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To transition successfully into independent practice, newly graduated independent physicians (new "attendings") undergo a process of professional identity formation (PIF) as a clinician within a new community of practice (CoP). PIF is crafted by socialization within a CoP including transfer of tacit knowledge. While certain tacit knowledge is critical for professional identity, we understand little how it shapes PIF. We set out to describe the tacit knowledge acquired by new attendings within a CoP and how it contributes to PIF. Informed by constructivist grounded theory, we interviewed 23 new attendings about the tacit knowledge they acquired in early practice. Data collection and analysis occurred iteratively. We identified themes using constant comparative analysis and generated a theory that underwent member checking and feedback. Implicit standards from group culture imparted high expectations on new attendings and led to internal stress. New attendings also encountered a tacit code of conduct as behavioral elements of group culture. These elements created external conflict between new attendings and group members such as departmental colleagues, consulting physicians, and other health professionals. Depending on the support they received, new attendings responded to the stress and conflict in three ways: they doubted, adjusted, or avoided. These strategies molded their professional identity, and moved them towards or away from the CoP as they navigated their transition and PIF. We describe a novel theory of how tacit group culture shaped new attending physicians' professional identity in a new community of practice. Internal stress and external conflict occurred due to high expectations and tacit culture elements. New attendings' doubt, adjust, or avoid responses, shaped by support they received, in turn crafted their professional identity. Education leaders should prepare graduating trainees to navigate aspects of transition to independent practice successfully.

Background: Work‐based assessments (WBAs) are increasingly used to inform decisions about trainee progression. Unfortunately, WBAs often fail to discriminate between trainees of differing abilities and have poor reliability. Entrustment‐supervision scales may improve WBA performance, but there is a paucity of literature directly comparing them to traditional WBA tools. Methods: The Ottawa Emergency Department Shift Observation Tool (O‐EDShOT) is a previously published WBA tool employing an entrustment‐supervision scale with strong validity evidence. This pre‐/post‐implementation study compares the performance of the O‐EDShOT with that of a traditional WBA tool using norm‐based anchors. All assessments completed in 12‐month periods before and after implementing the O‐EDShOT were collected, and generalisability analysis was conducted with year of training, trainees within year and forms within trainee as nested factors. Secondary analysis included assessor as a factor. Results: A total of 3908 and 3679 assessments were completed by 99 and 116 assessors, for 152 and 138 trainees in the pre‐ and post‐implementation phases respectively. The O‐EDShOT generated a wider range of awarded scores than the traditional WBA, and mean scores increased more with increasing level of training (0.32 vs. 0.14 points per year, p = 0.01). A significantly greater proportion of overall score variability was attributable to trainees using the O‐EDShOT (59%) compared with the traditional tool (21%, p < 0.001). Assessors contributed less to overall score variability for the O‐EDShOT than for the traditional WBA (16% vs. 37%). Moreover, the O‐EDShOT required fewer completed assessments than the traditional tool (27 vs. 51) for a reliability of 0.8. Conclusion: The O‐EDShOT outperformed a traditional norm‐referenced WBA in discriminating between trainees and required fewer assessments to generate a reliable estimate of trainee performance. More broadly, this study adds to the body of literature suggesting that entrustment‐supervision scales generate more useful and reliable assessments in a variety of clinical settings. Dewhirst et al. report that an entrustment‐supervision scale better discriminated between learners and was more responsive to level of training relative to a traditional workplace‐based assessement. [ABSTRACT FROM AUTHOR]

Introduction: The voices of authors who publish medical education literature have a powerful impact on the field's discourses. Researchers have identified a lack of author diversity, which suggests potential epistemic injustice. This study investigates author characteristics to provide an evidence‐based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing. Method: The authors conducted a bibliometric analysis of all articles published in 24 medical education journals published between 2000 and 2020 to identify author characteristics, with an emphasis on author gender and geographic location and their intersection. Article metadata was downloaded from Web of Science. Genderize.io was used to predict author gender. Results: The journals published 37 263 articles authored by 62 708 unique authors. Males were more prevalent across all authorship positions (n = 62 828; 55.7%) than females (n = 49 975; 44.3%). Authors listed affiliations in 146 countries of which 95 were classified as Global South. Few articles were written by multinational teams (n = 3765; 16.2%). Global South authors accounted for 12 007 (11.4%) author positions of which 3594 (3.8%) were female. Discussion: This study provides an evidence‐based starting point to discuss the imbalance of author voices in medical education, especially when considering the intersection of gender and geographical location, which further suggests epistemic injustice in medical education. If the field values a diversity of perspectives, there is considerable opportunity for improvement by engaging the community in discussions about what knowledge matters in medical education, the role of journals in promoting diversity, how to best use this baseline data and how to continue studying epistemic injustice in medical education. Authorship counts reveal an imbalance of voices in #meded, especially when considering the intersection of gender & geography, thereby providing a starting point for discussion of how to move towards a field that values diverse ways of knowing. [ABSTRACT FROM AUTHOR]

Background: The field of medical education remains poorly delineated such that there is no broad consensus of articles or journals that comprise 'the field'. This lack of consensus indicates a missed opportunity for researchers to generate insights about the field that could facilitate conducting bibliometric studies and other research designs (e.g., systematic reviews) and also enable individuals to identify themselves as 'medical education researchers'. Other fields have utilised bibliometric field delineation, which is the assigning of articles or journals to a certain field in an effort to define that field. Process: In this Research Approach, three bibliometric field delineation approaches—information retrieval, core journals, and journal co‐citation—are introduced. For each approach, the authors describe attempts to apply it in medical education and identify related strengths and weaknesses. Based on co‐citation, the authors propose the Medical Education Journal List 24 (MEJ‐24), as a starting point for delineating medical education and invite the community to collaborate on improving and potentially expanding this list. Pearls: As a research approach, field delineation is complicated, and there is no clear best way to delineate the field of medical education. However, recent advances in information science provide potentially fruitful approaches to deal with the field's complexity. When considering these approaches, researchers should consider collaborating with bibliometricians. Bibliometric approaches rely on available metadata for articles and journals, which necessitates that researchers examine the metadata prior to analysis to understand its strengths and weaknesses, and to assess how this might affect data interpretation. While using bibliometric approaches for field delineation is valuable, it is important to remember that these techniques are only as good as the research team's interpretation of the data, which suggests that an expanded approach is needed to better delineate medical education, an approach that includes active discussion within the medical education community. How do we draw lines around #MedEd? This article introduces 3 #bibliometric approaches: info retrieval, core journals & journal co‐citation to kickstart the conversation and provide a starter set of journals to build upon. [ABSTRACT FROM AUTHOR]