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Ayer — Octubre 2nd 2025Tus fuentes RSS

Transformative learning through communal documentary viewing: a mixed methods study on kidney transplantation and organ donation in medical education

Por: McCaffrey · D. · Corr · M. · Fergie · R. · Courtney · A. · Brown · T. · Gormley · G.
Objectives

To explore how learner transformation manifests in a communal arts and humanities (AH) educational activity for medical students.

Design

Mixed methods explorative study.

Setting

UK-based medical school that follows a 5-year case-based learning curricular model.

Interventions

A group of 105 first-year medical students attended a group viewing of a TV documentary titled, ‘Life on the List’ as part of their core curriculum. The documentary explores the humanistic aspects of kidney disease, organ donation and transplantation by portraying the personal stories of transplant recipients, donors and healthcare professionals. Following the screening, attendees engaged in a question-and-answer session with an expert panel.

Main outcome measures

Perceived transformation of learning was measured using a quantitative Likert-scale paired pre-screening and post-screening questionnaire. Additionally, the qualitative study used facilitated focus groups (FGs) to explore how learners may or may not have transformed their learning based on the AH educational activity.

Participants

Inclusion criteria were: (a) first-year medical students and (b) those who attended the screening. Those not meeting these criteria were excluded. The quantitative questionnaire was completed by 94 participants, while 19 attended FG interviews.

Results

Paired t-tests were conducted to compare pre-screening and post-screening responses across five questions. All results demonstrated statistical significance (phow learning was transformed: (1) an absorbing experience; (2) confronting and challenging: different ways of seeing the world; (3) collective reflection: the power and safety of the crowd; (4) ‘everything just came into perspective’: accepting the world in a new way; and (5) willing to change the world: advocacy and agency. By this collective experience focusing on real patient stories and providing an opportunity for discussion and reflection, participants were offered a holistic view on kidney medicine and transplantation. Overwhelmingly, participants were inspired to strive for person-centred care, with many being motivated to explore kidney medicine and transplantation as career options.

Conclusion

Couched in pedagogy, an AH educational activity for medical students can leverage learner transformation and promote person-centred care. With respect to kidney medicine, organ donation and transplantation, such activities can provide early career exposure to these fields. Students may be inspired to act as positive ambassadors for organ donation and transplantation and further explore these areas as future career options. Further research should investigate AH interventions in diverse groups from a longitudinal perspective to consider long-term effects in promoting holistic and empathetic patient care.

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Impact of intraoperative explanation combined with surgical video review on anatomy learning in laparoscopic distal gastrectomy

Por: Ding · Y. · Liu · X. · Cai · Y. · Cheng · F. · Shi · L. · Wu · K.
Objective

To investigate the educational value of combining intraoperative explanations with laparoscopic surgical video reviews for teaching the local anatomy of the stomach.

Methods

Thirty resident physicians undergoing standardised training in our hospital, including undergraduate resident physicians and clinical-type postgraduates in surgery who had not participated in radical gastrectomy for gastric cancer, were selected as study subjects. They were randomly divided into an experimental group and a control group, with 15 participants in each group. The experimental group received instruction through intraoperative explanations combined with laparoscopic surgical video reviews, while the control group participated in surgery without additional instructional methods. After the teaching sessions, both groups underwent clinical practice assessments, theoretical examinations and evaluations of teaching satisfaction. The distribution of the data was assessed using the Shapiro-Wilk normality test along with Quantile-Quantile plots. Two-way analysis of variance was employed to evaluate the main effects and interaction effects of clinical practice scores across different groups and student types. Statistical power was examined through post hoc power analysis.

Results

The clinical practice assessment results, theoretical examination scores and teaching satisfaction ratings of the experimental group were significantly higher than those of the control group, with all differences reaching statistical significance (p

Conclusion

Combining intraoperative explanations with laparoscopic surgical video reviews for teaching local anatomy during distal gastrectomy is more effective than participation in surgery alone. This approach allows students to review surgical videos at their convenience, enhancing their understanding and mastery of local anatomical structures and significantly improving the quality of local anatomy education for resident physicians.

Barriers and facilitators of implementing escape room in nursing education: a mixed-method systematic review protocol using an implementation framework

Por: Tan · X. · Cao · F. · Hua · N. · Zeng · Y. · Peng · J. · Pan · T. · Zhang · N. · Sun · M.
Introduction

Escape room (ER) methodology is recognised as an innovative pedagogical tool in nursing education, fostering an interactive environment that transforms students from passive observers into active participants. Current research on ER in educational contexts primarily emphasises their effectiveness and learner experiences, while neglecting the specific facilitators and barriers relevant to nursing education. This gap leads to a lack of essential frameworks for course design. Understanding these barriers and facilitators is crucial for the effective application of ERs in educational settings. Consequently, this review aims to identify factors associated with the implementation of ER in nursing education, using the Consolidated Framework for Implementation Research as a guiding framework.

