.S. IM residents. We administered an electronic Q-sort in which 218 IM residents sorted 50 statements reflecting the spectrum of opinions that influence postgraduate career choice decisions. Participants provided comments that explained the reasoning behind their individual responses. In the final year of residency training, we ascertained participating residents' chosen career. Factor analysis grouped similar sorts and revealed four distinct viewpoints. We characterized the viewpoints as "Fellowship-Bound-Academic," "Altruistic-Longitudinal-Generalist," "Inpatient-Burnout-Aware," and "Lifestyle-Focused-Consultant." There is concordance between residents who loaded significantly onto a viewpoint and their ultimate career choice. Four dominant career choice viewpoints were found among contemporary U.S. IM residents. These viewpoints reflect the intersection of competing priorities, personal interests, professional identity, socio-economic factors, and work/life satisfaction. Better appreciation of determinants of IM residents' career choices may help address workforce shortages and enhance professional satisfaction.

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.

Autism spectrum disorder and intellectual disability are associated with psychiatric comorbidities, yet a 2009 study of US child and adolescent psychiatry program directors indicated that psychiatry residents receive insufficient training in autism spectrum disorder/intellectual disability. This follow-up study surveyed child and adolescent psychiatry and general psychiatry program directors to assess (1) the current extent of residency training in autism spectrum disorder/intellectual disability, (2) program director perceptions of educational topics and resident competency in autism spectrum disorder/intellectual disability, and (3) preferred resources to strengthen autism spectrum disorder/intellectual disability training. As in 2009, many child and adolescent psychiatry program directors reported few lecture hours, although current child and adolescent psychiatry residents saw slightly more patients with autism spectrum disorder but not intellectual disability. General psychiatry program directors reported fewer lecture hours in autism spectrum disorder/intellectual disability and fewer patients with autism spectrum disorder than child and adolescent psychiatry program directors. Both child and adolescent psychiatry and general psychiatry program directors recognized the importance of a range of educational topics in autism spectrum disorder/intellectual disability. Child and adolescent psychiatry program directors reported higher resident competency, and lecture hours and patients seen moderately correlated with resident competency. Program directors indicated that online videos and other resources would help improve autism spectrum disorder/intellectual disability training in their programs. Collectively, these findings suggest minimal improvements in autism spectrum disorder/intellectual disability training over the past decade and highlight the urgent need to advance psychiatry training in this field through dissemination of resources.

People with intellectual disability receive breast, cervical, and colorectal cancer screening at lower rates relative to the general population, although the reasons for this disparity are largely unknown. Research, both with the general population and specific to people with intellectual disability, has revealed that a family physician's recommendation for cancer screening or continuity of primary care may increase screening rates. We interviewed family physicians and family medicine trainees regarding their experiences recommending cancer screening to patients with intellectual disability. We concluded that the decision to recommend cancer screening is complex, and includes physicians weighing their clinical judgement as to the best provision of care for patients with a patient's eligibility for screening, while continuing to respect patients' autonomy. This patient-physician interaction occurs within the larger medical environment. Further research with experienced family physicians is warranted to better understand this complex phenomenon.

Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice residents would learn the deliberate reflection procedure through 'learning-by-teaching' and apply it to diagnose new cases. The study was a two-phase experiment. In the learning phase, 56 general-practice residents were randomly assigned to one of two conditions. They either (1) studied examples of deliberate reflection and then explained the procedure to a fictitious peer on video; or (2) solved cases without reflection (control). In the test phase, one to three weeks later, all participants diagnosed new cases while thinking aloud. The analysis of the test phase showed no significant differences between the conditions on any of the outcome measures (diagnostic accuracy, p = 0.263; time to diagnose, p = 0.598; mental effort ratings, p = 0.544; confidence ratings, p = 0.710; proportion of contradiction units (i.e. measure of deliberate reflection), p = 0.544). In contrast to findings on learning-by-teaching from other domains, teaching deliberate reflection to a fictitious peer, did not increase reflective reasoning when diagnosing future cases. Potential explanations that future research might address are that either residents in the experimental condition did not apply the learned deliberate reflection procedure in the test phase, or residents in the control condition also engaged in reflection.

