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Explore the term "Social Justice" in this new "When I Say" article. The authors consider its origin, advocate for a broader definition, and encourage renewed focus in the field. [ABSTRACT FROM AUTHOR]

Introduction: Feedback is crucial to promote learning and improve performance. However, we lack a nuanced understanding of how medical teachers reflect on and internalise (or not) student feedback (SF). This study aims to fill this gap by exploring how teachers make sense of SF to improve their performance and nurture their personal and professional development. Methods: In this cross‐sectional qualitative study based on a constructivist paradigm, 14 medical teachers individually drew a Rich Picture (RP) of a feedback experience in which they received informal or formal feedback from students, resulting in a personal or professional change. After the drawing, we interviewed the participants to deepen our understanding of teachers' experiences. We analysed the drawings and interview transcripts using an iterative process of thematic analysis. Results: SF that culminated in personal or professional change is a highly emotional experience for teachers, often with long‐lasting consequences. It may threaten or reassure their self‐concept and professional identity, generating feedback avoidance or feedback‐seeking behaviour. SF is particularly powerful in transforming teaching practices when teachers feel connected to students through an honest and constructive relationship. Remarkably, some teachers intentionally build relationships with certain (selected) students to get 'qualified' feedback. SF acceptance also increases when teachers are open to receiving feedback and there is an institutional culture that values feedback. Finally, medical teachers believe that formal (planned) feedback is relevant to improve the curriculum, while informal (spontaneous) feedback is important for promoting teachers' personal and professional development. Discussion: SF has the potential to become a transformative learning experience for teachers. The student–teacher relationship and teachers' emotional reactions affect the way teachers make sense of and internalise SF and enact behavioural change. Understanding the complexity surrounding SF is vital for supporting teachers in seizing opportunities for growth and in nurturing a meaningful relationship with the act of teaching. Receiving students' feedback is detailed to be an emotional process that happens in the context of a relationship and can nurture teachers' professional and personal development. [ABSTRACT FROM AUTHOR]

Introduction: The mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less‐than‐ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment. Methods: Using constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of 'definitely', 'maybe' and 'definitely not' maltreatment across a variety of axes including experience level, clinical setting and type of interaction. Results: Our data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient. Conclusions: Only the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense‐making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention. How do medical learners and educators decide which negative interpersonal interactions count as mistreatment or abuse? @MGVanstone and team from @McMasterFamMed describe this appraisal process [ABSTRACT FROM AUTHOR]

Introduction: In health professions education, faculty may feel frustrated or challenged by aspects of their teaching. The concept of a hidden curriculum for students describes the expectations and assumptions enacted in educational programmes that tacitly impact students' learning experiences. A hidden curriculum has been suggested as a possible influence on faculty but has not been well explored. The aim of this study was to explain how a hidden curriculum might operate for faculty in health professions education. Methods: An interpretivist perspective was used to frame this qualitative study that examined one‐on‐one interview data generated with 16 faculty members from six different health care professions. Participants were asked to describe teaching experiences that they perceived as demanding. Using a hidden curriculum framework, descriptions of demanding teaching experiences were analysed inductively to identify relationships between a teacher's intended practice and what they could accomplish. These relationships were interpreted as the possible ways that a hidden curriculum was operating for faculty. Results: A hidden curriculum for faculty was found to operate in three ways by undervaluing the importance of having teaching expertise, undermining teaching goals through institutional conventions and perpetuating feelings of isolation. Discussion: A hidden curriculum for faculty can be represented as multiple overlapping domains and shape how faculty experience their teaching roles. The results provide examples that reveal how a hidden curriculum may operate for faculty. Faculty developers may find the insights provided by this study useful to make the hidden curriculum visible and help their faculty make sense of and navigate demanding teaching experiences. Lee and colleagues identify how a hidden curriculum for faculty operates in three ways: undervaluing the importance of teaching expertise, undermining teaching goals through institutional conventions, and perpetuating feelings of isolation. [ABSTRACT FROM AUTHOR]

Objectives: Many universities offer faculty development to support teachers in developing and improving clinical education in the health professions. Although research shows outcomes on individual levels after faculty development, little is known about its contribution to change within the organisation. To advance current faculty development and ensure that it can support wider educational change in healthcare organisations, a better understanding of educational change practices in these settings is needed. This study therefore explores the experiences of working with educational change in clinical workplaces from the perspective of clinical educators that have undergone faculty development training. The study adopts perspectives on change as influenced by context to include the impact from clinical workplaces on individuals' change work. Methods: A collective case study design with a multi‐institutional approach was applied and individual interviews with 14 clinical educators from two universities, one in Sweden and one in South Africa, were conducted. Data were analysed separately before a cross‐case analysis was performed, synthesising the findings from both sites. Findings: Participants shared experiences of having limited opportunities to work with educational change beyond their own individual teaching practices within their clinical workplaces. Also, participants appeared to refrain from leading change and rather pursued change on their own or relied on indirect approaches to change. They described several workplace aspects influencing their work, including the organisation and management of teaching, the resources and incentives for teaching and the attitudes and beliefs about teaching within the clinical community. Conclusions: The study shows that clinical educators are part of communities and contexts that shape their approaches to educational change and influence which changes are feasible and which ones are not. It thus adds to the understanding of change as contextual and dynamic and contributes with implications for how to advance faculty development to better support change in practice. Elmberger et al. find that faculty development has limited impact beyond the individual participants, with educators from different settings having similar difficulties enabling change in their clinical workplaces. [ABSTRACT FROM AUTHOR]

Introduction: Health professions training programmes increasingly rely on standardised patient (SP) programmes to integrate equity‐deserving groups into learning and assessment opportunities. However, little is known about the optimal approach, and many SP programmes struggle to meet these growing needs. This study explored insights from health care educators working with SP programmes to deliver curricular content around equity‐deserving groups. Methods: We interviewed 14 key informants in 2021 who were involved in creating or managing SP‐based education. Verbatim transcripts were analysed in an iterative coding process, anchored by qualitative content analysis methodology and informed by two theoretical frameworks: sociologic translation and simulation design. Repeated cycles of data collection and analyses continued until themes could be constructed, aligned with existing theories and grounded in empirical data, with sufficient relevance and robustness to inform educators and curricular leads. Results: Three themes were constructed: (i) creating safety for SPs paid to be vulnerable, (ii) fidelity as an issue broader than who plays the role and (iii) engaging equity‐deserving groups. SP work involving traditionally marginalised groups risk re‐traumatization, highlighting the importance of (i) informed consent in recruiting SPs, (ii) separating role portrayal from lived experiences, (iii) adequately preparing learners and facilitators, (iv) creating time‐outs and escapes for SPs and (v) building opportunity for de‐roling with community support. Conclusions: SP programmes are well positioned to be allies and advocates to equity‐deserving groups and to collaborate and share governance of the educational development process from its outset. SP programmes can support the delivery of curricular content around equity‐deserving groups by advocating with curricular leadership, building relationships with community partners, facilitating co‐creation and co‐delivery of educational content and building safety into simulation. The authors explore healthcare educator insights into how safety for Standardized Patient work related to equity‐deserving groups requires unique focus to avoid the educational process itself being oppressive. [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: Indirect patient care activities (IPCA) such as documentation, reviewing investigations and filling out forms require an increasing amount of physician time. While an essential part of patient care, rising rates of IPCA work correspond with increases in physician burnout and job dissatisfaction. It is not known how best to prepare residents in IPCA‐heavy specialties (e.g. family medicine) for this aspect of their career. This study investigates how educators and residency programmes can optimise IPCA work during residency to best prepare residents for future practice. Methods: Using Constructivist Grounded Theory, we conducted focus groups and individual interviews with 42 clinicians (19 family medicine residents, 16 family physicians in the first 5 years of practice and 7 family physician educators). All participants were connected to one family medicine residency programme. We analysed interview data iteratively, using a staged approach to constant comparative analysis. Results: While residents, early career physicians and educators perceived the educational value of IPCAs differently, they all reported IPCAs as a necessary weight that family physicians carry throughout their career. Some residents described IPCAs as a burden, creating inequities in workload and interfering with other learning and personal opportunities. In contrast, educators conceptualised IPCAs as an opportunity to build and develop the skills required to carry the weight of IPCAs throughout their career. We make specific recommendations for helping residents recognise this educational opportunity, such as clarifying expectations, navigating equity, understanding purpose and maintaining consistency when teaching IPCAs. Conclusion: IPCAs are a key competency for many medical residents but require explicit pedagogical attention. If the educational opportunities are not made explicit, residents may miss the opportunity to develop strategies for practice management, professional boundaries, and administrative efficiencies. Teaching residents how cope with the burden of indirect patient care activities is a challenge for many specialties. Vanstone et al offer guidance based on residents‐, early career physicians, and clinical supervisors‐ experiences. [ABSTRACT FROM AUTHOR]