Methods and analysis

The search will encompass six English databases and three Chinese databases from their inception to 1 October 2025: CINAHL, Embase, Education Resources Information Center, Scopus, Web of Science and MEDLINE, Wang Fang, China National Knowledge Infrastructure and the Chinese Biomedical Literature Database. Studies with qualitative, quantitative or mixed-methods designs will be included. Publications in English or Chinese will be considered from database inception. Two independent researchers will conduct screening and data extraction according to predefined criteria. A convergent integrated approach, including the transformation of quantitative results, will be employed, followed by thematic synthesis to analyse the findings. Discrepancies will be resolved through discussions with a third reviewer.

Ethics and dissemination

The ethical approval for this review is unnecessary due to the utilisation of secondary data. The outcomes are scheduled for publication in a peer-reviewed journal, with the aim of elucidating the facilitators and barriers linked to the integration of ER in nursing education.

PROSPERO registration number

CRD42024605953.

How do new doctors prescribe insulin? Qualitative exploration of the complexity of everyday practice and implications for medical education

Por: Dornan · T. · Lee · C. · Hancock · J. · Mattick · K. · Gillespie · H. · Findlay-White · F. · Conn · R.
Objectives

(1) Analyse in depth an exemplar safety-critical task required of newly qualified doctors (prescribing insulin) and (2) Provide transferable insights into how undergraduate education could better educate medical students to meet the demands of practice when they become postgraduate trainees.

Design

Document analysis of doctors’ reported experiences of insulin prescribing, an everyday task that has an emergent logic of practice and harms not just patients but (psychologically) new doctors. Application of third-generation (social emergence) complexity theory to explore why practice can be ‘mutually unsafe’.

Settings

A system of care comprising all five Northern Irish (UK) Health and Social Care Trusts, which together provide healthcare to a population of nearly two million people.

Participants

68 postgraduate year 1 and year 2 trainees (PGY1/2s), mainly PGY1s.

Main outcome measures

Thick description of new doctors’ contexts of action, reasons for acting and specific actions. We present this as a narrative compiling all 68 stories, 13 detailed exemplar stories and a diagram summarising how multiple factors interacted to make practice complex.

Results

Situations that required PGY1/2s to act had interacting layers of complexity: (1) disease trajectories; (2) social dynamics between stakeholders and (3) contextual influences on stakeholders’ interactions. Out-of-hours working and unsuitable wards intensified troublesome contextual influences. All three individually complex layers ‘crystallised’ briefly to create ‘moments of action’. At best, PGY1/2s responded proactively, ‘stretched time’ and checked the results of their actions. At worst, PGY1/2s ‘played safe’ in unsafe ways (eg, took no action), acted on unsafe advice or defaulted to actions protecting them from criticism. Informal, pervasive rules emerged from, and perpetuated, unsafe practice.

Conclusions

New doctors’ work includes acting on indeterminate, emergent situations whose complexity defies rules that are determinate enough to be taught off the job. If new doctors are to perform capably in moments of action, medical students need ample, supervised, situated experience of what it is like to take responsibility in such moments.

Effect of a structured educational intervention delivered through a mobile application on glycated haemoglobin and self-efficacy in adolescents with type 1 diabetes mellitus: a systematic review and meta-analysis

Por: Rubab · H. · Aziz · F. · Gul · R. · Froelicher · E. S.
Objectives

Type 1 diabetes mellitus (T1DM) is a chronic illness affecting children and adolescents worldwide. Mobile health apps (MHAs) are increasingly used to deliver structured educational interventions (SEI) aimed at reducing glycated haemoglobin (HbA1c), enhancing self-efficacy and self-management in adolescents with T1DM. This review and meta-analysis assessed the effectiveness of SEI via MHAs on HbA1c and self-efficacy in adolescents with T1DM.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Pak Medinet, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Wiley Online Library and host database Offshore Vessel Inspection Database (OVID) were searched from 1 January 2013 to 30 December 2023.

Eligibility criteria

Randomised controlled trials and quasi-experimental studies (QES) conducted in adolescents aged 10–19 years with T1DM that evaluated the effectiveness of SEIs delivered through mobile app on HbA1c and self-efficacy were included.

Data extraction and synthesis

Two independent reviewers screened the abstracts and articles by assuring standardised methods. Quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Tools for randomised controlled trials (RCTs) and QESs. The meta-analysis was conducted using a random-effects model.

