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Abstract Background Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs’ understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors. Methods An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs’ understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital. Results The factor analysis yielded two separate subscales, measuring HCPs’ (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5–16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist’s role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist’s activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities. Conclusion The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists’ understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

Background: Differences in students’ epistemic beliefs and approaches to learning influence how they appreciate small-group active learning methods. As students develop and advance through their study program, it is likely that their epistemic beliefs and approaches to learning change. However, it is unclear how these changes influence their appreciation of small-group active learning, and what this means for teachers who want to motivate and engage students at various stages of their study program. In a previous paper, we published findings of first-year medical students. In the present study, we followed up on the original student sample as they entered their fourth year. Methods: We repeated the Q-methodological study procedure from the previous study to explore change in appreciation of small-group active learning. Participants rank-ordered 54 statements, answered open-ended questions about their rank-ordering, and completed a demographic questionnaire. We also invited participants to take part in a subsequent interview to reflect on changes in their beliefs about small-group active learning since their start of medical training. Results: Twenty students participated (38.5% of the original sample). We decided on a 2-profile solution. Profile 1 students were ‘success-oriented’, while profile 2 students were ‘development-oriented’. Students’ appreciation of small-group active learning remained fairly stable over time, although key aspects related to students’ epistemic beliefs and approaches to learning developed. Seven students took part in the subsequent interview and reported personal, group, tutor, and medical program reasons for changes in their appreciation of small-group active learning. Discussion: This study showed how and why medical students’ appreciation of small-group active learning changed over time along with development of their epistemic beliefs and approaches to learning. These findings contribute to the study of active learning in (medical) education because they highlight the development of students as they advance through their studies. What motivates and engages first-year students is not necessarily motivating and engaging for students in later stages. Our findings support the development of interventions that can help teachers to teach in active learning settings.

Background: Case-based Interprofessional Education (IPE) can help students practise their roles and responsibilities. To construct these cases, input from experts in clinical practice is essential. Consensus between these experts can be facilitated using consensus methods. In this study, a geriatric focus for the cases was chosen because of the interprofessional nature of geriatrics and the ageing population in healthcare facilities. Methods: By combining the 3 most commonly used consensus methods, we developed a 6-step approach to validate cases for IPE. The 6 steps include 3 expert rounds (Steps 1, 3 and 5) and 2 rounds in which discussion points were formulated by the researcher (Steps 2 and 4). The cases were piloted with students as Step 6. Four facets of a case were included: the patient description, the complemented treatment plan, the difficulty of the case and the scoring of the treatment plan. Our educational setting required constructing 4 cases with increasing difficulty. Results: Step 1: 5 typical geriatric cases were assembled. Step 2: Similar characteristics were defined; 5 cases were merged into 4. The 4 cases showed increasing difficulty levels. Step 3: The constructed cases were validated for patient description authenticity, treatment plan adequacy, difficulty and scoring of the treatment plan. Step 4: The items for further discussion were defined. Step 5: Consensus was reached for all 4 cases through a face-to-face discussion. Step 6: The student pilot for Case 1 showed no significant adjustments. Conclusion: We developed a 6-step consensus method to validate cases for IPE, and we constructed 4 geriatric cases based on this method. While consensus about the patient descriptions and difficulty levels was reached easily, consensus on the treatment plans was more difficult to achieve. Validation of the scoring of the treatment plan was unsuccessful. Further research on this will be conducted.

Background: Students' clinical reasoning can be stimulated by guiding them to use their experiences with patients to develop own illness scripts. Debriefing during hospital shifts invites students to put patient experiences into words, link them to previously acquired knowledge and make connections., Objectives: To develop, implement and evaluate a debriefing procedure for nursing internships based on illness script theory and generate corresponding design principles., Design: Qualitative design-based research., Setting: Clinical education in dedicated educational hospital units., Participants: Nurse educators, nursing students., Methods: From a collaboration between nurse educators and a researcher, a short, peer-debriefing procedure was designed, tested and enacted through four cycles of planning, action, evaluation and reflection. Students drew mind maps about patients. Nurse educators and students joined focus group discussions to evaluate outcomes and processes. Mind map and iterative thematic analysis were applied to these data., Results: An adjusted design and more extensive design principles resulted. Differences in mind maps were evident over time. Three themes in the process evaluation were established: trigger to reason; energy giving and taking; and form follows function., Conclusions: This design-based investigation displays how nurse educators could design and implement a debriefing procedure to facilitate students' clinical reasoning skills and how students could learn from this. This method integrates research, innovation and collaboration. The design and enactment under real-life hospital conditions generated design principles for educators and researchers which may be useful for those seeking to improve teaching and learning clinical reasoning in practice. More clarification is needed about the path from design through enactment to real change in practice., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: No conflict of interests.

