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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]

Background: Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships. Methods: This was a qualitative study using interpretive description methodology. Eight internal medicine coach–resident dyads consented to audiotaping coaching meetings over a 1‐year period. Transcripts from meetings and individual exit interviews were analysed thematically using goal co‐construction as a sensitising concept. Results: Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co‐construction mainly occurred in how to meet goals, rather than in prioritising goals or co‐constructing new goals. Conclusions: In analysing goal development in the coach–resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage‐specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co‐regulation and reflection on both clinical competencies and professional identity formation. Farrell et al. demonstrate that longitudinal academic coaching provides residents a space to focus on professional identity development separate from clinical work. [ABSTRACT FROM AUTHOR]

Context: Practicing health professionals and educators frequently act together in an interdependent or joint capacity to reach goals. Teaching or learning a new skill or engaging with patients in shared decision‐making exemplifies this joint and goal‐directed nature of Health Professions Education (HPE) and practice. However, building a robust understanding of the complexity of action, and joint action in particular, in HPE or patient care remains a challenge because of a limited number of methodologies available within HPE research. Methods: In this manuscript, we describe the Action‐Project Method (A‐PM) as a qualitative research approach that can be used to describe and understand goal‐directed joint actions. A‐PM is grounded in contextual action theory and is a methodology focussed on action as an object of study, as it is occurring. A‐PM uses three distinct perspectives to understand goal‐directed joint actions: observable behaviour, internal processes (i.e. reported thoughts and feelings) and the social meaning reflected in goals. Data collection in A‐PM involves observations, interviews, recording of actions and a self‐confrontation procedure—where participants watch video‐recorded segments of action and reflect on their internal processes, describing what they were thinking or feeling as they were completing the action. Together, the rich data generated and the layered approach to analysis provide a means to better understand the joint actions embedded in complex systems and collaborative work. Furthermore, the participants are treated as equal partners within A‐PM, ensuring data equity even when the research context includes hierarchical relationships. Discussion Given increasing recognition to the importance of teamwork, relationships, interdependence, complex environments and centring patient or learner voices, A‐PM is a valuable research approach for HPE. A‐PM deepens our research arsenal with an approach that focusses on interdependent dyads or teams and provides a deeper understanding for how individuals engage together in goal‐oriented actions. In this Research Approaches article, the authors critically outline the Action‐Project Method as a means of gaining deeper understanding into how individuals engage together in goal‐oriented actions. [ABSTRACT FROM AUTHOR]

Introduction: Many health professions education (HPE) scholars frame assessment validity as a form of argumentation in which interpretations and uses of assessment scores must be supported by evidence. However, what are purported to be validity arguments are often merely clusters of evidence without a guiding framework to evaluate, prioritise, or debate their merits. Argumentation theory is a field of study dedicated to understanding the production, analysis, and evaluation of arguments (spoken or written). The aim of this study is to describe argumentation theory, articulating the unique insights it can offer to HPE assessment, and presenting how different argumentation orientations can help reconceptualize the nature of validity in generative ways. Methods: The authors followed a five‐step critical review process consisting of iterative cycles of focusing, searching, appraising, sampling, and analysing the argumentation theory literature. The authors generated and synthesised a corpus of manuscripts on argumentation orientations deemed to be most applicable to HPE. Results: We selected two argumentation orientations that we considered particularly constructive for informing HPE assessment validity: New rhetoric and informal logic. In new rhetoric, the goal of argumentation is to persuade, with a focus on an audience's values and standards. Informal logic centres on identifying, structuring, and evaluating arguments in real‐world settings, with a variety of normative standards used to evaluate argument validity. Discussion: Both new rhetoric and informal logic provide philosophical, theoretical, or practical groundings that can advance HPE validity argumentation. New rhetoric's foregrounding of audience aligns with HPE's social imperative to be accountable to specific stakeholders such as the public and learners. Informal logic provides tools for identifying and structuring validity arguments for analysis and evaluation. In #HPE we often conceptualize validity as an argument. But what is argumentation? From what guiding principles might HPE draw? @Midwest_MedPeds @DrDanSchumacher @erikwdriessen @LaraVarpio review argumentation theory to explore these questions. [ABSTRACT FROM AUTHOR]

Introduction: Medical students have voluntarily initiated service‐learning programmes with the aim of providing assistance to medically underserved communities, especially within remote indigenous villages. However, their values and goals have been challenged because rural health care demands have changed considerably since the introduction of integrated delivery system (IDS) programmes, that is, programmes that integrate local health care providers with outreach services provided by contracted hospitals. Our study aimed to explore how a health care service‐learning group negotiates its position and how it responds to the tension of IDS implementation and changes in rural health care demand. Methods: Medical students who have been engaged in building or operating the health care service‐learning group of one university in Taiwan were invited to participate in the study. We used cultural–historical activity theory (CHAT) to help us interpret the interactions between students, indigenous communities and the public health sectors and to understand the evolution of the service‐learning relationship and its effectiveness. Results: Eighteen participants were recruited for in‐depth interviews. The implementation of IDS programmes brought change to the rural community and challenges to students' service learning. Utilising cultural–historical activity theory, we highlighted points of fragmentation within the system. This tension lead to medical students' personal conflict and also served as an impetus for change and learning. Flexible goal setting and coping ability were considered critical to the sustainability and maintenance of students' value systems. Conclusions: IDS implementation can upset the balance of rural health care supply and demand, resulting in accumulating tensions within and between activity systems. Those contradictions exposed medical students to an expansive learning cycle, resulting in transformational change and learning. Under the context of IDS programmes, health care service‐learning can create a 'win‐win' situation. Not merely medical students but also community residents gain benefits. This result may be extrapolated to health care service‐learning programmes with similar context. Using cultural historical activity theory insights, the authors discover ways in which student‐led healthcare service‐learning programs can create a 'win‐win' situation, facilitating student learning and community benefit. [ABSTRACT FROM AUTHOR]