Results

Eight studies met the inclusion criteria, with 555 adolescents aged 10–19 years. The study duration ranged from 7 to 48 weeks. Meta-analysis showed no significant difference in HbA1c at 3 months between the MHAs and control groups (Hedge’s g: –0.03, 95% CI: –0.37 to 0.31, p=0.86). Study heterogeneity was moderate (I2=45%) with no publication bias (Begg’s test p>0.99). Self-efficacy outcomes were inconclusive, with only one RCT reporting improvement in the intervention group and two QES studies showing mixed results.

Conclusions

SEI via MHAs did not significantly affect HbA1c levels in adolescents with T1DM compared with those in the controls. We recommend conduction of well-designed RCTs with larger sample sizes, standardised measurements and tailored educational components to better determine the effectiveness of SEI via MHAs in adolescents.

PROSPERO registration number

CRD42024537942.

Effectiveness of a centrally designed, large-scale, multisite undergraduate medical simulation programme: student-reported confidence across eight London hospitals in a UK medical school setting

Por: Fung · C. Y. · Wraith · C. · Houghton · N. · Woods · B. · Brown · C. · Dharmarajah · A. · Sam · A. H.
Objectives

Simulation is well established in medical education. However, with rising numbers of medical students globally, provision of high-quality, equitable simulation teaching on a large, multisite scale is increasingly challenging. We sought to explore whether a centrally designed, multisite simulation programme could enhance student confidence equitably across multiple clinical sites with differing resources.

Design

An evaluative study on the changes in medical student confidence on defined intended learning outcomes (ILOs) in 3 undergraduate year groups across 11 simulation sessions delivered at eight different clinical sites with variable resources and facilitators.

Setting

Eight hospitals affiliated with Imperial College School of Medicine.

Outcomes

Students’ self-reported confidence in achieving the ILOs via a questionnaire at the end of each session. Changes in confidence following each session were analysed and compared across sites.

Results

522 students responded to the survey over 3 academic years. Students’ mean confidence in achieving ILOs increased in all sessions. Nine out of 10 sessions showed no statistically significant difference in the confidence increases between sites.

Conclusion

Our study suggests it is possible to deliver an equitable, centrally designed, large-scale simulation teaching programme to medical students across multiple clinical sites with different facilitator teams. The programme is sustainable, easily facilitated by new teaching fellows each year and is likely adaptable to other healthcare professions and settings.

Validity evidence for communication skills assessment in health professions education: a scoping review

Por: Dorrestein · L. · Ritter · C. · De Mol · Z. · Wichtel · M. · Cary · J. · Vengrin · C. · Artemiou · E. · Adams · C. L. · Ganshorn · H. · Coe · J. B. · Barkema · H. · Hecker · K. G.
Objective

Communication skills assessment (CSA) is essential for ensuring competency, guiding educational practices and safeguarding regulatory compliance in health professions education (HPE). However, there appears to be heterogeneity in the reporting of validity evidence from CSA methods across the health profession that complicates our interpretation of the quality of assessment methods. Our objective was to map reliability and validity evidence from scores of CSA methods that have been reported in HPE.

Design

Scoping review.

Data sources

MEDLINE, Embase, PsycINFO, CINAHL, ERIC, CAB Abstracts and Scopus databases were searched up to March 2024.

Eligibility criteria

We included studies, available in English, that reported validity evidence (content-related, internal structure, relationship with other variables, response processes and consequences) for CSA methods in HPE. There were no restrictions related to date of publication.

Data extraction and synthesis

Two independent reviewers completed data extraction and assessed study quality using the Medical Education Research Study Quality Instrument. Data were reported using descriptive analysis (mean, median, range).

Results

A total of 146 eligible studies were identified, including 98 394 participants. Most studies were conducted in human medicine (124 studies) and participants were mostly undergraduate students (85 studies). Performance-based, simulated, inperson CSA was most prevalent, comprising 115 studies, of which 68 studies were objective structured clinical examination-based. Other types of methods that were reported were workplace-based assessment; asynchronous, video-based assessment; knowledge-based assessment and performance-based, simulated, virtual assessment. Included studies used a diverse range of communications skills frameworks, rating scales and raters. Internal structure was the most reported source of validity evidence (130 studies (90%), followed by content-related (108 studies (74%), relationships with other variables (86 studies (59%), response processes (15 studies (10%) and consequences (16 studies (11%).

Conclusions

This scoping review identified gaps in the sources of validity evidence related to assessment method that have been used to support the use of CSA methods. These gaps could be addressed by studies explicitly defining the communication skill construct(s) assessed, clarifying the validity source(s) reported and defining the intended purpose and use of the scores (ie, for learning and feedback, for decision making purposes). Our review provides a map where targeted CSA development and support are needed. Limitations of the evidence come from score interpretation being constrained by the heterogeneity of the definition of communication skills across the health professions and the reporting quality of the studies.