COVID-19 provided an opportunity to experiment with alternative delivery mechanisms for a medical education programme offered through open and distance learning with face-to-face training as an essential component of the programme. Non-availability of hard copies of the course material (92%) and lack of communication from the university (32%) as well as training centres (42%) were some of the challenges faced by students of the Geriatric Medicine programme of the Indira Gandhi National Open University (IGNOU) during the COVID pandemic. Around 90% were willing to attend online classes and 65% to 77% were willing to present cases online for discussion. A programme-specific web portal containing all resource material and information was visited by 85% of students. Most students attended the online classes and 68% attempted the formative assessments based on the online classes. Online classes were recorded and uploaded and were found useful by 90% of students. The experiment successfully demonstrated the feasibility and acceptance of delivering practical skills using online technological tools. Further integrating technology to complement some of the face-to-face component could be used as a permanent and effective delivery strategy, which could also reduce resource requirements.

The use of mobile information and communication technologies within health and medical education contexts is widespread and generally viewed positively. Such technologies are primarily used for information seeking and are often undertaken informally. This qualitative, phenomenological study offers not only a deep and contextually sensitive discussion of how emergency physicians use mobile technologies in their day-to-day work, but also extends this discussion to the practice of ongoing professional learning in the workplace. We find that the most common uses for mobile technology include (re)checking medicine orders and/or diagnoses and for communicating with other physicians for advice, support, and on occasion, discussion. Moreover, physicians often perceive mobile technology as an extension of self and represent an externalisation of expertise. There is skepticism, however, about the use of these technologies particularly among more experienced and established Attending Physicians (or Consultants in other jurisdictions). In all, these findings provide new perspectives on and further directions for both research and practice in health and medical education contexts given that the use of mobile technology in the emergency department is ubiquitous and increasingly normalised, particularly within the clinical interaction with patients.

Diversity in terms of class, sexual identity and migration background among medical students in high income countries has increased greatly in recent decades. Some research into the experiences of these new groups of doctors has been performed. However, no previous research into the experiences of psychiatry residents specifically, is known. This qualitative study investigates how psychiatry residents, from these minoritized groups, experience their training regarding inclusion. Inclusion is defined as the degree to which one's needs for connection and for being valued in one's uniqueness, is satisfied. In-depth interviews with 16 psychiatry residents were conducted. These interviews were transcribed and coded using MaxQDA software. Initial themes that were constructed, were explored further in subsequent interviews and linked to literature. Finally, the developed themes were ordered in a model conceptualizing inclusion. Participants reported high belongingness within psychiatry training. Their experienced value in uniqueness, however, was generally quite low. Participants reported to experience little interest in and sensitivity for their perspectives and lived experiences from their co-workers. When faced with stigmatization and discrimination, participants reported lack of support from their colleagues. Assimilation was found to be the most frequently used coping strategy in dealing with diversity. Participants seemed to conform to the 'neutral' norm and experienced barriers in expressing themselves. Through this mechanism of assimilation, the added value that participants might bring with their unique knowledge and lived experiences was not used, both in patient care and in creating an inclusive climate within the organization. Moreover, assimilation is associated with psychological strain.

Abortion is a safe and common part of essential healthcare. To ensure patients have access to comprehensive reproductive care, clinical educators are tasked with training the next generation of clinicians in abortion care in the setting of growing restrictions. Medical schools and residency program programs must adopt purposeful strategies to optimize abortion education and increase educational efficacy. Abortion training should ideally combine hands-on clinical skills such as ultrasound imaging and procedural abortion techniques, as well as discussions of medical ethics, advocacy, and strategies to emotionally support patients.

The new curriculum of medical schools has brought the need to develop a professional committed to ethics, capable of understanding the role of social factors, the insertion of the individual into the family and their role in promoting health. These skills and the use of new methodologies in teaching-learning process have demonstrated that the traditional performance assessment methods are limited in holistically evaluating the student. This study analyzed the correlation among different methods for evaluating competencies in medical internship students and Objective Structured Clinical Examination (OSCE). A cross-sectional, descriptive and analytical study was performed among 5th year medical students at Pediatric, Surgery, Medical Clinic, Family and Community Medicine and Gynecology and Obstetrics. Grades of each student obtained through different evaluations (theoretical test, conceptual evaluation and test skills) at the end of each rotation were correlated with the individual results from OSCE. In regard to correlations with the OSCE score values, it was found a weak to moderate positive and statistically significant relationship with the global cognitive score (r= 0.22, p< 0.001), global abilities score (r= 0.26, p< 0.001) and with the global behavioral score (r= 0.38, p< 0.001). The students' performance in the various assessments of performance evaluated here was positively correlated to their performance on OSCE. Furthermore, the organization of an OSCE-type assessment prepared in multiple, committed and competent hands may serve as a unique assessment and, in fact, assess the development of clinical skills for future doctors.