Introduction: Narrative approaches to assessment provide meaningful and valid representations of trainee performance. Yet, narratives are frequently perceived as vague, nonspecific and low quality. To date, there is little research examining factors associated with narrative evaluation quality, particularly in undergraduate medical education. The purpose of this study was to examine associations of faculty‐ and student‐level characteristics with the quality of faculty member's narrative evaluations of clerkship students. Methods: The authors reviewed faculty narrative evaluations of 50 students' clinical performance in their inpatient medicine and neurology clerkships, resulting in 165 and 87 unique evaluations in the respective clerkships. The authors evaluated narrative quality using the Narrative Evaluation Quality Instrument (NEQI). The authors used linear mixed effects modelling to predict total NEQI score. Explanatory covariates included the following: time to evaluation completion, number of weeks spent with student, faculty total weeks on service per year, total faculty years in clinical education, student gender, faculty gender, and an interaction term between student and faculty gender. Results: Significantly higher narrative evaluation quality was associated with a shorter time to evaluation completion, with NEQI scores decreasing by approximately 0.3 points every 10 days following students' rotations (p =.004). Additionally, women faculty had statistically higher quality narrative evaluations with NEQI scores 1.92 points greater than men faculty (p =.012). All other covariates were not significant. Conclusions: The quality of faculty members' narrative evaluations of medical students was associated with time to evaluation completion and faculty gender but not faculty experience in clinical education, faculty weeks on service, or the amount of time spent with students. Findings advance understanding on ways to improve the quality of narrative evaluations which are imperative given assessment models that will increase the volume and reliance on narratives. With the field's increased reliance on narrative‐based assessment, @mooneymed and colleagues examine predictors of faculty narrative evaluation quality in clinical clerkships. #URResearch #Meded [ABSTRACT FROM AUTHOR]

Background: The pandemic catapulted the adoption of virtual care far ahead of its anticipated maturation date, forcing faculty to role model and teach learners with barely enough time to master it themselves. With a scant body of prepandemic literature now accompanied by experience gained under extraordinary circumstances, we can benefit from understanding ad hoc strategies implemented by those on the front lines and from listening to learners about what is working and what is not. The purpose of this study was to explore the experience of learner integration into virtual care from both the faculty and learner perspectives. Methods: Using a constructivist grounded theory methodology and sociomateriality as a sensitising concept, we recruited participants using purposeful and theoretical sampling from a Canadian University with limited prepandemic virtual care provision. We interviewed 16 faculty and 5 learners spanning a breadth of specialties and years of practice/education to probe their experience of teaching and learning virtual care. Data collection and analysis were conducted iteratively with themes identified through constant comparative analysis. Results: Integrating learners into virtual care proved challenging initially because of a lack of familiarity with the process and later because of disrupted workflow, triggered by the structure and logistics of the virtual care clinic. Both faculty and learners identified learning deficiencies in the virtual care experience when compared with in‐person clinics, but several unique and valuable learning affordances were noted. All faculty expressed a desire to keep virtual care as part of their future clinic practice, but paradoxically most felt that they were unlikely to include learners. Conclusions: Training learners in virtual care is an educational challenge that will not disappear with COVID‐19, even if our participants wished it could. The perceived value for patients but not learners begs a reconsideration of the sociomaterial contribution to this pandemic paradox. Paradoxically, virtual care is found to be valued for patients but not for the learners who need to care for those patients. This article explores the perception that virtual care settings offer inferior learning experiences. [ABSTRACT FROM AUTHOR]

Introduction: Medical students' longitudinal care of patients supports clinical learning and promotes patient‐centredness. The literature presents little empirically derived guidance for faculty to facilitate students' longitudinal learning and care. Informed by the conceptual framework of relational learning, this study investigated faculty perspectives about longitudinal teaching, their strategies for facilitating students' longitudinal learning and perceived barriers and enablers. Methods: Using a convergent mixed‐methods approach at a single academic medical centre, the authors conducted a survey and two focus groups in 2018–2019 with faculty members teaching in three longitudinal clinical courses. Quantitative analyses included descriptive statistics and chi‐square tests. Qualitative content analysis described deductive categories and identified inductive themes. Results: Forty‐three eligible faculty (69%) completed the survey. Ninety‐one percent (n = 39) reported that teaching in a longitudinal model enhanced their experience as preceptors. Faculty described activities students performed to provide longitudinal care: spending time with patients independently (n = 38, 88%), making follow‐up phone calls (n = 35; 81%) and participating in home‐ and community‐based visits (n = 20, 47%), among others. Twelve faculty participated in two focus groups. Deductive analysis characterised strategies for facilitating students' longitudinal learning and barriers and enablers. Strategies included "encouraging students to follow patients," "faculty adaptability," "offering guidance and setting expectations," and "careful patient selection." Barriers included scheduling limitations, and enablers included student initiative. Inductive analysis identified two themes: faculty goals for students and faculty benefits from teaching. Goals included meaningful engagement with patients and their illness over time. Benefits from teaching included personal gratification, mentorship, and holistic student assessment. Discussion: Our survey and focus group findings demonstrated positive faculty attitudes and experiences, characterised faculty goals and approaches, and identified elements of the educational context that hindered or facilitated longitudinal teaching and learning. This study's faculty perspectives build upon prior investigations of students' and patients' perspectives, offer teaching strategies, and may guide faculty development. This mixed‐methods study identified goals, strategies, barriers and enablers of longitudinal learning and caregiving. Findings are situated within the framework of relational learning and can inform faculty development. [ABSTRACT FROM AUTHOR]