Effects of standardised patients (SP) combined with case-based learning (CBL) in Chinese clinical education: a systematic review and meta-analysis

Por: Yu · Z. · Zhao · Z. · Chen · X. · Shi · J. · Liang · Y. · Zhang · X. · Qu · M. · Huang · M. · Li · P. · Li · D. · Li · M. · He · J.
Objectives

Combining standardised patients (SP) with case-based learning (CBL) enriches the learning experience by immersing learners in diverse clinical scenarios. This meta-analysis study aims to assess the intervention effects of this teaching approach on Chinese medical students’ and resident physicians’ teaching satisfaction, theoretical knowledge achievements and clinical practice performance.

Design

A systematic review and meta-analysis through Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.

Data sources

PubMed, Web of Science, Cochrane Library, Education Resources Information Center, China National Knowledge Infrastructure, Wanfang Database and the VIP Database from their inception up to 30 April 2025.

Eligibility criteria

Included studies were randomised controlled trials (RCTs) comparing SP+CBL (experimental group) with lecture-based learning (LBL) (control group) among Chinese medical students and resident physicians, with outcomes including teaching satisfaction, theoretical knowledge scores and clinical practice performance. Non-English/non-Chinese studies, non-RCTs, duplicate publications, studies with incomplete data or irrelevant topics were excluded.

Data extraction and synthesis

Two researchers (JS/XC) independently screened records. Disagreements were resolved by a third reviewer (ZZ). Study quality was assessed using the Cochrane Risk-of-Bias 2.0 tool (ROB 2.0). Meta-analysis used Stata V.17.0. A random effects (RE) model was prespecified due to anticipated heterogeneity, final model selection RE or fixed effects was based on I2 statistics. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Evidence profiles were generated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Publication bias was assessed using funnel plots and Egger’s test. Subgroup analyses compared theoretical/clinical outcomes between medical students and resident physicians to explore heterogeneity sources.

Results

A meta-analysis of 31 RCTs (n=2674), SP+CBL pedagogy outperformed traditional methods in three domains. Teaching satisfaction showed substantial improvement (OR 7.19, 95% CI 3.80 to 13.60, p

Conclusions

Despite some high outcomes heterogeneity stemming from unavoidable methodological constraints in education, our meta-analysis and systematic review of eligible literature demonstrate that integrating SP and CBL facilitates students and resident physicians in acquiring theoretical knowledge and practical skills. It also boosts teaching satisfaction and positively impacts Chinese clinical education.

INPLASY registration number

INPLASY202560118.

Development and validation of clinical vignettes to inform an educational intervention for physiotherapists to detect serious pathologies: a mixed-methods study

Por: Lackenbauer · W. · Gasselich · S. · Lickel · M. E. · Schabel · L. · Beikircher · R. · Keip · C. · Wieser · M. · Selfe · J. · Mazuquin · B. · Yeowell · G. · Janssen · J.
Objectives

To develop and validate educational clinical vignettes (CVs) based on real-life patients with serious pathology from the disciplines of oncology, internal medicine and orthopaedics that are relevant for physiotherapists (PTs) working in a non-direct access system.

Design

A mixed-methods study using an iterative design was employed to develop and validate CVs that focused on serious pathology.

Setting

Academic and clinical settings within health faculties at three universities in Austria and the UK.

Participants

Medical doctors (MD) (n=3) and PTs (n=4) developed CVs in the disciplines of internal medicine, oncology and orthopaedics. Validation of the CVs was undertaken in three stages: internal validation by the research team (n=7), external validation by MDs (n=3) and external validation by PTs (n=18).

Results

25 CVs focusing on internal medicine (9), oncology (8) and orthopaedics (8) were developed. Results of the consensus method of Haute Autorité de Santé ranged between 7 and 9 in the internal validation stage. In the external validation stage with MDs, one orthopaedic CV was excluded, resulting in a final total of 24 validated CVs.

Conclusions

This is the first time educational CVs have been developed and validated across such a broad range of pathologies for countries without direct access to physiotherapy, for use in the education of PTs. Furthermore, the approach described in the Methods section of this paper may serve as a template in similar future projects.