The authors discuss challenges inherent to playing the role of coach in postgraduate training by reflecting on role conflicts and benefits with regard to feedback's impact on professional development. [ABSTRACT FROM AUTHOR]

The authors critique methodologies commonly used to investigate interpersonal competence by contemplating how the action‐project method might better account for individuals' interdependence. [ABSTRACT FROM AUTHOR]

Commenting on Hu et al., Grainger and Gladman comment on how the purpose of student‐led community learning can change focus from the development of technical and professional skills to the aspirations and goals of the community in which students work. [ABSTRACT FROM AUTHOR]

The article discusses the trial of a coaching program that recruited senior medical students to be volunteer coaches to incoming medical students as of 2023. Topics covered include the online 7-week prematriculation course (PMC) and its implementation. Also noted are students' general positive comments on coaching, and the suggestion that pairing coaches and coachees with similar backgrounds and life experiences would be more ideal.

Context: Medical underperformance puts patient safety at risk. Remediation, the process that seeks to 'remedy' underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, although remediation is used in health care systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety. Method: We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE) and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations (CMOcs). Results: A 141 records were included. The majority of the studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal setting and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. Conclusion: Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors. The authors present a model for the remediation of practising doctors based on an extensive realist review of the literature. [ABSTRACT FROM AUTHOR]

Context: Solutionism is the all‐too‐common human propensity to jump to a solution before adequately understanding the nature of a problem. Solutionism has long been prevalent in efforts to improve education at all levels, including medical education. Thesis: Educational design research (EDR) is a genre of research that features the gaining of in‐depth understanding of a problem before any prototype solution is designed and tested. It is different from other forms of scientific inquiry because it is committed to the simultaneous development of both theoretical insights and practical solutions, together with stakeholders. This approach is powerful for theory building because it privileges ecologically valid studies that embrace the complexity of investigating learning in authentic (as opposed to laboratory) settings. When conducted well, both the research process and its outcomes generate valuable contributions to practice. Preview: This article constitutes an expository essay on EDR, comprised of three movements. First, the approach is defined, its origins are presented, and its characteristics are described. Second, a generic model for conducting EDR is offered, and illustrated with examples from the field of medical education. Third, pathways towards advancing this form of inquiry are discussed, including ways to address inherent challenges and limitations, as well as recommendations for the medical education community. Although EDR is no panacea, this article illustrates how it can serve medical education research in a wide variety of geographic and disciplinary contexts. [ABSTRACT FROM AUTHOR]

Context: The explicit, intentional and systematic application of continuous quality improvement (QI) in medical education practice and research can improve medical education and help it achieve its goals. Quality improvement and medical education share a foundation centred on learning—experiencing, reflecting, thinking and acting in continuous cycles that spiral to sustained advancement. This suggests that a QI mindset can be brought to bear on various aspects of medical education research and practice. Discussion: To explore this possibility, we turn to W. Edwards Deming's System of Profound Knowledge, widely regarded as one of the foundational frameworks in quality improvement, where he argues strongly that there are four highly interrelated elements that are required for improvement: Appreciation of a System, Theory of Knowledge, Knowledge about Variation and Knowledge of Psychology. In this article, we define and explore each of the four domains and their application in medical education, highlighting both opportunities and challenges. Conclusion: Medical educators who utilise QI in their educational practices can help create learning environments that imprint positively on learners and contribute to better outcomes in their clinical learning environments. We provide recommendations for how educators' informed use of QI can improve medical education and help it achieve its ultimate goal of improved health and health care. The authors turn to Deming for a #QI framework to support continuous improvement of #MedEd practice and scholarship. [ABSTRACT FROM AUTHOR]

Objectives: Educators and researchers recently implemented developmental progress assessment (DPA) in the context of competency‐based education. To reap its anticipated benefits, much still remains to be understood about its implementation. In this study, we aimed to determine the nature and extent of the current evidence on DPA, in an effort to broaden our understanding of the major goals and intended outcomes of DPA as well as the lessons learned from how it has been executed in, or applied across, educational contexts. Methods: We conducted a scoping study based on the methodology of Arksey and O'Malley. Our search strategy yielded 2494 articles. These articles were screened for inclusion and exclusion (90% agreement), and numerical and qualitative data were extracted from 56 articles based on a pre‐defined set of charting categories. The thematic analysis of the qualitative data was completed with iterative consultations and discussions until consensus was achieved for the interpretation of the results. Results: Tools used to document DPA include scales, milestones and portfolios. Performances were observed in clinical or standardised contexts. We identified seven major themes in our qualitative thematic analysis: (a) underlying aims of DPA; (b) sources of information; (c) barriers; (d) contextual factors that can act as barriers or facilitators to the implementation of DPA; (e) facilitators; (f) observed outcomes, and (g) documented validity evidences. Conclusions: Developmental progress assessment seems to fill a need in the training of future competent health professionals. However, moving forward with a widespread implementation of DPA, factors such as lack of access to user‐friendly technology and time to observe performance may render its operationalisation burdensome in the context of competency‐based medical education. Adding to the Cross‐cutting edge series, Johnston et al. introduce readers to the postmodern concept of the simulacrum, explore its relevance to the growing field of simulation education. [ABSTRACT FROM AUTHOR]

Context: Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end‐of‐life care. In previous research, medical learners have reported insufficient training and emotional distress about end‐of‐life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. Methods: Using purposive sampling at one Canadian medical school, individual semi‐structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. Results: Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. Conclusions: GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively. The research described in this paper illustrates how leading goals‐of‐care discussions as a very junior learner can lead to emotional distress and have negative impacts on professional identity development. [ABSTRACT FROM AUTHOR]

The article provides information on the Student-to-Student Clerkship Guide designed by senior medical students at Southern Illinois University School of Medicine to aid their junior peers' goal setting and integration into the clinical learning environment through providing guidelines for how the rotation runs and general expectations. Topics discussed include information on the resulting digital booklet, evaluation of the Guide's impact on students, and lessons learned from the Guide.