Background: University educators are expected to cope with emerging situations and complex issues in teaching and learning, and this requires them to be agentic and proactive. While professional agency of health educators has not been investigated adequately, this study explores health educators' perception of their enactment of professional agency in the PBL facilitation process in a postpandemic context. Methods: Forty PBL facilitators from medical and dental programs in Qatar University participated in the study during the fall semester of 2021, after resuming in‐person PBL sessions. To collect and analyse data both qualitatively and quantitatively, Q methodology was employed. A 33‐statement Q‐set was established based on a proposed theoretical framework of professional agency in PBL facilitation, which included three dimensions—intrapersonal, action, and environment. Results: Q factor analysis identified five significantly different viewpoints regarding how PBL facilitators perceive their professional agency sources, namely, (1) institutional resources, (2) policy guideline, (3) making efforts to improve support for students, (4) beliefs on PBL effectiveness, and (5) agentic actions. While four of the viewpoints were positive, participants with the second viewpoint reported negative perceptions and described lack of interest in facilitation work. All three dimensions of the framework were addressed and indicated complexity and interrelatedness of agency enactment. Consensus was observed regarding the need for more professional learning activities for faculty involved in PBL facilitation as source of professional agency. Discussion The results revealed a high variation of participants' perceptions of professional agency enactment throughout the three dimensions, indicating the need for establishing a common understanding of PBL facilitation work in a given context. For practical implications, further institutional efforts are required to support professional learning for PBL facilitation in a postpandemic context. Alternate approaches highlighting enforcement of agentic actions in all dimensions of intrapersonal values, stance and action taking, and active interactions with students, colleagues, and institutional environments are crucial. Q methodology provides new conceptual and empirical insights to explore the subjectivity of actors in health education. Du et al. reveal high variation in participants' perceptions of professional agency, indicating a need for establishing a common understanding of PBL facilitation in context. [ABSTRACT FROM AUTHOR]

Introduction: Differential rater function over time (DRIFT) and contrast effects (examiners' scores biased away from the standard of preceding performances) both challenge the fairness of scoring in objective structured clinical exams (OSCEs). This is important as, under some circumstances, these effects could alter whether some candidates pass or fail assessments. Benefitting from experimental control, this study investigated the causality, operation and interaction of both effects simultaneously for the first time in an OSCE setting. Methods: We used secondary analysis of data from an OSCE in which examiners scored embedded videos of student performances interspersed between live students. Embedded video position varied between examiners (early vs. late) whilst the standard of preceding performances naturally varied (previous high or low). We examined linear relationships suggestive of DRIFT and contrast effects in all within‐OSCE data before comparing the influence and interaction of 'early' versus 'late' and 'previous high' versus 'previous low' conditions on embedded video scores. Results: Linear relationships data did not support the presence of DRIFT or contrast effects. Embedded videos were scored higher early (19.9 [19.4–20.5]) versus late (18.6 [18.1–19.1], p < 0.001), but scores did not differ between previous high and previous low conditions. The interaction term was non‐significant. Conclusions: In this instance, the small DRIFT effect we observed on embedded videos can be causally attributed to examiner behaviour. Contrast effects appear less ubiquitous than some prior research suggests. Possible mediators of these finding include the following: OSCE context, detail of task specification, examiners' cognitive load and the distribution of learners' ability. As the operation of these effects appears to vary across contexts, further research is needed to determine the prevalence and mechanisms of contrast and DRIFT effects, so that assessments may be designed in ways that are likely to avoid their occurrence. Quality assurance should monitor for these contextually variable effects in order to ensure OSCE equivalence. Examiner DRIFT and contrast effects are well established effects in #AssessorCognition but how pronounced are they in real #OSCEs? Yeates et al found muted evidence and discuss why effects may vary between settings. [ABSTRACT FROM AUTHOR]

CONTEXT: Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging—and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism. METHOD: In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comparison to identify themes and to understand the relationships among them. RESULTS: Medical educators reported using reflective writing as a learning tool to develop insight and as an assessment tool to unearth evidence of insight. The goal of learning may compete with the goal of assessment, creating tension that leads to uncertainty about the sincerity, quality and effectiveness of reflective writing as well as concerns about learner safety. Educators reported uncertainty about whether learners write to pass or to introspect and about how to judge the effectiveness of reflective writing as a learning tool. They expressed concern about creating a safe environment for learners—one that enables the genuine reflection required for insight development—while meeting requirements of remediation. CONCLUSIONS: Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism. For medical educators using reflective writing to remediate professionalism, this work suggests using it only for learning around professional identity and engaging residents in multiple writings over time with feedback and coaching. [ABSTRACT FROM AUTHOR]

Lee and Kron describe the current use of virtual care to explain why faculty are reluctant to engage in education in that context in an effort to propose ways to promote better learner integration. [ABSTRACT FROM AUTHOR]

Background: Trigger warnings—prior notification of topics so recipients may prepare for ensuing distress—are encountered widely in contemporary culture. Students at some universities have expressed expectations for trigger warnings. Medical education routinely exposes students to numerous potentially distressing topics. However, this topic remains understudied in medical education. Little is understood about educators' views or practice relating to warnings in the context of medical education. Methods: Twenty medical educators from a medical degree programme in the UK participated in a semi‐structured qualitative interview study, exploring medical educators' views and experiences of managing distressing situations and, specifically, their use of warnings. We analysed interview transcripts by thematic coding and identified themes. Results: Analysis identified themes relating to educators' conceptualisation of trigger warnings and rationale for use, concerns about the use of warnings and the critical purpose of medical school in ensuring preparedness for clinical practice. Participants shared that warnings were given to empower students in approaching distressing topics and to enable engagement with learning. Warnings acknowledged that some experiences would be distressing and normalised and signalled acceptability of emotional responses. Decisions to use warnings were influenced by the nature of content and, reactively, in response to experiences of student distress. Terminology regarding trigger warnings was interpreted varyingly by participants. A broad variety of topics were identified as potentially sensitive. A number of concerns were noted regarding the use of warnings. Discussion: Warnings alone did not fulfil educators' responsibility in supporting students' professional development, but may be a useful adjunct, signalling that self‐care is valued and should be prioritised. Despite frequent use of warnings, individual educator practice was shaped by varying rationale. A framework that addresses competing tensions of preventing distress and supporting professional development is needed as part of a trauma‐informed approach to medical education. Trigger warnings are demonstrated to have supported students' professional development by signalling the need to recognise emotional responses and manage wellbeing. [ABSTRACT FROM AUTHOR]

Context: Medical educators hold and encounter different beliefs and values on politically charged health‐related topics such as reproductive rights and immigration. Their views on these topics have implications for how they approach them with learners, yet little work has explored medical educators' views and pedagogical approaches. In this study, we used Hess's approaches to controversial topics (avoidance, denial, privilege, balance) as a guiding conceptual framework to explore physician educators' views on and approaches to politically charged topics. We used this understanding to provide guidance on how best to address politically charged issues within medical education. Method: We used a constructivist qualitative approach to explore medical educators' approaches to politically charged topics. We interviewed 37 physician educators from two medical schools in different regions of the United States. In these semi‐structured interviews, we presented participants with vignettes depicting politically charged topics arising in an educational setting. Participants described and explained their response to each vignette. Interviews were recorded, transcribed and analysed using constructivist‐oriented thematic analysis. Results: Participants were thoughtful about preparing learners for participation in a professional community that holds certain responsibilities to a politically and culturally diverse society. Although some adopted clear approaches on politically charged topics and declared their stance on the topic to learners, others took a balanced approach, focused only on the medical aspects and withheld their views. The context and location of practice played a role in the approaches participants adopted. Additionally, they had varied views on which topics had a place in medical education. Conclusion: Our findings provide insights that can help guide medical educators and training programmes in decisions about their role in facilitating conversations about politically charged, health‐related topics and helping learners form their own perspectives and approaches to such topics. Noting the lack of clarity in medical education about how to approach politically charged topics with learners, the authors provide a framework to facilitate conversation and make the range of approaches more visible. [ABSTRACT FROM AUTHOR]