Background: The growth of academic medical centres associated with international programmes has raised questions about the benefits and harms of medical experiences abroad for medical trainees and patients. Few studies explore the potential benefits to the institution or country that send these individuals. Objective: This pilot qualitative study explores the benefits medical professionals perceive they bring back to the USA from their global health experiences abroad. Methods: Medical staff who participated in University of North Carolina (UNC)--Project Malawi and who could meet for an in-person interview from October 2016-March 2017 were recruited. Interviews were guided by an a priori semi-structured questionnaire. Each interview was transcribed and analysed by three reviewers. Results: A total of 8 out of 13 (62%) eligible potential respondents were interviewed. Participants perceived UNC-Project Malawi to benefit themselves, partnership institutions, and patients in Malawi, North Carolina, and throughout the world. After returning to UNC, participants recalled specific instances of increased diagnostic confidence (2/8) influenced by their experiences abroad. In addition, by partnering in research, participants felt that certain concepts were advanced including the syndromic management of symptomatic patients with sexually transmitted infections (1/8), the use of antiretroviral therapy to treat and prevent HIV transmission (2/8), and malaria vaccine development (1/8). Conclusion: Participants perceived that their global health experience either influenced their thought processes concerning the medical management of patients in the USA or resulted in a better understanding of research relevant to the global standard of care for specific diseases. International academic medical centre partnerships can offer rich settings for career skills development and a unique platform for collaborating on the management of clinical diseases that affect patients globally. These benefits can be maximised by establishing bi-directional curriculum goals and defining shared research agendas.

China's Clinical Medicine Level Test (CMLT) was designed to evaluate the key factors that affect the learning outcome of medical students prior to entering clinical practice. In this study, we systemically analyzed the performance of a cohort of medical students at Jinan University School of Medicine participating in the recent CMLT. The analytical results of the medical students' written and objective structured clinical examination (OSCE) scores showed that their academic performance was predominantly associated with students' internship allocations, although other demographic characteristics such as sex, age, geographical origin of students, and grade point average (GPA) might be sporadically related to the students' OSCE performance at different OSCE stations. To explore the inherent reasons behind this, a survey was implemented among the medical students who participated in the examination to further interpret the factors influencing the students' learning outcome. The findings of this questionnaire manifested that intrinsic motivation and identified regulation acted as the major motivational profiles for the medical students from three different internship sites, whereas external regulation emerged as the crucial factor to make the students perform well academically in the CMLT. The result of this study suggested that strengthening the quality control of the clinical learning environment and improving medical administration may still be the most effective approaches to ensure the quality of clinical medical education.

Successful family-professional partnerships (FPP) have been shown to positively impact both satisfaction with care and health outcomes for children with disabilities and their families. Many healthcare training programs have recognized the benefit of FPP training and often include learning experiences that feature families as teachers or mentors. However, most research on FPP training has focused on professionals' experiences, and not on families' experience in the roles of mentors and experts. The Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program is a graduate-level interdisciplinary training program with sites across the country. LEND programs train future healthcare and service professionals in the disability field and often utilize a Family Mentor Experience (FME) as one aspect of their training. This study used qualitative interviews to examine the experiences of eight family mentors who worked with trainees in one LEND program. Overall, the family mentors expressed positive views regarding the FME, describing how it allowed them to connect with trainees, other families, and community resources, as well as educating trainees. Family mentors also identified several facilitators and barriers to participation. Study findings provide information on the FFP's impact on family mentors and guidance on how programs can support sustainable, effective FPP experiences.