Objectives: The educational alliance is argued to be at the heart of supervision in medical education. This review aims to map the research field and develop a conceptualisation of the nature of such educational alliances within postgraduate supervision for general practitioners. Methods: An integrative review of the international literature on supervision from 2011 to 2018 was undertaken, and papers assessed for relevance and quality. Data analysis incorporated framework analysis techniques. Bordin's working alliance‐based model of supervision was used as a springboard for synthesis, as well as allowing for the emergence of new ideas, theories and concepts from the literature. Results: A total of 49 full texts were included for analysis. There was evidence of the importance of trust, agreement and bond in accordance with Bordin's model. The results also highlighted the importance of greater clarity on supervisory goals, and the tasks to support these goals, to effectively address competing priorities and roles within supervision. Non‐hierarchical relationships were advocated, although supervisors must remain impartial in their assessment and monitoring roles. The influence of the wider practice community and situated learning through legitimate peripheral participation are documented. A model of General practice (GP) supervision is proposed that integrates the findings. Conclusions: GP supervision requires a greater emphasis than is suggested by the working alliance model, both on the clarity of expectations and the appreciation of the multiple roles and competing priorities of both trainee and supervisor. Furthermore, as GP supervision develops within the rising workload of contemporary general practice, the role of the wider community of practice may become more prominent. We have adapted the working alliance model for postgraduate General practice (GP) supervision, emphasising the explicit sharing of expectations relating to goals, tasks and roles to facilitate negotiation and agreement. Expanding the notion of a working alliance as a means for enabling effective supervision in postgraduate GP training, the authors report the importance of considering clarity, roles, power and the socio‐cultural context. [ABSTRACT FROM AUTHOR]

Context: Meta‐analyses have shown that feedback can be a powerful intervention to increase learning and performance but there is significant variability in impact. New trials are adding little to the question of whether feedback interventions are effective, so the focus now is how to optimise the effect. Early career professionals (ECPs) in busy work environments are a particularly important target group. This literature review aimed to synthesise information to support the optimal design of feedback interventions for ECPs. Methods: We undertook a scoping literature review, using search terms such as 'feedback' and 'effectiveness' in MEDLINE, MEDLINE‐In‐Process, PsycINFO, CINAHL, Education Research Complete, Education Resources Information Center, the Cochrane Database of Systematic Reviews, the Social Sciences Citation Index and Applied Social Sciences Index and Abstracts, to identify empirical studies describing feedback interventions in busy workplaces published in English since 1990. We applied inclusion criteria to identify studies for the mapping stage and extracted key data to inform the next stage. We then selected a subset of papers for the framework development stage, which were subjected to a thematic synthesis by three authors, leading to a new feedback framework and a modified version of feedback intervention theory specifically for ECPs. Results: A total of 80 studies were included in the mapping stage, with roughly equal studies from hospital settings and school classrooms, and 17 papers were included in the framework development stage. The feedback framework comprised three main categories (audit, feedback and goal setting) and 22 subcategories. The review highlighted the limited empirical research focusing solely on feedback for ECPs, which was surprising given the particular nuances in feedback for ECPs identified through this study. Conclusions: We offer the feedback framework to optimise the design of future feedback interventions for early career professionals and encourage future feedback research to move away from generic models and tailor work to specific target audiences. Mattick et al. review the literature on feedback for early career professionals and encourage future feedback research to move away from generic models towards tailoring to specific target audiences. [ABSTRACT FROM AUTHOR]

Context: As the practice of medicine evolves, the knowledge, skills and attitudes required to provide patient care will continue to change. These competency‐based changes will necessitate the restructuring of assessment systems. High‐quality assessment programmes are needed to fulfil health professions education's contract with society. Objectives: We discuss several issues that are important to consider when developing assessments in health professions education. We organise the discussion along the continuum of medical education, outlining the tension between what has been deemed important to measure and what should be measured. We also attempt to alleviate some of the apprehension associated with measuring evolving competencies by discussing how emerging technologies, including simulation and artificial intelligence, can play a role. Methods: We focus our thoughts on the assessment of competencies that, at least historically, have been difficult to measure. We highlight several assessment challenges, discuss some of the important issues concerning the validity of assessment scores, and argue that medical educators must do a better job of justifying their use of specific assessment strategies. Discussion: As in most professions, there are clear tensions in medicine in relation to what should be assessed, who should be responsible for administering assessment content, and how much evidence should be gathered to support the evaluation process. Although there have been advances in assessment practices, there is still room for improvement. From the student's, resident's and practising physician's perspectives, assessments need to be relevant. Knowledge is certainly required, but there are other qualities and attributes that are important, and perhaps far more important. Research efforts spent now on delineating what makes a good physician, and on aligning new and upcoming assessment tools with the relevant competencies, will ensure that assessment practices, whether aimed at establishing competence or at fostering learning, are effective with respect to their primary goal: to produce qualified physicians. What are we assessing and what should we be assessing? This paper explores an ongoing tension regarding which competencies are required for patient care and which are known to be assessable in an effective and efficient manner. [ABSTRACT FROM AUTHOR]