Introduction: Optimising the use of subjective human judgement in assessment requires understanding what makes judgement fair. Whilst fairness cannot be simplistically defined, the underpinnings of fair judgement within the literature have been previously combined to create a theoretically‐constructed conceptual model. However understanding assessors' and learners' perceptions of what is fair human judgement is also necessary. The aim of this study is to explore assessors' and learners' perceptions of fair human judgement, and to compare these to the conceptual model. Methods: A thematic analysis approach was used. A purposive sample of twelve assessors and eight post‐graduate trainees undertook semi‐structured interviews using vignettes. Themes were identified using the process of constant comparison. Collection, analysis and coding of the data occurred simultaneously in an iterative manner until saturation was reached. Results: This study supported the literature‐derived conceptual model suggesting fairness is a multi‐dimensional construct with components at individual, system and environmental levels. At an individual level, contextual, longitudinally‐collected evidence, which is supported by narrative, and falls within ill‐defined boundaries is essential for fair judgement. Assessor agility and expertise are needed to interpret and interrogate evidence, identify boundaries and provide narrative feedback to allow for improvement. At a system level, factors such as multiple opportunities to demonstrate competence and improvement, multiple assessors to allow for different perspectives to be triangulated, and documentation are needed for fair judgement. These system features can be optimized through procedural fairness. Finally, appropriate learning and working environments which considers patient needs and learners personal circumstances are needed for fair judgments. Discussion: This study builds on the theory‐derived conceptual model demonstrating the components of fair judgement can be explicitly articulated whilst embracing the complexity and contextual nature of health‐professions assessment. Thus it provides a narrative to support dialogue between learner, assessor and institutions about ensuring fair judgements in assessment. Effectively utilising judgement in assessment requires understanding what is deemed 'fair'. Here the authors demonstrate the multifaceted nature of this construct along with its complexity and contextual nature. [ABSTRACT FROM AUTHOR]

Purpose: Competency‐based medical education (CBME) has prompted widespread implementation of workplace‐based assessment (WBA) tools using entrustment anchors. This study aimed to identify factors that influence faculty's rating choices immediately following assessment and explore their experiences using WBAs with entrustment anchors, specifically the Ottawa Surgical Competency Operating Room Evaluation scale. Method: A convenience sample of 50 semi‐structured interviews with Emergency Medicine (EM) physicians from a single Canadian hospital were conducted between July and August 2019. All interviews occurred within two hours of faculty completing a WBA of a trainee. Faculty were asked what they considered when rating the trainee's performance and whether they considered an alternate rating. Two team members independently analysed interview transcripts using conventional content analysis with line‐by‐line coding to identify themes. Results: Interviews captured interactions between 70% (26/37) of full‐time EM faculty and 86% (19/22) of EM trainees. Faculty most commonly identified the amount of guidance the trainee required as influencing their rating. Other variables such as clinical context, trainee experience, past experiences with the trainee, perceived competence and confidence were also identified. While most faculty did not struggle to assign ratings, some had difficulty interpreting the language of entrustment anchors, being unsure whether their assessment should be retrospective or prospective in nature, and if/how the assessment should change whether they were 'in the room' or not. Conclusions: By going to the frontline during WBA encounters, this study captured authentic and honest reflections from physicians immediately engaged in assessment using entrustment anchors. While many of the factors identified are consistent with previous retrospective work, we highlight how some faculty consider factors outside the prescribed approach and struggle with the language of entrustment anchors. These results further our understanding of 'in‐the‐moment' assessments using entrustment anchors and may facilitate effective faculty development regarding WBA in CBME. Why did you select that rating? The authors of this study went into the workplace to explore the factors that inform frontline #assessment using #entrustment anchors. [ABSTRACT FROM AUTHOR]

Objectives: Sense of Community (SoC) refers to the cognitive or emotional connections established between physically separated learners; it is essential for study success. The recent COVID‐19 pandemic highlighted the need for practical guidelines to facilitate building a SoC in online medical preclerkship education in the Netherlands. Therefore, this qualitative study aims to (a) examine perceptions of SoC from both students' and teachers' perspectives in an online elective course during the COVID‐19 pandemic in order to (b) provide a conceptual framework with practical guidelines to medical educators on how to build SoC in online education. Methods: The study had an exploratory qualitative design. Semi‐structured focus groups with student (n = 15) and teacher (n = 5) volunteers were conducted. Participants discussed their experienced SoC using the storyline method. In addition, course developers (n = 2) were interviewed and lecturers (n = 5) wrote an experience story. Audio‐ and video‐recordings were transcribed verbatim and both the ensuing transcripts and experience stories were analysed using an inductive thematic analysis. Results: All students experienced an increase of SoC during the eight‐week course. Five themes were identified: 'social contacts made possible by a physical campus', 'group dynamics', 'teacher influence', 'education format' and 'teachers' Sense of Community'. The authors formulated challenges and practical guidelines on how to build SoC based on these themes. Conclusions: This exploratory qualitative study provides a conceptual framework with practical guidelines for medical educators on how to build SoC in online medical preclerkship education. These guidelines provide a valuable starting point to build SoC in online education for medical educators and students alike. van der Meer et al provide a valuable conceptual framework with practical guidelines regarding how to build a Sense of Community in online medical preclerkship education. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study examines affiliate physician‐faculty perceptions and attitudes regarding a teaching incentive programme at a free‐standing children's hospital in the United States. We describe the compensation model and present faculty interpretations of its influence on the institutional culture. Methods: A case study methodology was applied to understand the sociological aspects of academic productivity interventions. In‐depth interviews, direct observation of leadership meetings, teaching activity logs, organisational theoretical lens and survey results were used for methodological triangulation. Data from these multiple sources were coded and discussed between investigators iteratively to identify core themes. Results: Of the faculty eligible for the incentive, 32 engaged in in‐depth interviews (N = 32/107; 30%) and 88 (interviewees included) in the survey (N = 88/107; 82%). Findings suggest that while the implementation made some strides in mitigating barriers for some, for others gaps were identified that suggest further exploration within this domain of study is warranted. The incentive implementation was perceived as strategic, intending to encourage the academic culture of the hospital, though participants commonly expressed confusion about the rationale behind the omission of teaching allocations in formal contracts. However, high satisfaction levels for the programme as a conduit to change were evident. There was a perception of a shift in the collective faculty morale that reflected an evolving institutional culture that increased enthusiasm for teaching. Finally, faculty noted their perception that institutions that employ teaching incentives could positively influence faculty recruitment. Conclusion: We found a modest incentive‐based reward for teaching activity was successful in informing the perceptions of faculty regarding their institution's academic prestige goals and teaching recognition. Such programmes, while requiring a small investment of time and resources by institutional leadership, can convey that the educational mission remains a priority in this era of increasing clinical and administrative pressure and an institutional culture that may positively influence faculty morale and dedication to teaching. The authors illustrate how rewards for teaching activities send a message, building morale by conveying that the educational mission remains a priority in this era of increasing clinical and administrative pressure. [ABSTRACT FROM AUTHOR]