Socioeconomic and demographic predictors of extracurricular achievements among UK medical students (FAST study)

Por: Ferreira · T. · Collins · A. M. · Handscomb · A. · French · B. · Bolton · E. · Fortescue · A. · Plumb · E. · Feng · O. · The FAST Collaborative · Fallows · Valnarov-Boulter · Kuo · Sagdeo · McDermott · Luo · Wong · Fitzsimons-West · Ho · Hemayet · Sreekumar · Burley · Stavrinou · Lew
Objective

To investigate the relationship between demographic characteristics and extracurricular achievements among UK medical students.

Design

National, cross-sectional survey.

Setting

All 44 UK medical schools recognised by the General Medical Council.

Participants

8,395 medical students.

Outcomes

Binary indicators of extracurricular engagement, including PubMed-indexed authorship, academic presentations, quality improvement projects, leadership roles and academic prizes. Logistic regression models were used to explore associations with demographic and extracurricular achievement predictors.

Results

Logistic regression analysis showed that students from private schools (OR 1.35, CI 1.20 to 1.53, p

Conclusions

Significant disparities in extracurricular achievement exist among UK medical students, principally associated with gender, private schooling and familial links to medicine. Apparent ethnic differences were largely attenuated after adjustment for other variables, indicating socioeconomic factors as stronger predictors of engagement. Given the role of these achievements in postgraduate selection, targeted interventions by medical schools and professional bodies to widen access to funding, mentorship and structured guidance for all students, regardless of perceived advantage, may support equitable opportunity without undermining merit-based standards.

Specialty choices among UK medical students: certainty, confidence and key influences--a national survey (FAST Study)

Por: Ferreira · T. · Collins · A. M. · Handscomb · A. · French · B. · Bolton · E. · Fortescue · A. · Plumb · E. · Feng · O. · the FAST Collaborative · Fallows · Valnarov-Boulter · Kuo · Sagdeo · McDermott · Luo · Wong · Fitzsimons-West · Ho · Hemayet · Sreekumar · Burley · Stavrinou · Lew
Objective

To explore factors influencing UK medical students’ specialty choices and examine variations in these influences across demographic groups and stages of training.

Design

National, cross-sectional online survey.

Setting

All 44 UK medical schools recognised by the General Medical Council.

Participants

8,395 medical students.

Primary and secondary outcomes

The primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.

Results

General Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p

Conclusions

This study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.

Impact of increased resident preparation time on internal medicine rounds in a tertiary teaching hospital: a time-motion study with a before-and-after comparison

Por: Garnier · A. · Cominetti · F. · Monti · M. · Marques-Vidal · P. · Bastardot · F. · Vollenweider · P. · Waeber · G. · Castioni · J. · Gachoud · D. · Kraege · V.
Objectives

To determine whether postponing daily medical rounds to provide additional preparation time for residents reduces round duration and alters time allocation during rounds, with the hypothesis that increased preparation leads to more efficient rounds without reducing patient contact.

Design

Time and motion study with a before-and-after comparison.

Setting

Internal medicine division of Lausanne University Hospital, a Swiss tertiary teaching hospital.

Participants

75 residents; 60% women; mean age of 29.6 years and 3.0 years of training.

Intervention

In 2017, the daily work schedule was reorganised by postponing rounds from 09:00 to 10:00 and moving educational sessions to the afternoon, thereby freeing 90 min to prepare patient cases before rounds.

Primary and secondary outcome measures

The primary outcome was the duration of rounds and the proportion thereof spent with patients, using computer systems or in discussion with colleagues. Secondary outcomes included the detailed distribution of resident activities during the officially scheduled round period, particularly time dedicated to supervision, teaching and administrative tasks.

Results

Round duration decreased from 142 min per shift (95% CI 128 to 156) in 2015 to 112 min (95% CI 101 to 124) in 2018 (p=0.001). The proportion of round time spent directly with patients remained stable at 47%. Computer use during rounds decreased from 43% to 32% (p

Conclusions

Postponing rounds to allow more preparation time was associated with shorter, possibly more efficient rounds, reduced computer use in patient presence and increased supervision and teaching.

Trial registration number

ISRCTN69703381, https://doi.org/10.1186/ISRCTN69703381 (registration date: 24 April 2018).

Bringing together conceptualisations of the health advocacy competence across the continuum of medical education: a scoping review protocol

Por: Oosthoek · W. R. W. · Cecilio-Fernandes · D. · Engel · M. F. M. · van Prooijen · L. T. · Otto · S. J. · Woltman · A. M.
Introduction

Health advocacy (HA) is acknowledged as a core competence in medical education. However, varying and sometimes conflicting conceptualisations of HA exist, making it challenging to integrate the competence consistently. While this diversity highlights the need for a deeper understanding of HA conceptualisations, a comprehensive analysis across the continuum of medical education is absent in the literature. This protocol has been developed to clarify the conceptual dimensions of the HA competence in literature as applied to medical education.