Context: The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them. Methods: The authors synthesise the literature related to the intersections and resulting tensions between standardization and contextual diversity in medical education. In doing so, the authors analyze the interplay between these competing concepts in two domains of medical education (admissions and competency‐based medical education), and provide concrete examples drawn from the literature. Results: Standardization offers many rewards: its common articulations and assumptions promote patient safety, foster continuous quality improvement, and enable the spread of best practices. Standardization may also contribute to greater fairness, equity, reliability and validity in high stakes processes, and can provide stakeholders, including the public, with tangible reassurance and a sense of the stable and timeless. At the same time, contextual variation in medical education can afford myriad learning opportunities, and it can improve alignment between training and local workforce needs. The inevitable diversity of contexts for learning and practice renders any absolute standardization of programs, experiences, or outcomes an impossibility. Conclusions: The authors propose a number of ways to examine the interplay of contextual diversity and standardization and suggest three ways to move beyond an either/or stance. In reconciling the laudable goals of standardization and the realities of the innumerable contexts in which we train and deliver care, we are better positioned to design and deliver a medical education system that is globally responsible and locally engaged. The authors propose three key strategies for advancing productively in the face of tensions arising from the interplay between increasing standardization and increasing contextual diversity. [ABSTRACT FROM AUTHOR]

Objectives: There are only a few descriptive reports on the implementation of distributed medical education (DME) and these provide accounts of successful implementation from the senior leadership perspective. In Saskatchewan, over a period of 4 years (2010–2014), four family medicine residency sites were established and two additional sites could not be developed. The aim of this study was to identify challenges, success factors and pitfalls in DME implementation based upon experiences of multiple stakeholders with both successful and unsuccessful outcomes. Methods: Data were obtained through document analysis (n = 64, spanning 2009–2016; perspectives of government, senior leadership, management and learners), focus groups of management and operations personnel (n = 10) and interviews of senior leaders (n = 4). Challenges and success factors were ascertained through categorisation. Iterative coding guided by three sensitising frameworks was used to determine themes in organisational dynamics. Results: Both challenges and success factors included contextual variables, governance, inter‐ and intra‐organisational relationships (most common success factor), resources (most common challenge), the learning environment and pedagogy. Management and operations were only a challenge. Organisational themes affecting the outcome and the pitfalls included the pace of development across multiple sites, collaborative governance, continuity in senior leadership, operations alignment and reconciliation of competing goals. Conclusions: Emerging opportunities for DME can be leveraged through collaborative governance, aligned operations and resolution of competing goals, even in constrained contexts, to translate political will into success; however, there are pitfalls that need to be avoided. Our findings based upon multi‐stakeholder perspectives add to the body of knowledge on deployment, carefully considering the conditions for success and associated pitfalls. The authors share challenges and pitfalls that need to be navigated to successfully implement Distributed Medical Education by drawing on the concept of organizational dynamics [ABSTRACT FROM AUTHOR]

Objectives: Research has suggested beneficial effects of self‐regulated learning (SRL) for medical students' and residents' workplace‐based learning. Ideally, learners go through a cyclic process of setting learning goals, choosing learning strategies and assessing progress towards goals. A clear overview of medical students' and residents' successful key strategies, influential factors and effective interventions to stimulate SRL in the workplace is missing. This systematic review aims to provide an overview of and a theoretical base for effective SRL strategies of medical students and residents for their learning in the clinical context. Methods: This systematic review was conducted according to the guidelines of the Association for Medical Education in Europe. We systematically searched PubMed, EMBASE, Web of Science, PsycINFO, ERIC and the Cochrane Library from January 1992 to July 2016. Qualitative and quantitative studies were included. Two reviewers independently performed the review process and assessed the methodological quality of included studies. A total of 3341 publications were initially identified and 18 were included in the review. Results: We found diversity in the use of SRL strategies by medical students and residents, which is linked to individual (goal setting), contextual (time pressure, patient care and supervision) and social (supervisors and peers) factors. Three types of intervention were identified (coaching, learning plans and supportive tools). However, all interventions focused on goal setting and monitoring and none on supporting self‐evaluation. Conclusions: Self‐regulated learning in the clinical environment is a complex process that results from an interaction between person and context. Future research should focus on unravelling the process of SRL in the clinical context and specifically on how medical students and residents assess their progress towards goals. [ABSTRACT FROM AUTHOR]

Looking to avoid 'tick box' supervision? Jackson and Davison suggest both trainees and supervisors need to understand certain tensions and challenges inherent in practice. [ABSTRACT FROM AUTHOR]

Context: Differential performance in postgraduate examinations between home medical graduates and those who qualified outside their country of practice is well recognised. This difference is especially marked in the practical component of the UK Membership of the Royal College of General Practitioners (MRCGP) examination. The potential causes of such disparities are not well understood. Methods: Data were available for 1874 international medical graduates who applied for general practice (GP) specialty training in the UK in 2008–2012. The primary outcome was performance in the Clinical Skills Assessment (CSA) OSCE component of the MRCGP. The main predictors were performance on a situational judgement test (SJT) and clinical problem‐solving test (CPST), a test of applied clinical knowledge, used in the selection for GP training. Data relating to demographic characteristics and English language fluency were also available. To better understand the relationship between the predictors, the selection measures and the outcome, a series of univariable and multivariable models were developed and tested, concluding with a structural equation model to explore causality. Results: The CSA rating was more strongly predicted by SJT scores (standardised beta, 0.26) than by performance on the CPST (standardised beta, 0.17). There was a relationship between English language fluency and CSA score that was mainly mediated via SJT performance. Conclusions: These findings demonstrate that performance on an SJT predicts performance in a high‐fidelity clinical simulation (the CSA) in international medical graduates. Although the constructs tested by SJTs are debated, and are likely to vary across settings, culturally appropriate knowledge of interpersonal competence is likely to be evaluated. Improving the confidence of doctors in this area through targeted educational interventions, rather than focusing on increased clinical knowledge, is likely to be more effective at reducing disparities observed in postgraduate examination performance. Thus, there are important implications for the design of specialty selection and licensing assessments globally. [ABSTRACT FROM AUTHOR]