Introduction: The underrepresentation of women among senior faculty members in medical education is a longstanding problem. The purpose of this international qualitative investigation was to explore women and men's experiences of attaining full professorship and to investigate why women remain underrepresented among the senior faculty ranks. Methods: Conducted within a social constructionist orientation, our qualitative study employed narrative analysis. Two female and two male participants working in medical education were recruited from five nations: Australia, Canada, the Netherlands, United Kingdom and United States. All participants held an MD or PhD. During telephone interviews, participants narrated the story of their careers. The five faculty members on the research team were also interviewed. Their narratives were included in analysis, rendering their experiences equal to those of the participants. Results: A total of 24 full professors working in medical education were interviewed (n = 15 females and n = 9 males). While some aspects were present across all narratives (ie personal events, career milestones and facilitating and/or impeding factors), participants' experience of those aspects differed by gender. Men did not narrate fatherhood as a role navigated professionally, but women narrated motherhood as intimately connected to their professional roles. Both men and women narrated career success in terms of hard work and overcoming obstacles; however, male participants described promotion as inevitable, whereas women narrated promotion as a tenuous navigation of social structures towards uncertain outcomes. Female and male participants encountered facilitators and inhibitors throughout their careers but described acting on those experiences differently within the cultural contexts they faced. Discussion: Our data suggest that female and male participants had different experiences of the work involved in achieving full professor status. Understanding these gendered experiences and their impact on career progression is an important advancement for better understanding what leads to the underrepresentation of women among senior faculty members in medical education. By showing promotion in medical education is shaped by ideologies that create different experiences for men and women, Varpio et al. offer insight into how we might reverse the underrepresentation of women in the field's highest ranks. [ABSTRACT FROM AUTHOR]

Introduction: Reflective ability is an important skill for enhancing professionalism and developing communication skills. To improve reflective ability, medical educators encourage use of written reflective journals, for which feedback is important. It is difficult for educators to anticipate how their feedback will be perceived. Therefore, this study examined students' experiences with educators' written feedback on reflective journals. Methods: A qualitative, immersion/crystallization analysis of 60 written feedback texts to 15 medical students (30 identified by students as meaningful and 30 as less meaningful) and in‐depth semi‐structured interviews with these students. We did not define 'meaningful', to leave room for students' own interpretations. We analysed the feedback to identify what it includes (its components) and analysed the interviews to learn about students' experiences of receiving the feedback and the specific components. Results: Students experienced five components as meaningful: supportive and encouraging statements; legitimisation of their emotions; educators sharing personal‐professional experiences; asking questions to enhance reflection; and focusing on the students' main concern. These components enhanced students' willingness to read and learn from the feedback. Three components were experienced as less meaningful: detached, impersonal feedback; negative tone (criticism); and technical issues, for example brevity. These disappointing and hurtful components led students to pay less attention to the feedback or to invest less effort in future written assignments. Conclusions: The present study identified components in written reflective journal feedback texts and the experience and needs of students who received them. It showed the complexity of writing reflective feedback because of the need to support students through it, help them deal with emotions, identify and focus on personal content that matters to them, and provide opportunities to develop and enhance their reflective ability, while being mindful of their emotional state. To help educators in this challenging task, a self‐assessment mnemonic ('FEEDBACK') for use before sending the initial feedback was developed. The authors demonstrate the importance of empathically addressing students' emotions and sharing personal experience when offering feedback on reflective journals. [ABSTRACT FROM AUTHOR]

Introduction: General practitioners (GPs) and family medicine clinicians should respond to Indigenous peoples' health needs. However, medical graduates feel underprepared for this work. The foundational elements of racism, white privilege and cultural self‐reflexivity remain conspicuously absent from medical education in general practice programmes, despite inclusion in curriculum frameworks. This study explored the perception and experiences of Australian GP educators in teaching this content. Methods: We undertook a qualitative study that gathered data through semi‐structured interviews with GP educators (n = 12) at a medical school in Victoria, Australia. We utilised the Reflection learning domain of the Aboriginal and Torres Strait Islander Health Curriculum Framework to shape interview questions on racism, white privilege and cultural self‐reflexivity. Data were analysed from constructivist and Critical Indigenous Theory paradigms to formulate key themes. Results: General practitioner educators were challenged by Reflection content, struggled to articulate a refined pedagogy for provision of anti‐racist, self‐reflexive learning and felt poorly qualified to teach Indigenous health, articulating preference for delegation of teaching to Indigenous peoples. They simultaneously stated the importance of inclusion of Reflection teaching in general practice, alongside expressing beliefs that appeared to devalue its perceived relevance. Students were perceived as being either disinterested or incapable of Reflection learning, or conversely, more engaged than previous generations with these topics. Discussion: The results call into question how skilled are GP educators to teach elements of Indigenous health education such as racism, white privilege and cultural self‐reflexivity. Unskilled educators can reinforce colonialism in curricula, including through minimisation of content. Stronger anti‐racist pedagogy is urgently required in medical education. Vital to this is active research on educator preparedness, evidence‐based teaching models and accountable curriculum accreditation. Vass and Adams explain why stronger anti‐racist pedagogy is urgently required in medical education through examination of knoweldge and expertise related to Indigenous health content. [ABSTRACT FROM AUTHOR]

Encouraging us to study like with like, Woodruff argues that scholarship is undermined when research and innovation in complex systems take place with reductionist approaches. [ABSTRACT FROM AUTHOR]

Context: Learning technologies are ubiquitous in medical schools, implemented in anticipation of more effective, active and authentic learning and teaching. Such thinking appears to be an instance of solutionism. The evidence is that academics' adoption of learning technologies is often limited in scale and scope and frequently fails to transform their teaching practices. Purpose: This paper aims to provide a contextualised analysis of considerations pertinent to the adoption of learning technologies by teaching staff. We contextualise a framework for understanding adoption of learning technologies in higher education by medical education. Conclusions: We identify multiple precursors that predict individual patterns of adoption, illuminating factors related to the technology, the individual staff member charged with adoption and the working environment. We offer conceptual clarity to the vexed issue of learning technology adoption and provide evidence explaining why, despite their widely promulgated potential, learning technologies do not offer an easy route to the transformation of medical education. If you build it will they learn? The authors explore why simply making learning technologies available does not optimize educational transformation. [ABSTRACT FROM AUTHOR]

The authors discuss the report "Situational judgement test (SJT) validity for selection: a systematic review and meta-analysis," by E.S. Webster, L.W. Paton, P.E.S. Crampton, and P.A. Tiffin, which was published within the issue. Topics mentioned include the validity of SJT for postgraduate medical education, and the assessment techniques used including interviews and objective structured clinical examinations.

Context: Both classroom and clinical sessional educators are often overlooked in faculty development, even though they play an important role in student learning. Our aim was to contrast classroom and clinical sessional educators´ experiences of and perceived needs for connectedness, appreciation and support, in relation to their teaching quality. We then utilised these results to make suggestions for supporting these educators. Methods: The participants (11 physical therapy sessional educators: four clinical; seven clinical, and classroom) took part in three focus groups. We based the interview guide questions on previous survey results, used a critical theory research paradigm and performed thematic analysis. Results: We identified four emerging differences between physical therapy sessional educators with experience in the classroom and clinic. Classroom sessional educators needed: (a) more connectedness; (b) more appreciation; (c) more access to the learning management system, and (d) both different and similar faculty development when compared to clinical sessional educators. Differences were greater in classroom sessional educators who taught more hours. We also saw similarities in the need for feedback on teaching, orientations and communication, a better salary and clinical workplace support their role of an educator. Suggestions for context‐dependent support for sessional educators were designed to address these similarities and differences. Conclusions: Talking to various types of sessional educators about their teaching needs is the first step in providing effective faculty development. Varying needs for connectedness, appreciation, pedagogy and access to the learning management system amongst physical therapy sessional educators highlighted the need for an investment in classroom educators who teach multiple hours and want to grow as health science educators. Differences between classroom and clinical sessional educators brought to the forefront the importance of individualised, contextual faculty development and administrative or departmental action that supports sessional educators. The resulting context‐dependent suggestions for improvement of support of sessional educators have the potential to improve the quality of health science teaching overall. Striving to tailor teacher support to the contextual reality of educators, Snook et al demonstrate differences in the needs of classroom and clinical sessional faculty. [ABSTRACT FROM AUTHOR]