Methods and analysis

The review will be conducted in line with the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. A comprehensive literature search was developed and already carried out in eight academic databases and Google Scholar, without restrictions on publication date, geography or language. Articles that describe the HA role among students and physicians who receive or provide medical education will be eligible for inclusion. Two independent reviewers will independently complete title and abstract screening prior to full-text review of selected articles and data extraction on the final set. A descriptive-analytical approach will be applied for summarising the data.

Ethics and dissemination

This scoping review does not involve human participants, as all evidence is sourced from publicly available databases. Therefore, ethical approval is not required for this study. The findings from this scoping review will be disseminated through submission to a high-quality peer-reviewed journal and presented at academic conferences. By clarifying the conceptualisations of HA, this review aims to contribute to a shared narrative that will strengthen the foundation for integrating the HA role into medical education.

Trial registration number

A preliminary version of this protocol was registered on the Open Science Framework on 9 December 2024, and can be accessed at the following link: https://osf.io/ed2br. We have also registered our scoping review protocol as a preprint at medRxiv: https://doi.org/10.1101/2024.12.09.24318699.

Impostor syndrome, associated factors and impact on well-being across medical undergraduates and postgraduate medical professionals: a scoping review

Por: Chua · S. M. · Tan · I. Y. K. · Thummachai · M. E. · Chew · Q. H. · Sim · K.
Objectives

Impostor syndrome (IS) is a psychological state whereby individuals doubt their abilities despite evidence of competence. Though IS has been studied in specific medical groups, no review to date compares findings across groups. This study aimed to: (1) determine the range of IS rates among medical undergraduates versus postgraduates and (2) examine associated factors across both groups.

Design

This scoping review used the Joanna Briggs Institute methodology for scoping reviews, using a five-step framework.

Data sources

PubMed, Scopus and PsycINFO databases were searched from inception until September 2024.

Eligibility criteria

Studies were included if they were (1) empirical studies with a defined IS rating scale, (2) involving medical undergraduates, residents or clinicians and (3) published in English.

Data extraction and synthesis

Three independent reviewers used standardised methods to screen and review selected studies, and extract key variables.

Results

54 studies (77.8% from the West) were included. There was equal study distribution between undergraduates (46.3%, 25 studies) and postgraduates (46.3%, 25 studies), with the rest covering both groups. IS prevalence was substantial across all groups when assessed using the Clance Impostor Phenomenon Scale, ranging from 30.6% to 75.9% among undergraduates, 33.0% to 75.0% among residents and 23.5% to 50.0% among faculty and clinicians. In undergraduates, IS was associated with learning breaks, transition periods and poor academic performance. Among postgraduates, IS was correlated with younger age, junior ranking, fewer work years, inadequate faculty support or self-perceived poor clinical and teaching skills. Additionally, IS affected physical and psychological well-being (stress, anxiety, depression, burnout) and was associated with sociodemographic factors (single status, females), personality (neuroticism, perfectionistic traits, with conscientiousness, agreeableness and extraversion as protective) and interpersonal issues (conflicts, poor sense of belonging).

Conclusions

Given the high IS prevalence and associations with specific factors, practical measures are recommended to address IS and optimise learning and care for medical undergraduates and professionals.

Modified Alliance-Focused Training with Doubling as an integrative approach to improve therapists competencies in dealing with alliance ruptures and prevent negative outcomes in psychotherapy for depression: study protocol of a randomised controlled multi

Por: Gumz · A. · Kästner · D. · Reuter · L. · Martinez Moura · C. · Ehlers · K. · Daubmann · A. · Eubanks · C. F. · Muran · J. C. · Anderson · T. · Stöckl · R. · Schwanitz · G. · Stegemann · L. · Rohr · L. · Willutzki · U. · Jacobi · F. · Zapf · A.
Introduction

Alliance ruptures constitute a high risk of premature treatment termination and poor psychotherapy outcome. The Alliance-Focused Training (AFT) is a promising transtheoretical approach to enhance therapists’ skills in dealing with alliance ruptures.

Methods and analysis

To evaluate the effectiveness of Modified AFT with doubling (MAFT-D), a randomised, patient and evaluator-blinded, multicentre trial was designed comparing MAFT-D (delivered to trainee therapists and supervisors) and psychotherapy training/treatment as usual (TAU) for therapists (n=120) and their patients with depressive disorders (n=240). A total of 17 cooperating centres, each offering either cognitive-behavioural or psychodynamic psychotherapy training, will contribute to recruitment. Stratification by centre (both for therapists and patients) and hence therapeutic approach (cognitive-behavioural vs psychodynamic psychotherapies), and by comorbid personality disorder (yes vs no, for patients) will be carried out. The two hierarchically ordered primary hypotheses are: In MAFT-D compared with TAU, a stronger reduction of depressive symptoms and a lower rate of patient dropout is expected from baseline to 20 weeks after baseline. Follow-up assessments are planned at 35 weeks, 20 months and 36 months postbaseline to evaluate the persistence of effects. Secondary patient-related and therapist-related outcomes as well as predictors, moderators and mediators of change will be investigated. Mixed models with repeated measures will be used for the primary analyses.