Objective Measurement of motivation and cognitive load has potential value in health professions education. Our objective was to evaluate the validity of scores from Dweck's Implicit Theories of Intelligence Scale ( ITIS), Elliot's Achievement Goal Questionnaire-Revised ( AGQ-R) and Leppink's cognitive load index ( CLI). Methods This was a validity study evaluating internal structure using reliability and factor analysis, and relationships with other variables using the multitrait-multimethod matrix. Two hundred and thirty-two secondary school students participated in a medical simulation-based training activity at an academic medical center. Pre-activity ITIS (implicit theory [mindset] domains: incremental, entity) and AGQ-R (achievement goal domains: mastery-approach, mastery-avoidance, performance-approach, performance-avoidance), post-activity CLI (cognitive load domains: intrinsic, extrinsic, germane) and task persistence (self-directed repetitions on a laparoscopic surgery task) were measured. Results Internal consistency reliability (Cronbach's alpha) was > 0.70 for all domain scores except AGQ-R performance-avoidance (alpha 0.68) and CLI extrinsic load (alpha 0.64). Confirmatory factor analysis of ITIS and CLI scores demonstrated acceptable model fit. Confirmatory factor analysis of AGQ-R scores demonstrated borderline fit, and exploratory factor analysis suggested a three-domain model for achievement goals (mastery-approach, performance and avoidance). Correlations among scores from conceptually-related domains generally aligned with expectations, as follows: ITIS incremental and entity, r = −0.52; AGQ-R mastery-avoidance and performance-avoidance, r = 0.71; mastery-approach and performance-approach, r = 0.55; performance-approach and performance-avoidance, r = 0.43; mastery-approach and mastery-avoidance, r = 0.36; CLI germane and extrinsic, r = −0.35; ITIS incremental and AGQ-R mastery-approach, r = 0.34; ITIS incremental and CLI germane, r = 0.44; AGQ-R mastery-approach and CLI germane, r = 0.48 (all p < 0.001). We found no correlation between the number of task repetitions (i.e. persistence) and mastery-approach scores, r = −0.01. Conclusions ITIS and CLI scores had appropriate internal structures and relationships with other variables. AGQ-R scores fit a three-factor (not four-factor) model that collapsed avoidance into one domain, although relationships of other variables with the original four domain scores generally aligned with expectations. Mastery goals are positively correlated with germane cognitive load. [ABSTRACT FROM AUTHOR]

Context Medical professionals often express weight-biased attitudes. Prior research suggests that people who overcome a challenge are critical of individuals who struggle to overcome the same challenge. Thus, medical trainees who have successfully achieved and maintained weight loss may express greater weight bias and more critical attitudes toward patients with obesity who fail to overcome these challenges. Objectives This study was designed to determine the effects of medical trainees' weight-loss history on weight-biased attitudes and responses to patients with varying weight-loss outcomes. Methods An online survey was completed by 219 medical students and internal medicine residents. Participants' weight-biased attitudes were assessed before they were randomly assigned to read one of three patient vignettes in which the patient lost no weight, lost/regained weight, or lost/maintained weight. Independent measures included trainee gender, trainee weight loss and maintenance, and the three experimental conditions of patient outcomes. Dependent measures included the Anti-Fat Attitudes ( AFA) Questionnaire's Willpower and Dislike subscales, ratings (on a scale of 1-7) of compassion, frustration, and blame toward the patients presented in the vignettes, and perceptions of the physician-patient alliance. All analyses controlled for trainee body mass index. Results Among trainees, 67.1% reported having successfully lost weight. Of those who had lost weight, 79.5% reported maintaining their weight loss. Trainees who had successfully lost/maintained weight expressed less compassion toward patients across vignettes (5.4 ± 1.2 versus 5.9 ± 1.2; p<0.05), and more blame toward the patient who lost/regained weight than did trainees who had lost/regained weight (3.4 ± 1.3 versus 2.3 ± 1.3; p<0.01). Overall, the patient who did not lose weight was viewed most negatively, followed by the patient who lost/regained (all p-values < 0.05). Female (but not male) trainees who had successfully lost weight expressed stronger weight-biased attitudes on the AFA scales than did those who had never lost weight (all p-values < 0.01). Conclusions Medical trainees' personal success with weight loss and maintenance may negatively affect their perceptions of patients with obesity who struggle with weight management. [ABSTRACT FROM AUTHOR]

Objectives Scholarly concentration ( SC) programmes are increasingly common in medical school curricula, fostering student participation in mentored research. Endpoints including publication rates and impact on career path have been reported, but student goals have not been described. We describe how career plans and gender impact the importance of students' SC-related goals. Understanding student goals may enhance mentorship of professional development and self-directed learning skills. Methods First-year students at two US medical schools were surveyed. Students reported intentions regarding career-long research and specialty interests. Using a 5-point scale, students assigned importance to 13 goals (eight skill-related goals, four accomplishment-related goals and mentorship), Composite scores for skills-related and accomplishment-related goals were used for analysis. Regression analyses, controlling for school, were used to determine whether intentions regarding career-long research, interest in highly competitive residency or gender were associated with increased importance of different goals. Results We surveyed 288 first-year medical students and received 186 responses (64.6% response rate). Compared with their peers, students interested in career-long research placed more importance on both skill-related goals (beta coefficient, 1.87; 95% confidence interval [ CI], 1.03-2.71; p < 0.001) and accomplishment-related goals (odds ratio [ OR], 1.71; 95% CI, 1.09-2.69; p = 0.02). By contrast, compared with their peers, students interested in highly competitive specialties placed more importance only on accomplishment-related goals ( OR, 2.18; 95% CI, 1.15-4.11; p = 0.02). Compared with men, women placed more importance on mentorship ( OR, 2.47; 95% CI, 1.23-4.97; p = 0.01) and were less likely to be interested in highly competitive residencies (39.4% versus 54.9%, p = 0.04). Conclusions Gender and career plans are associated with importance of SC-related goals in the first year of medical school. This knowledge enables faculty to promote students' appreciation of important learning goals in the setting of student research, which may help students engage in self-directed learning across their medical education. [ABSTRACT FROM AUTHOR]