Health disparities faced by transgender people are partly explained by barriers to trans-inclusive healthcare, which in turn are linked to a lack of transgender health education in medical school curricula. We carried out a theory-driven systematic review with the aim to (1) provide an overview of key characteristics of training initiatives and pedagogical features, and (2) analyze barriers and facilitators to implementing this training in medical education. We used queer theory to contextualize our findings. We searched the PubMed/Ovid MEDLINE database (October 2009 to December 2021) for original studies that reported on transgender content within medical schools and residency programs (N = 46). We performed a thematic analysis to identify training characteristics, pedagogical features, barriers and facilitators. Most training consisted of single-session interventions, with varying modes of delivery. Most interventions were facilitated by instructors with a range of professional experience and half covered general LGBT+-content. Thematic analysis highlighted barriers including lack of educational materials, lack of faculty expertise, time/costs constraints, and challenges in recruiting and compensating transgender guest speakers. Facilitators included scaffolding learning throughout the curriculum, drawing on expertise of transgender people and engaging learners in skills-based training. Sustainable implementation of transgender-health objectives in medical education faces persistent institutional barriers. These barriers are rooted in normative biases inherent to biomedical knowledge production, and an understanding of categories of sex and gender as uncomplicated. Medical schools should facilitate trans-inclusive educational strategies to combat transgender-health inequities, which should include a critical stance toward binary conceptualizations of sex and gender throughout the curriculum.

Home-based therapy has become an ongoing trend within the mental health field. This transcendental phenomenologically designed study explored the lived experiences of clinical mental health counseling internship students (N=8) who provided home-based therapy as their primary method of gaining required clinical experience for the completion of their master's degree. The overall personal and professional development of the students providing therapy in this setting was explored. Insights of the internship students regarding their experiences and challenges in providing home-based therapy were revealed. Recommendations based on the experiences of the students providing home-based therapy were offered. Implications to students, counselor educators, and supervisors have also been provided.

Background: Studies have called for reforms in medical education to create a better generation of doctors who can cope with the system-based problems; they would encounter in an interdisciplinary and collaborative environment and make better-reasoned decisions for quality patient care. To achieve this, critical thinking (CT) is at the very heart of development of new medical knowledge. Medical academics and practitioners have raised concerns about the low levels of CT and stress the need for fostering CT among medical practitioners. Objective: The objective of this study was to identify and analyze the gap among the interns with respect to their CT skills and attitude toward CT. Materials and Methods: A cross-sectional descriptive study was conducted among the MBBS interns of an institution of national importance in India. The interns were administered with a short version of Watson-Glaser CT appraisal tool to assess their CT skills and with CT disposition self-rating form to assess their attitude toward CT, respectively. The data were analyzed to assess their level of CT skills and their attitude toward CT. Results: Sixty-one percent of the interns responded to the survey, and only 26% of interns had high CT skills; the five dimensions of CT showed varied levels of skills among the interns. Fifty-one percent of interns showed positive attitude toward CT. Conclusion: The findings showed a gap among the interns in their CT skills and their attitude toward CT.

Assessment is more educationally effective when learners engage with assessment processes and perceive the feedback received as credible. With the goal of optimizing the educational value of assessment in medical education, we mapped the primary literature to identify factors that may affect a learner's perceptions of the credibility of assessment and assessment-generated feedback (i.e., scores or narrative comments). For this scoping review, search strategies were developed and executed in five databases. Eligible articles were primary research studies with medical learners (i.e., medical students to post-graduate fellows) as the focal population, discussed assessment of individual learners, and reported on perceived credibility in the context of assessment or assessment-generated feedback. We identified 4705 articles published between 2000 and November 16, 2020. Abstracts were screened by two reviewers; disagreements were adjudicated by a third reviewer. Full-text review resulted in 80 articles included in this synthesis. We identified three sets of intertwined factors that affect learners' perceived credibility of assessment and assessment-generated feedback: (i) elements of an assessment process, (ii) learners' level of training, and (iii) context of medical education. Medical learners make judgments regarding the credibility of assessments and assessment-generated feedback, which are influenced by a variety of individual, process, and contextual factors. Judgments of credibility appear to influence what information will or will not be used to improve later performance. For assessment to be educationally valuable, design and use of assessment-generated feedback should consider how learners interpret, use, or discount assessment-generated feedback.