Ethics and dissemination

Ethical approvals were obtained by the institutional ethics review board of the main study centre as well as by review boards in each federal state where one or more cooperating centres are located (secondary votes). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.

Trial registration number

DRKS00014842; https://drks.de/search/de/trial/DRKS00014842.

Insights and interventions for improving cultural humility towards Asian American, Native Hawaiian and Pacific Islander populations in medical curricula: a qualitative case study

Por: Cai · C. · Kong · S. · Im · C. · Mondell · E. · Le · T. K. · Irvin · N. · Lawson · S. M.
Objectives

The Asian American, Native Hawaiian and Pacific Islander (AANHPI) community is the fastest-growing racial/ethnic population in the USA. Previous research identified that medical students perceived a lack of exposure to AANHPI patients and topics in medical school curricula; however, there remains a lack of potential interventions to address this need. The goal of our study is to present a case study for identifying interventions in medical school curricula that improve cultural humility-based training for providing medical care for AANHPI populations.

Design

In this qualitative study, authors conducted four virtual focus groups with 15 medical students at a single institution to identify curricular interventions. The authors then conducted virtual semistructured interviews with eight medical educators one-on-one to explore the feasibility of the proposed interventions. Data were analysed using qualitative thematic analysis, and analysis was performed with ATLAS.ti.

Setting

Medical students and medical educators based at medical institutions in the USA.

Participants

15 medical students and eight medical educators participated in the study.

Results

All medical students (n=15) and educators (n=8) noted that there is limited engagement of AANHPI communities in current medical curricula and limited curricular components that address the diversity within the AANHPI umbrella. Medical student focus groups identified three interventions to improve cultural humility-based training for treating AANHPI patients: reflection spaces, community engagement and clinical training on documenting cultural needs. Educators supported the feasibility and importance of these interventions to prepare students to work with not only AANHPI patients but also with patients of other diverse backgrounds.

Conclusion

AANHPIs represent a heterogeneous population consisting of unique cultural heritages. Our research demonstrates the importance of highlighting this community in cultural humility curricula to provide an example of how to consider and appreciate diversity in patient populations. In this paper, we present student and medical educator-supported curricular interventions that not only increase awareness of issues impacting AANHPI communities, but also emphasise building skills of self-reflection, lifelong learning and empathy that are applicable to patients of all backgrounds.

What do Australian university staff perceive are the features of high-quality rural health student placements? A sequential explanatory study

Por: Green · E. · Rasiah · R. L. · Quilliam · C. · Moore · L. · Ridd · M. · Ferns · J. · Sheepway · L. · Seaton · C. · Taylor · C. · Fitzgerald · K.
Objectives

The aim of this study was to explore the features of high-quality rural health student placements from the perspective of university staff involved in designing, delivering and evaluating these programmes.

Design

A sequential explanatory mixed methods design was employed, integrating quantitative survey data with qualitative interview findings to provide a comprehensive understanding of the research question.

Setting and participants

The study was conducted online and sampled staff from universities across Australia, focusing on rural health student placements. The study involved 121 university staff members who participated in the survey, with 10 of these participants also taking part in follow-up qualitative interviews.

Methods

Quantitative data were collected using an online survey distributed to university staff involved in designing, delivering and evaluating rural health student placements. The survey included Likert scale, open-ended and demographic questions, and a preliminary analysis was used to write the interview questions. Qualitative data were gathered through semi-structured interviews, which were transcribed and analysed using the Framework approach. The quantitative and qualitative results were integrated to produce a narrative summary of findings.

Results

Key features identified as essential for high-quality rural health placements included safe and affordable accommodation, financial support and personal safety. High-quality supervision, cultural awareness training and opportunities for interprofessional education were also highlighted. The qualitative findings provided depth to the quantitative data, emphasising the importance of structuring learning within a continuum of education and fostering connections through co-location and community engagement.

Conclusions

This study identifies fundamental features of high-quality rural health placements in Australia, including accommodation, student safety, supervision and cultural responsiveness training. These findings can inform the design, delivery and evaluation of rural health student placements, contributing to the quality of these programmes as an efficacious learning experience.