CONTEXT Learning goal programmes are often created to help students develop selfregulated learning skills; however, these programmes do not necessarily consider the social contexts surrounding learning goals or how they fit into daily educational practice. OBJECTIVES We investigated a high-frequency learning goal programme in which students generated and shared weekly learning goals with their clinical teams in core Year 3 clerkships. Our study explores: (i) how learning goals were incorporated into the clinical work, and (ii) the factors that influenced the use of students' learning goals in work-based learning. METHODS We conducted semi-structured interviews with 14 students and 14 supervisors (attending physicians and residents) sampled from all participating core clerkships. Interviews were coded for emerging themes. Using cultural historical activity theory and knotworking as theoretical lenses, we developed a model of the factors that influenced students' learning goal usage in a work-based learning context. RESULTS Students and supervisors often faced the challenge of reconciling contradictions that arose when the desired outcomes of student skill development, grading and patient care were not aligned. Learning goals could function as tools for developing new ways of acting that overcame those contradictions by facilitating collaborative effort between students and their supervisors. However, for new collaborations to take place, both students and supervisors had to engage with the goals, and the necessary patients needed to be present. When any one part of the system did not converge around the learning goals, the impact of the learning goals programme was limited. CONCLUSIONS Learning goals are potentially powerful tools to mediate interactions between students, supervisors and patients, and to reconcile contradictions in work-based learning environments. Learning goals provide a means to develop not only learners, but also learning systems. [ABSTRACT FROM AUTHOR]

Objectives This study was designed to identify the self-regulated learning ( SRL) processes of medical students during a biomedical science learning task and to examine the associations of the SRL processes with previous performance in biomedical science examinations and subsequent performance on a learning task. Methods A sample of 76 Year 1 medical students were recruited based on their performance in biomedical science examinations and stratified into previous high and low performers. Participants were asked to complete a biomedical science learning task. Participants' SRL processes were assessed before (self-efficacy, goal setting and strategic planning), during (metacognitive monitoring) and after (causal attributions and adaptive inferences) their completion of the task using an SRL microanalytic interview. Descriptive statistics were used to analyse the means and frequencies of SRL processes. Univariate and multiple logistic regression analyses were conducted to examine the associations of SRL processes with previous examination performance and the learning task performance. Results Most participants (from 88.2% to 43.4%) reported task-specific processes for SRL measures. Students who exhibited higher self-efficacy (odds ratio [ OR] 1.44, 95% confidence interval [ CI] 1.09-1.90) and reported task-specific processes for metacognitive monitoring ( OR 6.61, 95% CI 1.68-25.93) and causal attributions ( OR 6.75, 95% CI 2.05-22.25) measures were more likely to be high previous performers. Multiple analysis revealed that similar SRL measures were associated with previous performance. The use of task-specific processes for causal attributions ( OR 23.00, 95% CI 4.57-115.76) and adaptive inferences ( OR 27.00, 95% CI 3.39-214.95) measures were associated with being a high learning task performer. In multiple analysis, only the causal attributions measure was associated with high learning task performance. Conclusions Self-efficacy, metacognitive monitoring and causal attributions measures were associated positively with previous performance. Causal attributions and adaptive inferences measures were associated positively with learning task performance. These findings may inform remediation interventions in the early years of medical school training. [ABSTRACT FROM AUTHOR]

Objective To succinctly summarise five contemporary theories about motivation to learn, articulate key intersections and distinctions among these theories, and identify important considerations for future research. Results Motivation has been defined as the process whereby goal-directed activities are initiated and sustained. In expectancy-value theory, motivation is a function of the expectation of success and perceived value. Attribution theory focuses on the causal attributions learners create to explain the results of an activity, and classifies these in terms of their locus, stability and controllability. Social- cognitive theory emphasises self-efficacy as the primary driver of motivated action, and also identifies cues that influence future self-efficacy and support self-regulated learning. Goal orientation theory suggests that learners tend to engage in tasks with concerns about mastering the content (mastery goal, arising from a 'growth' mindset regarding intelligence and learning) or about doing better than others or avoiding failure (performance goals, arising from a 'fixed' mindset). Finally, self-determination theory proposes that optimal performance results from actions motivated by intrinsic interests or by extrinsic values that have become integrated and internalised. Satisfying basic psychosocial needs of autonomy, competence and relatedness promotes such motivation. Looking across all five theories, we note recurrent themes of competence, value, attributions, and interactions between individuals and the learning context. Conclusions To avoid conceptual confusion, and perhaps more importantly to maximise the theory-building potential of their work, researchers must be careful (and precise) in how they define, operationalise and measure different motivational constructs. We suggest that motivation research continue to build theory and extend it to health professions domains, identify key outcomes and outcome measures, and test practical educational applications of the principles thus derived. [ABSTRACT FROM AUTHOR]

de Leng et al. argue that feedback communicators can be made more comfortable delivering unpleasant messages if clinical training settings promote trainees' learning‐goal orientation. [ABSTRACT FROM AUTHOR]

Moroz reviews various ways of dealing with tensions that are common in medical education assessment, including avoidance, acceptance and change‐making. [ABSTRACT FROM AUTHOR]

The article discusses a student-led curriculum aimed to empower the use by clerks of initiative in coaching relationships by developing their coachability prior to clinical training. Topics covered include the problems that were addressed by the program, self-regulated learning concepts that were incorporated in the curriculum and the lessons that were learned from implementing the curriculum, such as the adaption of session materialsto address coachability attributes and skills.