When physicians do not estimate their diagnostic accuracy correctly, i.e. show inaccurate "diagnostic calibration," diagnostic errors or overtesting can occur. A previous study showed that physicians' diagnostic calibration for easy cases improved, after they received feedback on their previous diagnoses. We investigated whether diagnostic calibration would also improve from this feedback when cases were more difficult. Sixty-nine general-practice residents were randomly assigned to one of two conditions. In the feedback condition, they diagnosed a case, rated their confidence in their diagnosis, their invested mental effort, and case complexity, and then were shown the correct diagnosis (feedback). This was repeated for 12 cases. Participants in the control condition did the same without receiving feedback. We analysed calibration in terms of (1) absolute accuracy (absolute difference between diagnostic accuracy and confidence), and (2) bias (confidence minus diagnostic calibration). There was no difference between the conditions in the measurements of calibration (absolute accuracy, p = 0.204; bias, p = 0.176). Post-hoc analyses showed that on correctly diagnosed cases (on which participants are either accurate or underconfident), calibration in the feedback condition was less accurate than in the control condition, p = 0.013. This study shows that feedback on diagnostic performance did not improve physicians' calibration for more difficult cases. One explanation could be that participants were confronted with their mistakes and thereafter lowered their confidence ratings even if cases were diagnosed correctly. This shows how difficult it is to improve diagnostic calibration, which is important to prevent diagnostic errors or maltreatment.

The hidden curriculum has been investigated as a powerful force on medical student learning and ongoing physician professional development. Previous studies have largely focused on medical students' experiences as 'receivers' of the hidden curriculum. This study examined how residents and newly graduated physicians conceived of their roles as active participants in the hidden curriculum. An interpretative phenomenological study was employed using individual, semi-structured interviews with residents and newly graduated physicians (n = 5) to examine their roles in perpetuating the hidden curriculum. A thematic analysis was conducted using a reflexive approach. Findings include insight into how residents and newly graduated physicians: (1) navigate the hidden curriculum for their own professional development; (2) intervene in others' enactment of the hidden curriculum; and (3) seek to repair the hidden curriculum for the next generation through their teaching. In light of our findings, we argue that: (1) more research is needed to understand how early career physicians navigate their engagement with the hidden curriculum; (2) students and educators be supported to consider how their agency to impact the hidden curriculum is influenced by the sociocultural context; and (3) residents and early career physicians are poised to powerfully impact the hidden curriculum through the learning environments they create.

Medical professionals need to be equipped with competencies to provide sustainable healthcare and promote planetary health. The aims of this study were to map the presence of planetary health themes in one Australian medical program, develop and pilot a planetary health blended-learning module drawing on constructivism learning theory, and evaluate the effectiveness of the activities. A mixed methods approach was used comprising quantitative mapping of learning outcomes, measurement of pre- and post-intervention planetary health knowledge, and a feedback survey. Mapping revealed little integration of environmental issues across the medical program. Student's knowledge score increased by 2.37 points on average (95% confidence interval 1.66-3.09) (response rate 46%); 84.2% of respondents rated the activities as excellent/good. Since planetary health education is not currently required in Australian medical curricula, there is still little information for local medical educators on how to develop it, therefore studies such as this can provide some preliminary guidance.

This account of practice focusses on insights from the 'early days' of an action learning set within a leadership development programme in the English NHS. The account describes experiences of forming as a set as an important foundation for trust. Developing trust between set members enabled members to take more risks, sharing current and complex work and leadership challenges within the set. The structured space for thinking and reflection alongside people facing similar challenges brought learning and insights that led to taking new action on work issues. Included in this account are stories and reflections from set members and set facilitator on their experiences of trust, safety and trying new approaches to learning and leadership through action learning. This account will be of relevance to healthcare leaders that are participating in action learning, healthcare leadership developers involved in the delivery and facilitation of action learning and those considering including action learning as part of healthcare improvement programmes.

In recent decades, a number of training environments have moved toward program approaches targeting the development of competencies. Because of their complexity, monitoring the development of those competencies is a considerable challenge. Our hypothesis is that a computerized system could help overcome this challenge if it is well accepted by its users. We first summarize the context surrounding the implementation of such approaches. Next, we present a computerized assessment system established in the Family Medicine Residency Program of Laval University (Québec, Canada) that we have developed for tracking the development of residents' competencies. We then present the analysis of interactions between the system and users and the various proposals that were made to improve the system and longitudinal tracking of the development of the targeted competencies. We consider that this research provides useful guidelines for the computerized monitoring of learners' competencies development and for the design of such systems.