Background: While multidisciplinary teams with clinical pharmacists improve medication use and outcomes, their integration in South Africa faces limitations. A lack of dedicated positions and healthcare professionals' misunderstanding restrict ward activities and hinder full collaboration, limiting their potential to optimize patient care. This study addresses a gap by exploring how perceived healthcare professionals' understanding of clinical pharmacists' roles impacts their motivation and service implementation. Understanding these dynamics, particularly in resource-constrained settings, is crucial for optimizing integration and healthcare delivery., Methods: Adopting a constructivist approach, this qualitative study was conducted using focus group discussions. Through purposive sampling clinical pharmacists were recruited across South Africa's public healthcare sector. A semi-structured guide based on previous findings explored how the perceived understanding around clinical pharmacy impacts service delivery and work motivation. Transcripts were analyzed using thematic analysis, guided by the Self-Determination Theory framework. Thematic analysis employed an inductive approach, following an initial preliminary analysis of open and selective coding to develop a coding framework., Results: Clinical pharmacists (n = 16) reported various challenges impacting service implementation and motivation. Two main themes were identified: (1) Time: Dedicated ward time is crucial for both the proper implementation of clinical services, as well as the clinical pharmacists' motivation; and (2) Trust: Clinical pharmacists experience a lack of trust amongst healthcare professionals in the value of clinical pharmacy services. The themes illustrated mechanisms at work at three levels: systemic (lack of dedicated positions), inter-relational (healthcare professional's misconceptions), and personal (thwarted autonomy)., Conclusions: Systemic challenges, like the absence of official positions present the biggest obstacle, affecting support, scope of practice, and healthcare professional interactions. While systemic changes are crucial for full integration of clinical pharmacists, in resource-constrained settings fostering autonomous motivation is equally important. This study emphasizes the need for a multi-faceted approach, including policy changes, international collaboration, interprofessional education, and interventions to empower clinical pharmacists for proactive service delivery. By addressing these interconnected challenges, healthcare systems can leverage the full potential of clinical pharmacists, ultimately improving healthcare delivery and patient outcomes., (© 2024. The Author(s).)

Background: The increasing geriatric population in India needs special attention from the oral health workforce. This study explores dental teachers' perceptions of the status of geriatric dentistry in the dental curriculum and the challenges of implementing geriatric dentistry curriculum in the present dental training sector in India from the trainers' (teachers) perspective., Methods: We utilised a qualitative approach, and four focus group discussions were conducted with/among various levels of academic teachers-Heads of Departments (n = 8), Board of Study members (n = 7), Deans (n = 5), Lecturers and Associate professors (n = 8). All discussions were audio-taped and transcribed. Data was analysed thematically, and coding was done using an inductive approach. Consensus on themes was achieved through deliberations., Results: Three themes were identified-Unique challenges in managing geriatric patients (bordering on Dental care, Attitude, Awareness, Social issues and dependency on family); Current issues with provision of geriatric care (Curricular concerns-Teachers' training, Students' training, Instructional content, timing of delivery; Students' and trainers' attitudes; Infrastructural issues) and Strategies for advancement (Sensitisation of policymakers, Collaboration with other agencies, Modification in course design, Improved educational strategies and Shift in patient care delivery)., Conclusion: Trainers perceived a strong need to develop geriatric competencies among dental students. A geriatric dentistry curriculum based on local needs could ensure the success and sustenance of change. Introducing specialisation in geriatric dentistry would ensure quality oral care for the rising geriatric population. Innovative teaching strategies, interdisciplinary training and the use of newer technologies could aid in improved teaching of geriatric dentistry., (© 2024 Gerodontology Association and John Wiley & Sons Ltd.)