Context We developed, implemented and evaluated an evidence-based programme of feedback designed to address limitations identified in the current literature. Objectives We sought to advance understanding about how and why feedback processes might be more effective in clinical education. Methods Three faculty members and nine first-year internal medicine residents participated in the pilot programme. To counter challenges identified in the literature, feedback was based on direct observation, grounded in longitudinal faculty-resident relationships, and devoid of summative assessment. We used a qualitative case study design to address three research questions: (i) What benefits did the participants describe? (ii) What elements of the programme facilitated these benefits? (iii) What were the limitations and challenges of the programme? Collected data included audiotapes of interactions between faculty members and residents, field notes written during observations, and semi-structured interviews and focus groups with resident participants. Data analysis moved cyclically and iteratively through inductive and deductive analysis. Results Residents described benefits relating to their ways of working (clinical skills), ways of learning (accountability for learning) and ways of feeling (emotional well-being). According to participants, specific elements of the programme that achieved these benefits included the direct observation of authentic clinical work, the longitudinal relationship with a faculty member and the emergence of feedback as a conversation between the faculty member and learner. Conclusions We conclude that the conditions established within our pilot feedback programme influenced the learning culture for first-year internal medicine residents by grounding direct observation in authentic clinical work and setting the observations in the context of a longitudinal, non-assessment-based relationship between a faculty member and resident. These conditions appeared to influence residents' participation in the feedback process, their ways of approaching their daily clinical work, their emotional well-being and their engagement in their own learning. [ABSTRACT FROM AUTHOR]

Context Workplace learning is optimised when learners engage in the activities of the workplace; learner engagement is influenced by workplace affordances and learner agency. Learner agency can be operationalised through achievement goal theory, which explains that students can have different goal orientations as they enter learning situations: mastery (learn and improve), performance approach (demonstrate competence) or performance-avoid (avoid demonstrating incompetence). Mastery-orientated, compared with performance-orientated, students approach curricular experiences as opportunities for developing rather than demonstrating competence. This study explored the relationships among students' achievement goal orientations, workplace affordances and learning outcomes in the context of early clinical experiences. Methods Students who completed their preclerkship curricula at four medical schools answered a questionnaire about their personal goal orientation and the perceived goal structure and workplace affordances of their preceptorship experiences. All items used a 5-point scale (1 = strongly disagree/not at all true, 5 = strongly agree/very true). Students were evaluated by their preceptors and completed standardised-patient exams at the end of their pre-clerkship curricula. Analyses included descriptive statistics and mediation analysis. Results Of 517 students, 296 (57.3%) responded and 253 (85.5%) had linked performance data. Student goal orientation means were: mastery, mean = 4.27 ( SD = 0.65); performance-approach, 2.41 (0.76); performance-avoid, 2.84 (0.88). Student goal orientation and performance on preceptor evaluations ( PEval) or standardised-patient exams ( SPExam) were not significantly related. Perceptions of a mastery-structured curriculum and inviting workplace were associated with higher SPExam (β = 0.28, p = 0.02) and PEval (β = 0.51, p = 0.00) scores, respectively. Student mastery goal orientation was positively associated with perceptions of a mastery-structured curriculum (β = 0.59, p = 0.00) and positive workplace affordances (β = 0.25-0.29, p ≤ 0.01). Conclusions Students held a predominant mastery goal orientation towards their early clinical experiences. Mastery-orientated students perceived preceptorships as mastery-structured with positive workplace affordances, and those perceiving a mastery-structured or inviting preceptorship performed better. Clinical experiences should be structured to emphasise learning rather than demonstration of skills to promote learning outcomes. [ABSTRACT FROM AUTHOR]

Quigley defines the term 'feedback literacy' and describes how we can support healthcare students to make the most of feedback. [ABSTRACT FROM AUTHOR]

Objectives The generation of learning goals ( LGs) that are aligned with learning needs ( LNs) is one of the main purposes of formative workplace-based assessment. In this study, we aimed to analyse how often trainer-student pairs identified corresponding LNs in mini-clinical evaluation exercise (mini- CEX) encounters and to what degree these LNs aligned with recorded LGs, taking into account the social environment (e.g. clinic size) in which the mini- CEX was conducted. Methods Retrospective analyses of adapted mini- CEX forms (trainers' and students' assessments) completed by all Year 4 medical students during clerkships were performed. Learning needs were defined by the lowest score(s) assigned to one or more of the mini- CEX domains. Learning goals were categorised qualitatively according to their correspondence with the six mini- CEX domains (e.g. history taking, professionalism). Following descriptive analyses of LNs and LGs, multi-level logistic regression models were used to predict LGs by identified LNs and social context variables. Results A total of 512 trainers and 165 students conducted 1783 mini- CEXs (98% completion rate). Concordantly, trainer-student pairs most often identified LNs in the domains of 'clinical reasoning' (23% of 1167 complete forms), 'organisation/efficiency' (20%) and 'physical examination' (20%). At least one 'defined' LG was noted on 313 student forms (18% of 1710). Of the 446 LGs noted in total, the most frequently noted were 'physical examination' (49%) and 'history taking' (21%). Corresponding LNs as well as social context factors (e.g. clinic size) were found to be predictors of these LGs. Conclusions Although trainer-student pairs often agreed in the LNs they identified, many assessments did not result in aligned LGs. The sparseness of LGs, their dependency on social context and their partial non-alignment with students' LNs raise questions about how the full potential of the mini- CEX as not only a 'diagnostic' but also an 'educational' tool can be exploited. [ABSTRACT FROM AUTHOR]

The article provides information on an elective seminar to address the lack of curriculum time devoted to geriatrics, palliative care and serious illness conversations, titled "Being Mortal," after Atul Gawande's book. Topics discussed include the main learning goals of the course, first surprising finding during the initial curriculum evaluation, and positive curriculum outcomes from "Being Mortal."