Objectives: Implicit bias is common and is thought to drive discriminatory behaviour. Having previously demonstrated discrimination against specific applicant demographics by academic radiology departments in a simulated resident selection process, the authors sought to better understand the relationship between implicit bias and discrimination, as well as the potential and mechanisms for their mitigation. Methods: A total of 51 faculty reviewers at three academic radiology departments, who had participated in a 2017 audit study in which they were shown to treat applicants differently based on race or ethnicity and physical appearance, were invited to complete testing for implicit racial and weight bias using the Implicit Association Test in 2019. Respondents were also surveyed regarding awareness of their own personal racial and weight biases, as well as any prior participation in formal diversity training. Comparisons were made between implicit bias scores and applicant ratings, as well as between diversity training and self‐awareness of bias. Results: A total of 31 out of 51 faculty reviewers (61%) completed and submitted results of race and weight Implicit Association Tests. A total of 74% (23/31) reported implicit anti‐obese bias, concordant with discrimination demonstrated in the resident selection simulation, in which obese applicants were rated 0.40 standard deviations (SDs) lower than non‐obese applicants (P <.001). A total of 71% (22/31) reported implicit anti‐Black bias, discordant with application ratings, which were 0.47 SDs higher for Black than for White applicants (P <.001). A total of 84% (26/31) of participants reported feeling self‐aware of potential racial bias at the time of application review, significantly higher than the 23% (7/31) reporting self‐awareness of potential anti‐obese bias (P <.001). Participation in formal diversity training was not associated with implicit anti‐Black or anti‐fat bias, nor with self‐reported awareness of potential racial or weight‐based bias (all P >.2). Conclusions: These findings suggest that implicit bias, as measured by the Implicit Association Test, does not inevitably lead to discrimination, and that personal awareness of implicit biases may allow their mitigation. With countless reasons to worry about bias, discrimination in healthcare, education, Maxfield et al. offer hope by demonstrating that implicit bias does not inevitably lead to discrimination, can be managed. [ABSTRACT FROM AUTHOR]

Context: An important part of a doctor's identity is the social position he or she adopts relative to patients. Dialogic theory predicts that medical school discourses influence the positions students incorporate into their professional identities. As this may affect how students later exercise power in doctor‐patient relationships, we set out to examine how medical teachers position doctors in relation to patients. Methods: Informed by Holland's Figured Worlds theory, which draws important assumptions from Bakhtin, we chose dialogic research methodology to examine how educators' language positions doctors and may influence students' identity formation. We recruited a maximum variation sample of 10 teaching staff and used open prompts in individual semi‐structured interviews to elicit discourses of doctors' social position. We used Sullivan's dialogic methodology reflexively to identify informative speech acts (utterances) and to examine how the language used in these constructed doctors' positions. Results: Dominant discourses of Social Superiority, Technical Effectiveness, and Benevolence elevated doctors' positions based on their social status, applied knowledge and trustworthiness, respectively. These positions were defended by predicating medical care on doctors' mastery of treatments and their superior knowledge. A non‐dominant discourse of Distributed Power and Responsibility narrowed the positional gap by constructing doctors as empowering patients. Conclusions: Whereas three conservative discourses upheld doctors' elevated social position, a non‐dominant, transformative discourse distributed power. We suggest that doctors will form the best relationships with patients when they are aware of these discourses and know how to navigate them. In pursuit of effective and compassionate patient care, we commend critical pedagogy as a means of articulating non‐dominant discourses and increasing students', educators' and doctors' awareness of how they learn the positions of doctors. Dornan et al. identify four discourses that position doctors in relationships with patients: superiority, effectiveness, benevolence, distribution. Awareness of these discourses could encourage students, faculty to better understand how status, power influence healthcare. [ABSTRACT FROM AUTHOR]

Context: Internationalisation in medical education raises ethical concerns over, for instance, its for‐profit orientation, the potential erosion of cultural diversity and the possibility that standardised education may not meet the needs of patients everywhere. These concerns fit into a broader debate on social responsibility in higher education. This study aims to explore how academic staff in international medical education experience and act upon the ethical concerns that pertain to their programmes. By adding their perspectives to the debate, this study helps us understand how theory‐based ethical concerns are reflected in practice. Methods: We conducted a multicentre instrumental case study across three international medical programmes, all of which were characterised by an international student intake, an internationalised curriculum and international partnerships, and all of which used English as the medium of instruction. We conducted 24 semi‐structured interviews with purposively sampled curriculum directors and teaching staff. Participants shared their personal experiences and responded to ethical concerns expressed in the literature. Our multidisciplinary team performed a template analysis of the data based on theoretical frameworks of ethics and social responsibility. Results: Participants primarily experienced the internationalisation of their institutions and programmes as having a positive impact on students, the university and the future global society. However, they did face several ethical dilemmas. The first of these involved the possibility that marketisation through international recruitment and the application of substantial tuition fees might widen access to medical education, but might allow weaker students to enter medical schools. The second concern referred to the homogenisation of education methods and content, which offers opportunities to expose students to best practices, but may also pose a risk to education quality. The third issue referred to the experience that although student diversity helped to promote intercultural learning, it also jeopardised student well‐being. Conclusions: In the eyes of teaching staff in international medical education, internationalisation can benefit education quality and society, but poses ethical dilemmas through the forces of marketisation, homogenisation and diversification. The findings reflect a tension between the views of scholars and those of practitioners. The critical perspective found in academic debates is largely missing in practice, and theoretical frameworks on ethics possibly overlook the benefits of international education. To facilitate ethical decision making, we propose that scholars and practitioners globally try to learn from each other. Internationalisation is generally embraced with positivity by teaching staff in international medical programmes. This article, however, shines a light on the ethical dilemmas it poses through marketisation and homogenisation. [ABSTRACT FROM AUTHOR]

Context: Critical reflection may improve health professionals' performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value‐conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches. Methods: The study context was the interface between health care and education for children with chronic conditions or disabilities necessitating health‐related recommendations and supports (eg accommodations or equipment) at school. We conducted a secondary analysis of 42 interview transcripts from an institutional ethnographic study involving health professionals, school‐based educators and parents of children with chronic conditions or disabilities. We coded all transcripts for instances of critical reflection, moments that seemed to lack but could benefit from critical reflection, and participant‐attributed sources of critically reflective insights. Results: Critically reflective practice involved getting to know the other, valuing and leveraging different forms and sources of knowledge, identifying and communicating workarounds (ie strategies to circumvent imperfect systems), seeing inequities, and advocating as collaborators, not adversaries. Participants invariably attributed critically reflective insights to personal experiences such as former careers or close personal relationships. Conclusions: This study shows that personal experiences and connections inspire critically reflective views, and that being critically reflective is not a binary trait possessed (or not) by individuals. It is learnable through personally meaningful experiences. Health professions education could aim to preserve philosophical space for personal experience as a source of learning and integrate evidence‐informed approaches to foster critically reflective practice. Ng et al. explore the implications of their observation that critical reflection improved social aspects of practice (advocacy and collaboration) when clinicians worked with schools to support children with disabilities, but that it did so opportunistically. [ABSTRACT FROM AUTHOR]