Higher education institutions increasingly aim to implement equity in admissions. However, there is no one-size-fits-all solution to determine which equitable admissions procedures are suitable in a specific context, nor which groups should be its beneficiaries. Therefore, we applied the Formal Consensus Method (FCM) to investigate the support amongst experts and stakeholders for different equitable admissions policies and target groups within the context of Health Professions Education in The Netherlands. We found majority support (median of ratings ≥ 7 on a scale of 1 to 9) in both groups for the target groups 'applicants with a low or average socio-economic status' and 'applicants with an underrepresented migration background'. The majority of participants was also in favor of Contextualized Admissions, especially when used to increase enrolment of applicants with a low or average socio-economic status, with an underrepresented migration background, and asylum status holders. Lastly, both groups supported lottery with extra tickets for applicants with an underrepresented migration background. However, as the range of ratings fell outside the FCM prescribed range of 5-9, no case in which there was majority support could be defined as a 'consensus'. The expert group proposed the use of Bonded Medical Places for applicants from the Caribbean parts of the Dutch Kingdom. The policies and target groups for which broad support was found, could contribute to equitable admissions, improved student diversity, and enhanced quality of health education and future care. Our application of the FCM in the area of equitable admissions policies may be useful for researchers in other countries where equity principles are not (widely) used in admissions decisions., (© 2024. The Author(s).)

Background: Health professions learners are taught by full-time university faculty and by clinicians who teach alongside their clinical practice. This distributed healthcare education model ensures high-quality education but is at risk due to high learner demand, shortage of educators, and economic pressures. Understanding what factors influence clinical educators' motivation to teach may contribute to the model's sustainability and educator retention. The present review therefore aimed to systematically search and synthesise factors influencing clinical educators' motivation to teach., Methods: Multiple databases, relevant journals, and the grey literature were searched for studies reporting on clinical educators' motivation to teach. Data were analysed using a framework synthesis method, based on self-determination theory's amotivation (e.g. disinterest or unachievable challenges), controlled (e.g. interest in rewards or pressure avoidance), and autonomous (e.g. personal importance and interest) concepts, and nested within a motivation from 'above' (i.e. interactions with stakeholders and societal expectations), 'within' (i.e. personal beliefs and personality dispositions), and 'below' (i.e. perception on learners' motivation and engagement) framework., Results: Twenty-nine studies were included, published between 1998 and 2022, which reported on educators from diverse disciplines and settings. Educators reported autonomous over controlled motivation to teach, favouring enjoyment, connectedness, professional development, feeling valued for their teaching efforts, and altruistic reasons to teach, over being motivated by incentives and rewards. These results are presented in relation to their origin, as factors influencing motivation 'above', 'within', and 'below'., Conclusions: Results from this study have important implications for the development of contextual strategies to optimise learning/work environments and maximise autonomous reasons to teach, enhancing clinical educators' job satisfaction and retention.

Background: With a growing population of older people in all Western countries, interprofessional education (IPE) can help to prepare students for the complex care for these patients. Which aspects of this complex care could benefit from IPE? In this study we evaluated the differences in content of health care plans made by students who participated in IPE., Methods: Undergraduate nursing and medical students were included and attended four sessions in which they wrote a health care plan for a paper-based geriatric patient case. Approximately half of the students were included in the IPE-group. To evaluate the content of interprofessional collaboration between the students, the other half of the students were included in a 'uniprofessional education' (UPE) group. UPE-students made the health care plan alone. In the IPE-group a medical and a nursing students compiled the health care plan together. All health care plans were assessed by comparing them with a validated health care plan. We zoomed into the differences in the content of the health care plans, and calculated a score ratio, proportion of correct items., Results: The health care plans made by IPE-students had an average score ratio of 0.31. The health care plans made by UPE-students had an average score ratio of 0.22. Most differences were found in the subcategories medication, nursing actions and aftercare. Specific items within these categories were more frequently thought of in the IPE-group than in the UPE-group, for example delirium interventions and consultation with a transfer nurse., Conclusion: This study gives insights into which health care actions are more often considered by interprofessional couples in IPE than by students in UPE. Awareness of these items in clinical practice could make a difference in the care for older patients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