Introduction Health care professionals work and learn in complex environments. Some are able to continue learning from their practice and the challenges it presents, whereas others refrain from investing more effort when faced with setbacks. This paper discusses a social cognitive model of motivation that helps to explain the different kinds of behaviour that emerge when individuals are confronted with challenges. Self-theories Self-theories (people's theories on what competence is and means for the self) play a major role in establishing the goals people set for themselves, the emotions they experience and the meanings they attach to situations. These self-views are often not explicitly articulated and are therefore called 'implicit' ('self-') theories. Social cognitive research suggests there are two distinct ways of thinking about one's personal attributes: entity theorists view a trait as a fixed, concrete internal entity, whereas incremental theorists instead believe a trait to be something malleable that can be developed or cultivated through effort. Holding an entity theory leads one to set performance goals and to harbour concerns about performing well and making a good impression. Holding an incremental theory tends to lead one to set learning goals, and to focus less on performance and more on spending time and effort in determining which strategies work. Discussion The current literature on self-theories is used to explore the relevance of these theories in medical education in three contexts: (i) it is argued that, in order to support lifelong learning, both individual and organisational efforts fit best with an incremental outlook on professional development; (ii) if it is to move forward in the domain of feedback-seeking behaviour, medical education might benefit from a better understanding of the interactions among self-theories, feedback behaviour, and the pervading role of organisational culture, and (iii) the impact of self-theories on assessors' evaluations of performance. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 748-756 Context Capacity-building programmes in low-income countries (LICs) are subject to a tension between the requirement to best train workers to fulfil national needs and the requirement to meet international expectations of their students, academics and institutions. This paper presents a theoretical framework developed from a case study of an undergraduate degree programme in Malawi and explores how national needs and international expectations can be managed in health profession settings in LICs to ensure successful curriculum development. Methods An inductive qualitative methodology, grounded theory, combined with open-ended interviews with students, graduates, tutors and external stakeholders in the programme, was used to develop a theoretical framework. Results A total of 22 interviews were performed; their analysis conceptualised the tension between national needs and international expectations, and resulted in 12 codes, in four categories: competing and advancing agendas; processes of collaboration; developing a programme or professional identity, and perceptions of programme change. Conclusions This study describes a conceptual framework highlighting three particular areas for analysis to aid in understanding how to best manage competing agendas. These areas refer to, respectively, the significance of international expectations, the organisational climate, and the development of a professional identity. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 317-325 Objectives This study aimed to examine concepts of altruism and empathy among medical students and professionals in conjunction with health care initiatives designed to support the maintenance of these qualities. Methods We searched for the terms 'altruism', 'altruistic', 'helping', 'prosocial behaviour' and 'empathy' in the English-language literature published from 1980 to the present within the Ovid MEDLINE, PsycInfo and PubMed databases. We used conceptual analysis to examine the relationships among altruism, empathy and related prosocial concepts in health care in order to understand how such factors may relate to emotional and career burnout, cynicism, decreased helping and decreased patient-centredness in care. Results Altruistic ideals and qualities of empathy appear to decrease among some medical students as they progress through their education. During this process, students face increasingly heavy workloads, deal with strenuous demands and become more acquainted with non-humanistic informal practices inherent in the culture of medicine. In combination, these factors increase the likelihood that emotional suppression, detachment from patients, burnout and other negative consequences may result, perhaps as a means of self-preservation. Alternatively, by making a mindful and intentional choice to endeavour for self-care and a healthy work-life balance, medical students can uphold humanistic and prosocial attitudes and behaviours. Conclusions Promoting altruism in the context of a compensated health care career is contradictory and misguided. Instead, an approach to clinical care that is prosocial and empathic is recommended. Training in mindfulness, self-reflection and emotion skills may help medical students and professionals to recognise, regulate and behaviourally demonstrate empathy within clinical and professional encounters. However, health care initiatives to increase empathy and other humanistic qualities will be limited unless more practical and feasible emotion skills training is offered to and accepted by medical students. Success will be further moderated by the culture of medicine's full acceptance of empathy and humanism into its customs, beliefs, values, interactions and daily practices. [ABSTRACT FROM AUTHOR]

An abstract of the article "Exploring meaningful and truly integrative changes: a call to arms for medical education," by J. D. Gonzalo and colleagues is presented.

The authors present their thoughts on a study which suggested that workplace opportunities influence students' workplace learning outcomes. They discuss the importance of considering both the students' role in the workplace as well as the clinical context. Particular attention is given to the value of achievement goal theory.

The article discusses the deployment of the COVID-19 Student Service Corps (CSSC) at Columbia University Irving Medical Center to support health systems and their patients, workforce and communities facing the COVID-19 pandemic through interprofessional student service-learning projects. Topics include guiding principles developed by the CSSC, project areas to consider given local health care setting needs, and important resources for administration of the CSSC.

The authors express their opinion regarding the article "The mini-clinical evaluation exercise during medical clerkships: are learning needs and learning goals aligned?" by S. Montagne, A. Rogauschm, and A. Gemperli et all. The authors discuss medical students' reception of feedback, the link between self-efficacy and social cognitive theory, and the self-monitoring confidence of medical trainees.

The article focuses on the article "Believing is Seeing: How People’s Beliefs Influence Goals, Emotions and Behaviour" by P. W. Teunissen and H. G. J. Bok. In the article the authors offer their opinions on several points raised in Teunissen and Bok's article, which is concerned with C.S. Dweck's views on students' self-theories, and on the role of self theories in medical student goal orientation.

The article offers information on a program that enabled newly-hired medical faculty members to receive feedback from the patient's perspective as an introduction to the institution's expectations and standards around physician communication and patient safety. Topics covered include the problem that was addressed by the experiential faculty orientation program, program activities, and the lessons that were learned from implementing the program.

The article offers information on the Peer to Peer (P2P) medical faculty development program designed to provide them opportunities to grow and evolve as educators. Topics covered include the problem that was addressed by the program, the standardized process of the program that allowed faculty members to be observed and to observe others, and the lessons that were learned from implementing the program.

The author discusses the challenges associated with using student learning goals in clinical or medical education. Topics include