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Introduction: Developing a physician equipped with both technical and affective skills is crucial in ensuring quality patient care. Of these skills, nurturing empathy is a key skill that has been studied in great detail, particularly among medical undergraduates. Despite numerous studies trending the changes in empathy, the results are often contradictory or confusing. Our study aims to find what interventions are effective to inculcate empathy in both undergraduate and postgraduate medical education and suggest areas for improvement. Methods: A narrative review was conducted on the interventions in nurturing empathy in undergraduate and postgraduate medical education. Original research articles and systematic reviews with clear interventions and outcomes were included in the study. Results: A total of 44 articles were reviewed. About 44% (n = 18) of the studies used a mixture of different approaches as their interventions. Some interventions were anchored by specific topics: Seven papers focusing on communication skills, three papers on humanities, and three on arts. A majority of the interventions (60%; n = 26) were implemented over a span of time as compared to studies which suggested a one‐off intervention (30%; n = 12). Of the 26 papers in which the interventions were enforced over a period of time, 62% (n = 16) indicated an increase in student empathy whereas 16% (n = 4) indicated no changes in empathy post‐intervention. On the contrary, 50% (n = 6) of the one‐off interventions revealed no significant change in student empathy. Jefferson Scale of Empathy (JSE) is widely used in measuring student empathy postintervention, but approximately 41% of the studies included measuring tools other than JSE. Conclusions: Pedagogical methods that invoke thought processes related to the affective domain of learning and experiential learning are more effective than the didactic methods of teaching and learning. Multimodal mixed‐methods approach that combine different pedagogical interventions is more likely to bring about the desired results. Got empathy? Samarasekera et al.'s narrative review indicates that how interventions aimed at improving empathy are implemented determines their outcome while drawing attention to the value of time and context. [ABSTRACT FROM AUTHOR]

Introduction: The threshold concept framework (TCF) was first described nearly 20 years ago, but its application in the field of medical education has recently seen a significant growth of interest with a diverse range of literature published on the subject. The transformative nature of threshold concepts (TCs) offers potential for the design of learning experiences and curricula across the medical education continuum. A scoping review was conducted to map the extent of the current literature regarding TCs in medical education—to describe the types of available evidence and its focus—and identify research gaps. Methods: The review followed the JBI Manual for Evidence Synthesis approach for scoping reviews. Four databases and two additional websites were searched for articles exploring TCs in medical education. Data were analysed using quantitative and qualitative thematic approaches. A framework of conceptual change was used to synthesise the TCs identified. Results: Thirty‐six papers, spanning undergraduate, postgraduate and continuing medical education, were included in the final analysis. The most frequent application of the TCF was in the identification of TCs, which related to basic scientific knowledge, ways of thinking and ways of practising in medicine. Uncertainty, patient care, clinical reasoning and professional identify formation were themes that emerged at multiple stages of training. Several papers evaluated the use of the TCF in teaching. Conclusion: The understanding and embodiment of TCs increases in complexity across the medical education continuum, with TCs recurring with changes in clinical environment and responsibilities. This lends support to a holistic approach to curriculum design spanning all stages of training. Further research is needed to develop a consistent approach for describing and applying the TCF in medical education and to address how the TCF can be used in teaching and how threshold crossing can be measured. Understanding and embodiment of threshold concepts across the medical education continuum is argued through this review to support a holistic approach to curriculum design. [ABSTRACT FROM AUTHOR]

Introduction: Entrustable professional activities (EPAs), discrete profession‐specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programmes. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA framework poses a crucial but often difficult first step. The logic of an EPA framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programmes. Methods: A scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis. Results: In total, 42 studies were included. Most studies were conducted in the United States (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), paediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified, namely, 'service provision', 'procedures' and/or 'disease or patient categories'. The majority of papers (n = 37; 88%) used two or more logics when developing EPA frameworks (median = 3, range = 1–4). Disease or patient groups and service provision were the most common logics used (39% and 37%, respectively). Conclusions: Most programmes used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development. This study mapped the 3 dominant logics used in development of EPA‐frameworks. For each, a definition is provided with examples, benefits and limitations. [ABSTRACT FROM AUTHOR]