WHAT IS INCLUSION AND INCLUSIVE LEADERSHIP?: In this article, based on the literature and my own experiences, I try to shed light on the concepts of inclusion and inclusive leadership, as well as what leaders need to do in order to be inclusive. Inclusion means the act of including or being included in a group, which creates a sense of belonging as well as empowers individuals to contribute in an authentic and meaningful manner. Inclusive leadership is important in the health professions and health professions education so that health professionals and faculty in health professions education are able to contribute to their work in ways that they find meaningful. WHAT DO LEADERS NEED TO DO TO BE INCLUSIVE?: To be inclusive leaders need to to do the following: truly believe in inclusion, define the boundaries of acceptable behaviours, make difficult diversity conversations possible, build authentic diverse relationships, develop shared leadership, drive and role model inclusive practices in the organisation, and find the right balance between individual and institutional EDI initiatives. Driving inclusion in a health professions (education) organisation demands changes in the concept of leadership, as well as the organisational policy and culture., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Interprofessional education is one of the interventions used to increase health care students' motivation for working with older patients. Previous research about such interventions has been conducted without the use of control groups and has given inconclusive results. The objective of the present curricular resource was: Does geriatric paper-based interprofessional education influence students' interest in treating older people? During a one-year period, undergraduate fourth-year medical and third-year nursing students wrote four health care plans for four different paper-based older patient cases. In the intervention group students were paired up in interprofessional couples. In the control group students made the assignment alone. Interest for working with older patients was measured on a 5-point Likert scale before and one year after the intervention. In both groups, no significant change was found. Before-interest score of the interprofessional group was relatively high (3.8) so the non-significant results may be due to a ceiling effect. Nursing students' interest in treating older people at the start of the research was higher than medical students' interest., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Teuwen CJ et al.)

Purpose: Autonomous motivation is important for university students, but it remains a challenge to stimulate their autonomous motivation for their curricula. We developed an extracurricular intervention (Societal Impact Project) with basic psychological needs supportive characteristics such as learning with self-defined problems relevant to curriculum and society, collaborative group work, and coaching by a teacher. This study aims at evaluating the intervention in fostering students' autonomous motivation for their regular curricula., Methods: We conducted a quasi-experimental study, using between-group pre- and post-test design. Participants from the intervention and control group completed a survey before and after the intervention, which measured the satisfaction of three basic psychological needs, autonomous motivation, controlled motivation, enjoyment, value, and well-being within their regular curricula. We compared the post-test differences between the two groups while controlling for pre-test scores., Results: Students in the intervention group had greater enjoyment in their regular curricula and perceived their regular curricula to have more value compared to students in the control group. The other variables did not differ significantly between the two groups in the post-test., Conclusion: The intervention is effective for improving students' enjoyment and perceived value in their regular curricula. The variables with non-significant differences indicate the difficulty to alter students' basic psychological needs and motivation in their regular curricula, even after participating in a long-term intervention.

To design effective instruction, educators need to know what design strategies are generally effective and why these strategies work, based on the mechanisms through which they operate. Experimental comparison studies, which compare one instructional design against another, can generate much needed evidence in support of effective design strategies. However, experimental comparison studies are often not equipped to generate evidence regarding the mechanisms through which strategies operate. Therefore, simply conducting experimental comparison studies may not provide educators with all the information they need to design more effective instruction. To generate evidence for the what and the why of design strategies, we advocate for researchers to conduct experimental comparison studies that include mediation or moderation analyses, which can illuminate the mechanisms through which design strategies operate. The purpose of this article is to provide a conceptual overview of mediation and moderation analyses for researchers who conduct experimental comparison studies in instructional design. While these statistical techniques add complexity to study design and analysis, they hold great promise for providing educators with more powerful information upon which to base their instructional design decisions. Using two real-world examples from our own work, we describe the structure of mediation and moderation analyses, emphasizing the need to control for confounding even in the context of experimental studies. We also discuss the importance of using learning theories to help identify mediating or moderating variables to test., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development expand, we argue that the traditional dyadic format of mentoring alone will not help mentees to maximise their professional growth. Newer formats of mentoring are discussed in detail and their advantages and disadvantages compared. We use a variety of theoretical concepts to anchor the practice of mentorship: self-focussed and other-focussed motives; psychological safety; personal interpretive framework; Daloz model for balancing support and challenge; zone of proximal development; communities of practice; and development along multiple layers of competence. Recommended strategies for effective mentoring are based on extensive review of literature, as well as combined professional mentoring experiences of the authors. We use key principles from the theories described and phases of mentoring relationships as foundations for the suggested best practices of mentorship. Finally, we emphasise the role of mentees in their own professional development and provide tips for them on seeking mentors, expanding their mentoring network and taking the lead in setting the agenda during mentoring meetings and formulating action plans for their own advancement.