Objective: Is the statement 'assessment drives learning' a myth? Background: Instructors create assessments and students respond to these assessments. Although such responses are often labelled indications of learning, the responses educators observe can also be considered a performance. When responses are aligned with generating stable changes, then assessment drives learning. When responses are not aligned with stable changes, we must consider them to be something else: a performance put on partially or fully for the sake of implying capability rather than actual learning. The alignment between the assessments educators create and the way students respond to these assessments is determined by the actions students take in our curriculum, in preparation for our assessments and after engaging with our assessments. Conclusions: Not all assessments need to or should support learning, but when we assume all assessments 'drive learning', we endorse the myth that assessment is necessarily a formative aspect of our curricula. When we create assessments that encourage performance activities such as cramming, competing for tutorial airtime and impression management in the clinical setting we drive students to a performance. By thinking about how our students, institutions, curricula and assessments support learning and how well they support performance, we can modify and more fully align our curricular and assessment efforts to support learners in achieving their (and our) desired outcome. So, is the phrase 'assessment drives learning' a myth? This paper will conclude that it often is but we as educators must, through our leadership, move this myth towards a reality. Assessment drives learning may be the most commonly stated phrase in medical education. Here Scott demonstrates that how curriculum and assessments are organized and structured may drive students to perform for faculty rather than learn for themselves. [ABSTRACT FROM AUTHOR]

Context: Medical schools face growing pressures to develop quality improvement (QI) strategies to ensure the continuous quality of their education. To best achieve quality, both organisational processes and culture need to be oriented towards quality. Quality processes already exist at medical schools, at least externally driven by accreditation. However, the dominant culture in most medical schools is not typically oriented towards quality. Objectives: This study explores whether QI practices are recognised as such in organisations not culturally QI‐oriented. Specifically, it examines faculty members' perceptions about the degree of QI implementation in their medical education programmes. Understanding this perception will inform medical school leadership on how best to use resources for a successful execution of the school's QI vision. Methods: Leaders, clinical teachers and formal teachers at 16 of the 17 Canadian medical schools were invited to complete the 'Are We Making Progress?' questionnaire of the Malcolm Baldrige National Quality Award framework, the results of which have been broadly validated. The questionnaire measures the perceived level of QI implementation within organisations using 40 statements grouped under the framework's seven domains of performance excellence. Results: A total of 491 respondents from 11 (69%) schools completed the questionnaire; 173 (35%) identified as clinical teachers, 150 (31%) as formal teachers, and 168 (34%) as leaders. Perceived QI implementation levels were low across programmes (0.70–1.90 in Rasch person measures) and for each category of respondents. This was especially true for the domains of 'Strategy', 'Measurement/analysis/knowledge management' and 'Operations'. Leaders' perceptions of QI implementation were higher than those of teachers. Conclusions: Medical schools' existing QI processes are not recognised as QI activities. For QI strategies to succeed, a programme's culture must embrace QI. In the execution of their QI visions, medical schools should spend resources on embedding quality in the organisation culture in addition to strengthening existing QI practices, especially in the domains listed above. Blouin reports on how the culture of medical schools, specifically their quality orientation, impact on the degree to which Quality Improvement initiatives are considered to be implemented effectively. [ABSTRACT FROM AUTHOR]

Attributing value to teaching work has been problematic, but here Park et al. offer holistic reframing as a potential solution. [ABSTRACT FROM AUTHOR]

Prompted by Varpio et al.'s exploration of sex‐related experiences in medical education, Cavanagh et al. intertwine race‐based ideology to offer an intersectional lens on the problem. [ABSTRACT FROM AUTHOR]

Finding light in the darkness of interactions with poor clinical role models, Giamto argues most of us have missed opportunities to learn invaluable lessons from such encounters. [ABSTRACT FROM AUTHOR]

Context: Interprofessional practice is required to manage complex health care needs globally. It is well established that interprofessional placements (IPP) prepare students to work collaboratively, yet IPP implementation remains limited and disjointed. Objectives: This review synthesised student, educator and service user perspectives in order to better understand challenges of IPP and provide recommendations for sustainable IPP implementation. Methods: A systematic metasynthesis of qualitative literature sourced from databases including CINAHL, Embase and PsycINFO was completed. Studies that incorporated student, educator and/or service user perspectives on IPP experiences were included. We focused specifically on factors limiting implementation of IPP. The presage‐process‐product (3P) theory provided the theoretical framework for inductive synthesis of 41 empirical studies. A confidence rating for findings was formulated using CERQual (confidence in evidence from reviews of qualitative research). Results: We developed three themes, which represent key challenges to IPP becoming embedded in placement culture: (i) thin theoretical foundations underpinned IPP, limiting understanding of the learning processes involved; (ii) implementation relied heavily on individual champions, which curtails investment and sustainability when personnel change, and (iii) students, educators and service users were unsure of the function of IPP and their respective roles, leading to uncertainty along with some negative perceptions of this placement approach. Conclusions: In line with the 3P theoretical framework, IPP would benefit from explicit connections with educational and change management theories during presage stage IPP requires coordinated leadership and resource investment, and during product stage clear integration of interprofessional learning outcomes in curricula is advised. Addressing the identified challenges across the stages of IPP will support further development of IPP, firmly establishing this approach within placement culture. IPP can them make a significant contribution to the development of a collaborative practice‐ready workforce. This in turn will enhance service user outcomes and safety. This review provides an overview of the challenges faced during interprofessional placements and makes recommendations for facilitating collaborative practice to address increasingly complex healthcare needs. [ABSTRACT FROM AUTHOR]

Objectives: 'Wicked problems' are complex in nature, have innumerable causes associated with multiple social environments and actors with unpredictable behaviour and outcomes, and are difficult to define or even resolve. This paper considers why and how the frameworks of complexity theory and wicked problems can help medical educators consider selection and widening access (WA) to medicine through fresh eyes to guide future policy and practice. We illustrate how 'wickedity' can frame the key issues in this area, and then address steps that education stakeholders might take to respond to and act on these issues. Methods: We used the 10 properties of a wicked problem to frame common issues in the broad field of selection and WA in medicine. We drew heavily on literature from different disciplines, particularly education, and, through debate and reflection, agreed on the applicability of the theory for illuminating and potentially addressing outstanding issues in selection and WA. Results: Framing medical school selection using the 10 properties of wicked problems is a means of shifting thinking from erroneous 'simple' solutions to thinking more contextually and receptively. The wicked problem framework positions selection as a multi‐causal, complex, dynamic, social problem and foregrounds stakeholders' views and context as being highly relevant in medical school selection. Conclusions: The wicked problem lens shifts thinking and action from seeking one elusive, objective truth to recognising the complexity of medical school selection, managing uncertainty, questioning and considering 'issues' associated with medical school selection more productively. Although there are criticisms of this framework, labelling medical selection as 'wicked' provides original insights and genuine reframing of the challenges of this important, and high profile, aspect of medical education. Doing so, in turn, opens the door to different responses than would be the case if selection and WA were simple and readily tamed. By discussing how complexity theory and the "wicked problems" framework can help medical educators consider selection and widening access the authors provide a new lens to guide policy and practice. [ABSTRACT FROM AUTHOR]

Straight out of the Diagnostic and Statistical Manual COVID‐19 edition comes Covido‐pedago‐phobia. Here the authors identify its manifestations and reflect on its prevalence. [ABSTRACT FROM AUTHOR]

Reflection has long been promoted as a means to encourage medical student professional development, but can it do more? This commentary encourages reflection to help students examine and critique the underlying assumptions of modern medicine. [ABSTRACT FROM AUTHOR]