Evolution of medical students tolerance for uncertainty throughout their curriculum: a systematic mixed studies review protocol

Por: Belhomme · N. · Robin · F. · Lescoat · A. · Pottier · P. · Triby · E. · Pelaccia · T.
Introduction

Understanding how uncertainty tolerance (UT) evolves in medical students is crucial to identify training needs and implement effective interventions. However, the dynamic nature of UT and the mechanisms behind its changes over time remain poorly understood. This systematic review aims to map the development of UT in medical students across the course of their training by synthesising the available evidence. We will adopt a systematic mixed studies review approach to provide an integrative synthesis of both quantitative and qualitative data, offering a comprehensive overview of UT temporal evolution.

Method and analysis

The protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will conduct searches in Embase, Medline, Cumulative Index to Nursing and Allied Health Literature, ERIC, Cochrane Library and PsycINFO, from inception to July 2026. We will manually search the references of included studies and track citations through Google Scholar to identify additional eligible studies. Two reviewers will independently extract data from each eligible study using a pre-piloted Microsoft Excel data extraction form. A thematic synthesis will be employed to develop analytic themes from the existing literature, generating new concepts and explanatory hypotheses. Study quality will be evaluated using the QuADS score.

Ethics and dissemination

Ethical approval is not necessary for this systematic review, as no primary data will be collected. The protocol for this review has been registered with the International Prospective Register of Systematic Reviews PROSPERO: CRD42024591340.

Understanding medical students transition to clinical training: a qualitative study of transformative learning and professional identity formation

Por: Ha · M. T. · Siddiqui · Z. S.
Introduction

The transition from preclinical to clinical training represents a pivotal stage in medical education, offering opportunities for transformative learning and professional identity formation. This study aims to explore how medical students reflect on their initial clinical learning experiences during the first week of clinical training, and how these reflections reveal early shifts in their professional identity, using Mezirow’s transformational learning framework.

Method

A qualitative descriptive study was conducted at VinUniversity, Hanoi, Vietnam. 47 fourth-year medical students from a single cohort submitted reflective writings after their first week of clinical training. Thematic analysis was performed, with emergent themes mapped against the dominant phases of Mezirow’s transformational learning framework.

Results

Thematic analysis revealed four main themes: (1) disorientation and emotional adaptation, (2) bridging theory and practice, (3) learning from the clinical environment and (4) personal and professional growth. Reflections revealed both emotional and cognitive shifts, highlighting students’ early adaptation and growth. Findings emphasised the need for enhanced mentorship, emotional resilience training and tailored bilingual communication strategies to optimise the transition.

Conclusions

Reflective writing captured students’ first impressions of clinical training and highlighted the critical role of emotional adaptation, mentorship and experiential learning in supporting identity formation. These insights offer practical implications for enhancing student support strategies and curriculum design in medical education.

How do programme directors perceive trainee attrition? A qualitative focus group study in three Dutch teaching hospitals

Por: Dijkhuizen · K. · Bustraan · J. · van den Bogaard · M. E. D. · van Lith · J. M. M. · Driessen · E. · De Beaufort · A. J.
Objective

To gain insight into programme directors’ (PDs’) perceptions of trainee attrition from postgraduate medical education (PGME), focusing on interactions between stakeholders within the learning environment and roles of PDs in the process leading to attrition.

Design, setting and participants

We performed a focus group study with 27 PDs from three Dutch teaching hospitals and analysed transcripts using template analysis.

Results

PDs identified attrition as a multilevel problem, in which personal, workplace and system-bound factors play a role. PDs mentioned balancing professional and personal responsibilities, in particular parenthood and high ambitions, as important trainee-related factors. PDs adopt different, at times conflicting, roles when guiding trainees, for example, assessor and mentor, and they struggle to balance these roles. They displayed various emotions when discussing attrition, varying from disappointment to frustration and anger, yet could also frame attrition positively as new opportunity. PDs used numerous resources to support trainees in difficulty, in a reactive rather than in a pro-active manner. A generation difference between faculty and trainees regarding work-life balance was mentioned as impeding mutual understanding. On the system level, PDs observed how implicit beliefs and negative interactions between actors in the learning environment impede trainees’ well-being.

Conclusions

PDs perceived trainee attrition as a multi-level problem that highlighted conflicting roles for the PD and evoked a wide range of emotions. The authors propose the following interventions: (1) address conflicting roles of PDs by reallocating specific tasks to other independent ‘third parties’, for example, professional coaching; (2) implement pro-active support for trainees unrelated to assessment; (3) create awareness of implicit assumptions of stakeholders and promote social belonging; (4) foster a supportive learning climate with clinical leaders as role models.

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