Introduction: In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education., Methods: Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT., Results: Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules., Discussion: School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Medical Teacher is a leading international journal in health professions education. The Journal recognizes its responsibility to publish papers that reflect the breadth of topics that meet the needs of its readers around the globe including contributions from countries underrepresented in the health professions education arena. This paper sets out the Journal's policy with regard to Equity Diversity Inclusion (EDI) and the steps to be taken to implement the policy in practice.

Introduction: Engaging students in small-group active learning methods is essential for their development. Yet, medical teachers frequently face difficulties in stimulating this engagement, resulting in students remaining passive or detached from the learning process. The aim of this study was to uncover ways in which expert medical teachers, proficient at cultivating high levels of student engagement, stimulate such engagement. This knowledge might inform faculty development initiatives, so that medical teachers can be better equipped to teach in a way that engages students., Methods: We conducted an interview study using a constructivist grounded theory approach, integrating elements from appreciative inquiry. The eleven participants were qualified medical teachers who repeatedly received high scores on student engagement. Each interview was transcribed, coded, and analyzed using constant comparison until theoretical saturation was achieved., Results: We constructed a grounded theory of expert teaching practice, describing student engagement as an integrated process consisting of three components: 1) aiming for a supportive learning environment; 2) employing a personal educational approach; and 3) facilitating the active learning process., Discussion: This study uncovered that there are multiple ways to stimulate high levels of student engagement. Although there was consensus on the importance of a supportive learning environment and the ability to facilitate the active learning process, participants recognized the contextual nature of student engagement and took on a reflective mindset to adapt strategies to their specific situations. These findings highlight the need for faculty development initiatives to adopt a comprehensive, context-sensitive approach that considers the complexity of student engagement., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: The increasingly complex patient care in the twenty-first century is delivered by interprofessional health care teams. Interprofessional collaboration can be taught during interprofessional education. However, whether a long-term change in collaborative competencies can be achieved by interprofessional education has not been studied sufficiently. Our research questions were: How does motivation for interprofessional collaboration and interprofessional collaborative skills change up to one year after an interprofessional educational intervention? How are they related to each other?, Methods: During a one-year period, undergraduate medical and nursing students attended four interprofessional (intervention) or uniprofessional (control group) education sessions. Self-determination Theory was used as the theoretical framework. Autonomous and controlled motivation scores for interprofessional collaboration were calculated using the Academic Self-Regulation Questionnaire, before (T1), directly after (T2) and one year post-intervention (T3). At T3, the students also filled out the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), which measured the perceived attainment of collaborative competencies by a retrospective pre-test/post-test design. We used linear mixed effects models to analyse the motivation scores and linear regression for the relation between motivation and competence., Results: In the interprofessional group, autonomous motivation scores of the participants were significantly lower at T2 vs. T1. Controlled motivation scores were significantly higher at T3 vs. T1. Controlled motivation scores for T2 were significantly higher in the uniprofessional group than in the interprofessional group. Perceived competence was related to higher autonomous motivation scores. At T3 the interprofessional collaborative competencies seemed to have grown more among students in the interprofessional group., Conclusions: The perceived growth in interprofessional collaboration competence lasted at least up to one year after the intervention, and was measurable with the ICCAS. The growth was significantly more in the IPE students than in the UPE students. The few differences found in motivation scores for interprofessional collaboration were probably caused by an imbalance of nursing versus medical students over the different time points. This finding indicates that classroom based IPE can contribute to interprofessional collaboration skills of nursing and medical students at least up to one year after an intervention., (© 2024. The Author(s).)

Dedicated Interprofessional Training Units (ITUs) in hospital wards are one way to prepare healthcare students for Interprofessional patient-centered care. Based on theoretical foundations, research, and our lived experiences of successes as well as failures, we propose 12 tips on how to prepare, implement, and sustain a dedicated ITU, combining the Grol & Wensing model for planning change with the Self-determination Theory of motivation. Start with a steering group, with a dedicated project leader, to translate awareness of the need for an ITU into wider awareness and motivation among stakeholders, with the ITU being a solution to authentic problems. Create shared ownership by jointly formulating feasible educational goals and starting with a pilot to provide opportunities for change. Motivate all stakeholders by stimulating their autonomy, interprofessional competence as well as relatedness to each other, in line with the Self-determination Theory. Confirm the value of the ITU at all stages and embed the ITU in the organizational strategy.