Introduction: Competency‐based medical education (CBME) led to the widespread adoption of workplace‐based assessment (WBA) with the promise of achieving assessment for learning. Despite this, studies have illustrated tensions between the summative and formative role of WBA which undermine learning goals. Models of workplace‐based learning (WBL) provide insight, however, these models excluded WBA. This scoping review synthesizes the primary literature addressing the role of WBA to guide learning in postgraduate medical education, with the goal of identifying gaps to address in future studies. Methods: The search was applied to OVID Medline, Web of Science, ERIC and CINAHL databases, articles up to September 2020 were included. Titles and abstracts were screened by two reviewers, followed by a full text review. Two members independently extracted and analysed quantitative and qualitative data using a descriptive‐analytic technique rooted in Billett's four premises of WBL. Themes were synthesized and discussed until consensus. Results: All 33 papers focused on the perception of learning through WBA. The majority applied qualitative methodology (70%), and 12 studies (36%) made explicit reference to theory. Aligning with Billett's first premise, results reinforce that learning always occurs in the workplace. WBA helped guide learning goals and enhanced feedback frequency and specificity. Billett's remaining premises provided an important lens to understand how tensions that existed in WBL have been exacerbated with frequent WBA. As individuals engage in both work and WBA, they are slowly transforming the workplace. Culture and context frame individual experiences and the perceived authenticity of WBA. Finally, individuals will have different goals, and learn different things, from the same experience. Conclusion: Analysing WBA literature through the lens of WBL theory allows us to reframe previously described tensions. We propose that future studies attend to learning theory, and demonstrate alignment with philosophical position, to advance our understanding of assessment‐for‐learning in the workplace. The authors' synthesis of literature that focuses on the overlap between workplace learning and workplace assessment highlights gaps and identifies key strategies for enabling "assessment for learning" in the workplace. [ABSTRACT FROM AUTHOR]

Introduction: There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high‐quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. Methods: Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. Results: 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self‐reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. Conclusions: Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher‐quality study is required to identify longer‐term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms. Two sides of the coin: With this systematic review, the authors synthesize evidence demonstrating how #SoMe can improve outcomes despite ongoing questions about professionalism [ABSTRACT FROM AUTHOR]

Context Competency‐based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent. Methods: We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment. Results: We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand‐alone group or part of a multi‐source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise. Conclusion: Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading‐comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way. With this scoping review, Khalife et al. demonstrate that patients' involvement in the assessment of residents offers unique insights on competence that may not be captured by other assessment methods. [ABSTRACT FROM AUTHOR]

Context Person‐centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person‐centredness are successful. Methods: A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person‐centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person‐centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person‐centredness. Results: Sixty‐one papers representing fifty‐three interventions were included in the final synthesis. Nine context–intervention–mechanism–outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person‐centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person‐centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person‐centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person‐centredness. Conclusion: Our findings offer explanations as to why communication skills‐based interventions may be insufficient to develop learners' person‐centredness. Integrating experiential person‐centred learning with theory on why person‐centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person‐centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person‐centredness. By reviewing training strategies, the authors offer practical explanations for what does and doesn't work to support person‐centredness, arguing it is critical for us to explain why person‐centredness matters. [ABSTRACT FROM AUTHOR]