Context: Single‐best‐answer questions (SBAQs) have been widely used to test knowledge because they are easy to mark and demonstrate high reliability. However, SBAQs have been criticised for being subject to cueing. Objectives: We used a novel assessment tool that facilitates efficient marking of open‐ended very‐short‐answer questions (VSAQs). We compared VSAQs with SBAQs with regard to reliability, discrimination and student performance, and evaluated the acceptability of VSAQs. Methods: Medical students were randomised to sit a 60‐question assessment administered in either VSAQ and then SBAQ format (Group 1, n = 155) or the reverse (Group 2, n = 144). The VSAQs were delivered on a tablet; responses were computer‐marked and subsequently reviewed by two examiners. The standard error of measurement (SEM) across the ability spectrum was estimated using item response theory. Results: The review of machine‐marked questions took an average of 1 minute, 36 seconds per question for all students. The VSAQs had high reliability (alpha: 0.91), a significantly lower SEM than the SBAQs (p < 0.001) and higher mean item–total point biserial correlations (p < 0.001). The VSAQ scores were significantly lower than the SBAQ scores (p < 0.001). The difference in scores between VSAQs and SBAQs was attenuated in Group 2. Although 80.4% of students found the VSAQs more difficult, 69.2% found them more authentic. Conclusions: The VSAQ format demonstrated high reliability and discrimination and items were perceived as more authentic. The SBAQ format was associated with significant cueing. The present results suggest the VSAQ format has a higher degree of validity. [ABSTRACT FROM AUTHOR]

Context: Medical educators often have prior and primary experience in other academic and clinical disciplines. Individuals seeking successful careers in the education of medical students and doctors must, at some point in their development, make a conscious transition into a new identity as a medical educator. This is a necessary move if individuals are to commit to acquiring and maintaining specialist expertise in medical education. Some achieve this transition successfully, whereas others struggle and may even lose interest and abandon the endeavour. We explored senior educators' experiences of achieving the transition into medical education and their views on what helps and what hinders the process. Methods: In 2015 we conducted three focus groups with 15 senior medical educators. All focus group discussions were audiorecorded and transcribed verbatim. We applied transition theory to guide our deductive analysis, using Schlossberg's Four S (4S) framework to code and report participants' self‐reported perceptions of those factors relating to Self, Situation, Support and Strategy that had assisted them to make a successful transition to a fully acknowledged medical educator identity. Through inductive analysis, we then identified 17 explanatory sub‐themes common to all three focus groups. Results: Background and circumstances, individual motivation, a sense of control, organisational support, and effective networking and information‐seeking behaviour were factors identified as contributing to successful transition into, and maintenance of, a strong self‐identity as a medical educator. Conclusions: The experiences of established medical educators and, in particular, an exploration of the factors that have facilitated their transition to an acknowledged self‐identity as a medical educator could assist in supporting new educators to cope with the changes involved in developing as a medical educator. [ABSTRACT FROM AUTHOR]

To create belonging in medical education, Wyatt et al. argue that institutions must consider diversity, equity and inclusion (DEI) from a systems‐based perspective that integrates each of these components. [ABSTRACT FROM AUTHOR]

Context While medical curricula were traditionally almost entirely comprised of bioscientific knowledge, widely accepted competency frameworks now make clear that physicians must be competent in far more than biomedical knowledge and technical skills. For example, of the influential CanMEDS roles, six are conceptually based in the social sciences and humanities (SSH). Educators frequently express uncertainty about what to teach in this area. This study concretely identifies the knowledge beyond bioscience needed to support the training of physicians competent in the six non-Medical Expert CanMEDS roles. Methods We interviewed 58 non-clinician university faculty members with doctorates in over 20 SSH disciplines. We abstracted our transcripts (meaning condensation, direct quotations) resulting in approximately 300 pages of data which we coded using top-down (by CanMEDS role) and bottom-up (thematically) approaches and analysed within a critical constructivist framework. Participants and clinicians with SSH PhDs member-checked and refined our results. Results Twelve interrelated themes were evident in the data. An understanding of epistemology, including the constructed nature of social knowledge, was seen as the foundational theme without which the others could not be taught or understood. Our findings highlighted three anchoring themes ( Justice, Power, Culture), all of which link to eight more specific themes concerning future physicians' relationships to the world and the self. All 12 themes were cross-cutting, in that each related to all six non-Medical Expert CanMEDS roles. The data also provided many concrete examples of potential curricular content. Conclusions There is a definable body of SSH knowledge that forms the academic underpinning for important physician competencies and is outside the experience of most medical educators. Curricular change incorporating such content is necessary if we are to strengthen the non-Medical Expert physician competencies. Our findings, particularly our cross-cutting themes, also provide a pedagogically useful mechanism for holistically teaching the underpinnings of physician competence. We are now implementing our findings into medical curricula. [ABSTRACT FROM AUTHOR]

Context The problems associated with generating a collaborative ranked preference list represent a common source of dilemma in academic medicine and medical education. Such issues present during the process of choosing among applicants to medical schools, during the selection of postgraduate trainees, and in the course of performance assessments and the prioritising of financial expenditures. Currently, most institutions use pseudo-quantitative methods, such as the averaging of scores awarded on an arbitrary scale. These methods are mathematically problematic and may not accurately reflect group opinion. Methods The present authors developed a novel algorithm for creating a collaborative preference list that generates and sorts a matrix of pairwise comparisons between applicants or choices without placing any reliance on arbitrary Likert scale-type scores. This method achieves equality in influence across individual assessors, as well as transparency and reproducibility. The authors report a case study of their experience using this new algorithm in the 2013 neonatal-perinatal fellowship match. Results When used by this group in the selection of fellowship trainees, the method proposed here allowed for greater efficiency and created a rank-order list that did not require reshuffling or significant debate. A survey of faculty staff and fellows showed much higher levels of satisfaction with the new algorithm and a unanimous desire to use the new algorithm in the future, in preference to a score-based system. Conclusions The algorithm developed and described here may reduce arbitrariness in processes that require the collaborative creation of a preference list. This method may have wide applicability in medical education and training, and beyond. The present authors' experience of using this algorithm during the National Resident Matching Program match showed improved perceptions of fairness, ease of use and efficiency. [ABSTRACT FROM AUTHOR]

This commentary explores the worthy goal of refining decision‐making heuristics for educators, clinicians, and other individuals in learner support roles. [ABSTRACT FROM AUTHOR]

Context Although research from Western contexts suggests that considerable inequalities for female medical educators exist in the workplace, we do not yet know the views and experiences of women within non-Western contexts. By examining the influence of context, intersecting identities and language use, this study explores female medical educators' views and experiences of gender, career progression and leadership in academic medicine in the Kingdom of Saudi Arabia ( KSA). Methods We conducted individual interviews employing narrative interviewing techniques with 25 female medical educators from five schools in the KSA (June to December 2014). Data were analysed using framework analysis and drew on intersectionality theory. Results Participants expressed their views and experiences of career progression, leadership and gendered workplace cultures. Women's experiences of career progression and leadership in the KSA were influenced by their gender and varied according to their career stage, work environment and specialty. Participants discussed the gendered organisational cultures of academic medicine in the KSA in terms of gender inequalities (e.g. females being overlooked for leadership positions), gender stereotypes (e.g. women perceived as more likely to take part in shared leadership) and gendered specialties (e.g. surgery being male dominated). We revealed women's more tacit understandings about gender, career progression and leadership by examining how they talk (e.g. metaphoric, pronominal and emotional talk). Finally, participants constructed multiple intersecting personal (e.g. female, mother and young) and professional identities (e.g. doctor, teacher and leader) for themselves through their narratives. Conclusion This study provides important new insights into female medical educators' experiences of career progression and leadership in a non-Western context. Investment in the future of women's careers in the KSA through faculty development initiatives and equality and diversity policies is now essential to help close the gender gap. [ABSTRACT FROM AUTHOR]