Background: Although the number of older patients requiring medical care is increasing, caring for older patients is often seen as unattractive by medical trainees (i.e., medical students, residents, interns, and fellows). Terror Management Theory states that people have a negative attitude towards older people, because they remind people of their own mortality. We hypothesize that ageism, death anxiety, and ageing anxiety among medical trainees negatively affect their attitude towards medical care for older patients. This review aimed to examine and generate an overview of available literature on the relationship between ageism, death anxiety, and ageing anxiety among medical trainees and their attitude towards medical care for older patients., Methods: A systematic review was performed with a review protocol based on the PRISMA Statement. PubMed, Ebsco/PsycInfo, Ebsco/ERIC and Embase were searched from inception to August 2022, using the following search terms, including their synonyms and closely related words: "medical trainees" AND "ageism" OR "death anxiety" OR "ageing anxiety" AND "(attitude AND older patient)"., Results: The search yielded 4072 different studies; 12 eligible studies (10 quantitative and 2 qualitative) were identified and synthesized using narrative synthesis. Findings suggest that a positive attitude towards older people was related to a positive attitude towards medical care for older patients among medical students. The available literature on the relationship between death anxiety and/or ageing anxiety and attitude towards medical care for older patients among medical trainees was limited and had a heterogeneity in focus, which hindered comparison of results., Conclusion: Our findings suggest that a positive attitude towards older people in general is related to a positive attitude towards medical care for older patients among medical students. Future research should focus on further exploring underlying mechanisms affecting the attitude towards medical care for older patients among medical trainees., (© 2024. The Author(s).)

Competing Interests: No conflict of interests.

Purpose: Self-regulated learning (SRL) can enhance students' learning process. Students need support to effectively regulate their learning. However, the effect of learning climate on SRL behavior, its ultimate effect on learning and the underlying mechanisms have not yet been established. We explored these relationships using self-determination theory., Materials and Methods: Nursing students ( N  = 244) filled in questionnaires about SRL behavior, perceived learning, perceived pedagogical atmosphere and Basic Psychological Needs (BPN) satisfaction after their clinical placement. Structural equation modelling was used to test a model in which perceived pedagogical atmosphere affects SRL behavior and subsequent perceived learning through BPN satisfaction., Results: The tested model had an adequate fit (RMSEA = 0.080, SRMR = 0.051; CFI = 0.972; TLI = 0.950). A positively perceived pedagogical atmosphere contributed to SRL behavior, which was fully explained by BPN satisfaction. SRL partially mediated the contribution of pedagogical atmosphere/BPN to perceived learning., Conclusions: A learning climate that satisfies students' BPN contributes to their SRL behavior. SRL behavior plays a positive but modest role in the relationship between climate and perceived learning. Without a culture that is supportive of learning, implementation of tools to apply SRL behavior may not be effective. Study limitations include reliance on self-report scales and the inclusion of a single discipline.