Introduction: Like medicine and health care, feedback is a practice imbued with emotions: saturated with feelings relevant to one's identity and status within a given context. Often this emotional dimension of feedback is cast as an impediment to be ignored or managed. Such a perspective can be detrimental to feedback practices as emotions are fundamentally entwined with learning. In this critical review, we ask: What are the discourses of emotion in the feedback literature and what 'work' do they do? Methods: We conducted a critical literature review of emotion and feedback in the three top journals of the field: Academic Medicine, Medical Education and Advances in Health Sciences Education. Analysis was informed by a Foucauldian critical discourse approach and involved identifying discourses of emotion and interpreting how they shape feedback practices. Findings Of 32 papers, four overlapping discourses of emotion were identified. Emotion as physiological casts emotion as internal, biological, ever‐present, immutable and often problematic. Emotion as skill positions emotion as internal, mainly cognitive and amenable to regulation. A discourse of emotion as reflexive practice infers a social and interpersonal understanding of emotions, whereas emotion as socio‐cultural discourse extends the reflexive practice discourse seeing emotion as circulating within learning environments as a political force. Discussion Drawing on scholarship within the sociology of emotions, we suggest the merits of studying emotion as inevitable (not pathological), as potentially paralysing and motivating and as situated within (and often reinforcing) a hierarchical social health care landscape. For future feedback research, we suggest shifting towards recognising the discourse‐theory‐practice connection with emotion in health professional education drawing from reflexive and socio‐cultural discourses of emotion. This cross‐cutting edge article explores how effective feedback can be open to emotions and gauges how to leverage emotions for learning and practice. [ABSTRACT FROM AUTHOR]

Background: Many medical students may encounter a range of academic and personal challenges during their course of study, but very little is known about their experiences. Our aim was to review the literature to inform future scholarship and to inform policy change. Methods: A scoping review was conducted searching PubMed, MEDLINE, EMBASE, PsycInfo, British Education Index, Web of Science and ERIC for English language primary research with no date limits. This retrieved 822 papers of which eight met the requirements for inclusion in the review. Data were independently reviewed by two researchers and underwent thematic analysis by the research team. Results: Three major themes emerged. Theme 1: 'Identity preservation' addressed students' aim to preserve their sense of self in the face of academic difficulty and their tendency to seek support. This connected the apprehension many students expressed about their educational institutions to Theme 2: 'The dual role of the medical school'—medical schools are required to support struggling students but are predominantly seen as a punitive structure acting as the gatekeeper to a successful career in medicine. Students' apprehension and attempts to protect their identities within this complex landscape often resulted in 'maladaptive coping strategies' (Theme 3). Conclusion: Understanding and exploring the academic challenges faced by medical students through their own experiences highlight the need for the development of more individualised remediation strategies. Educators may need to do more to bridge the gap between students and institutions. There is a need to build trust and to work with students to enhance their sense of self and remediate approaches to engagement with learning, rather than focusing efforts on success in assessments and progression. Kirtchuk et al review qualitative studies of students' experiences with academic challenges. Their results highlight a need for institutions to build students' trust, enhance their self‐esteem, and improve engagement. [ABSTRACT FROM AUTHOR]

Background: Since 2017, more than 50% of UK doctors have undertaken a 'Foundation 3 (F3) Year' training break after completing their foundation programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field. Methods: Following Arksey and O'Malley's guidelines, 12 databases and three UK‐based national postgraduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the 'F3' time‐period, including 'post‐foundation' or 'pre‐specialty' training. Title, abstract and full‐paper screening selected articles reporting any aspect of F3, including within a wider context (eg postgraduate training breaks), and then underwent mixed‐methods analysis. Results: Of 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, and the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK postgraduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non‐clinically) and/or travel. The decision to undertake an F3 is made either prior to or during foundation training. Evidence regarding the impact of F3 on health care service provision was limited but evenly balanced. Conclusions: In summarising the existing F3 evidence, this review has highlighted important issues including health care workforce equality and diversity, training pathway inflexibility and the effect of negative early‐career experiences on subsequent career decisions. More research is needed to understand the financial impact of training breaks on health care service provision, how training programmes must adapt to retain more trainees and the long‐term effects of training breaks, such as F3, on subsequent career progression. The authors synthesize the evidence pertaining to how breaks in training (specifically in the context of the UK's Foundation Year 3) impact on the healthcare system, highlighting areas of future research interest. [ABSTRACT FROM AUTHOR]