Introduction: Educators need design strategies to support medical students' motivation in online environments. Prompting students to frame a learning activity as preparing them to attain their life goals (e.g., helping others) via their clinical practice, a strategy called 'life goal framing', may enhance their autonomous motivation, learning strategy use, and knowledge retention. However, for students with low perceived competence for learning (PCL), life goal framing may have an adverse effect. A randomized controlled trial was conducted to test the effectiveness of life goal framing and the moderating effect of students' PCL., Methods: First- and second-year medical students across four Canadian universities ( n = 128) were randomized to receive a version of an online module with an embedded prompt for life goal framing, or one without. Students' motivation, learning strategy use, and knowledge retention were assessed. Differences between conditions on each outcome were estimated using Bayesian regression., Results: Students' PCL was a moderator for autonomous motivation but no other outcomes. The prompt did not have a statistically significant effect on any outcome, even for learners with high PCL, except for a small effect on link-clicking behaviour., Discussion: The results of this study suggest that learners' autonomous motivation is influenced by how they make meaning of instruction in terms of their future life goals and their present confidence. We cannot recommend life goal framing as an effective design strategy at this point, but we point to future work to increase the benefit of life goal framing for learners with high confidence., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Selection for higher education (HE) programs may hinder equal opportunities for applicants and thereby reduce student diversity and representativeness. However, variables which could play a role in inequality of opportunity are often studied separately from each other. Therefore, this retrospective cohort study conducts an innovative intersectional analysis of the inequality of opportunity in admissions to selective HE programs. Using a combination of multivariable logistic regression analyses and descriptive statistics, we aimed to investigate 1) the representativeness of student populations of selective HE programs, as compared to both the applicant pool and the demographics of the age cohort; 2) the demographic background variables which are associated with an applicant's odds of admission; and 3) the intersectional acceptance rates of applicants with all, some or none of the background characteristics positively associated with odds of admission. The study focused on all selective HE programs (n = 96) in The Netherlands in 2019 and 2020, using Studielink applicant data (N = 85,839) and Statistics Netherlands microdata of ten background characteristics. The results show that student diversity in selective HE programs is limited, partly due to the widespread inequality of opportunity in the selection procedures, and partly due to self-selection. Out of all ten variables, migration background was most often (negatively) associated with the odds of receiving an offer of admission. The intersectional analyses provide detailed insight into how (dis)advantage has different effects for different groups. We therefore recommend the implementation of equitable admissions procedures which take intersectionality into account., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mulder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce., Methods: We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory., Findings: Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist., Interpretation: In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce., Funding: ODISSEI., Competing Interests: The authors declare that they have no competing interests., (© 2023 The Author(s).)

Objective: During autonomy-supportive consultations, professionals use a need-supportive interaction style to facilitate patients' self-regulated behaviour. To improve maternity care professionals' need-supportive interactions, it is important to provide insights into their interaction style. No tool is currently available for measuring need-supportive interactions in maternity care. Therefore, the aim of this study was to adapt the COUNSEL-CCE to evaluate need-supportive interactions in maternity care and to validate their measurements., Methods: A five-step adaptation and validation process was performed based on the guideline of Sousa and Rojjanasrirat: 1) adaptation of COUNSEL-CCE by two authors independently; 2) development of a consensus-based tool: CONSUL-MCC; 3) qualitative assessment of CONSUL-MCC; 4) pilot testing of CONSUL-MCC in the target population ( N  = 10) and 5) psychometric testing in the target population ( N  = 453)., Results: All indicators of the original tool remained relevant. Four items were rephrased, one indicator was added, and all examples were adapted to maternity care. The results of psychometric testing indicated good construct validity. However, the data characteristics made it impossible to prove the presumed factor structure and perform an accurate intraclass correlation., Conclusions and Innovation: COUNSEL-CCE proved to be a new instrument to gain insights into professionals' interactions and be applied to maternity care., Competing Interests: None declared., (© 2023 The Authors.)

Purpose: In health professions education (HPE), the effect of assessments on student motivation for learning and its consequences have been largely neglected. This is problematic because assessments can hamper motivation and psychological well-being. The research questions guiding this review were: How do assessments affect student motivation for learning in HPE? What outcomes does this lead to in which contexts?, Method: In October 2020, the authors searched PubMed, Embase, APA PsycInfo, ERIC, CINAHL, and Web of Science Core Collection for "assessments" AND "motivation" AND "health professions education/students." Empirical papers or literature reviews investigating the effect of assessments on student motivation for learning in HPE using quantitative, qualitative, or mixed methods from January 1, 2010, to October 29, 2020, were included. The authors chose the realist synthesis method for data analysis to study the intended and unintended consequences of this complex topic. Assessments were identified as stimulating autonomous or controlled motivation using sensitizing concepts from self-determination theory and data on context-mechanism-outcome were extracted., Results: Twenty-four of 15,291 articles were ultimately included. Assessments stimulating controlled motivation seemed to have negative outcomes. An example of an assessment that stimulates controlled motivation is one that focuses on factual knowledge (context), which encourages studying only for the assessment (mechanism) and results in surface learning (outcome). Assessments stimulating autonomous motivation seemed to have positive outcomes. An example of an assessment that stimulates autonomous motivation is one that is fun (context), which through active learning (mechanism) leads to higher effort and better connection with the material (outcome)., Conclusions: These findings indicate that students strategically learned what was expected to appear in assessments at the expense of what was needed in practice. Therefore, health professions educators should rethink their assessment philosophy and practices and introduce assessments that are relevant to professional practice and stimulate genuine interest in the content., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Background: Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors., Methods: An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital., Results: The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities., Conclusion: The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession., (© 2023. The Author(s).)

When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Vreugdenhil, Somra, Ket, Custers, Reinders, Dobber and Kusurkar.)

The combination of measuring performance and giving feedback creates tension between formative and summative purposes of progress evaluations and can be challenging for supervisors. There are conflicting perspectives and evidence on the effects supervisor-trainee relationships have on assessing performance. The aim of this study was to learn how progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships. Progress evaluations in a two-year community-pharmacy specialization program were studied with a mixed-method approach. An adapted version of the Canadian Medical Education Directives for Specialists (CanMEDS) framework was used. Validity of the performance evaluation scores of 342 trainees was analyzed using repeated measures ANOVA. Semi-structured interviews were held with fifteen supervisors to investigate their response processes, the utility of the progress evaluations, and the influence of supervisor-trainee relationships. Time and CanMEDS roles affected the three-monthly progress evaluation scores. Interviews revealed that supervisors varied in their response processes. They were more committed to stimulating development than to scoring actual performance. Progress evaluations were utilized to discuss and give feedback on trainee development and to add structure to the learning process. A positive supervisor-trainee relationship was seen as the foundation for feedback and supervisors preferred the roles of educator, mentor, and coach over the role of assessor. We found that progress evaluations are a good method for directing feedback in longitudinal supervisor-trainee relationships. The reliability of scoring performance was low. We recommend progress evaluations to be independent of formal assessments in order to minimize roles-conflicts of supervisors., (© 2022. The Author(s).)

Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students' learning processes. Little is known about how HPE students can make these "boundary experiences" productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students' understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects., (© 2022. The Author(s).)

Objectives: The aim of this study was to identify mechanisms of autonomy-supportive consultation (ASC) that maternity care professionals use during decision-making in prenatal consultations., Design: This study was a descriptive, qualitative analysis of professional-patient interactions in maternity care, using concepts and analytic procedures of conversation analysis., Setting: The prenatal consultations took place in hospitals and midwifery practices in the Netherlands. This study was part of a larger project. For the current study, we selected prenatal consultations concerning three topics in which patients make their own choices., Participants: The first author invited the patient who was waiting in the waiting room. Participants were not selected a priori., Main Outcome Measures: The main outcome measures were mechanisms of ASC., Results: We selected 20 consultations which were conducted by 20 different professionals. We found eight mechanisms in the professional-patient interaction which were categorised into three overarching themes. The first theme, 'Lightheartedness', comprises the interactional mechanisms 'minimising language' and 'humour'. The theme 'Orientation to agreement' describes how professionals and patients seem to be oriented towards demonstrating agreement and mutual understanding. The last theme, 'Offering information and options', describes the professional formally giving factual information almost completely without verbal interaction between the professional and the patient., Conclusion: The results of this study show that the model of ASC can be enriched by adding minimising language and humour to the mechanisms that can be used to fulfil the psychological need 'relatedness'. Second, our results show that professionals use only few mechanisms to meet the patients' psychological needs 'competence' and 'autonomy'. They mainly use information giving to meet patients' need competence. To meet patients' need for autonomy, the professionals keep all options open. This suggests that professionals could pay more attention to other mechanisms to meet patients' needs for 'competence' and 'autonomy'., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Web-based instruction plays an essential role in health professions education (HPE) by facilitating learners' interactions with educational content, teachers, peers, and patients when they would not be feasible in person. Within the unsupervised settings where web-based instruction is often delivered, learners must effectively self-regulate their learning to be successful. Effective self-regulation places heavy demands on learners' motivation, so effective web-based instruction must be designed to instigate and maintain learners' motivation to learn. Models of motivational design integrate theories of motivation with design strategies intended to create the conditions for motivated engagement. Teachers can use such models to develop their procedural and conceptual knowledge in ways that help them design motivating instruction in messy real-world contexts. Studies such as randomized controlled trials (RCTs) and other quasi-experimental designs that compare different motivational design strategies play a critical role in advancing models of motivational design. Synthesizing the evidence from those studies can identify effective strategies and help teachers and researchers understand the mechanisms governing why strategies work, for whom, and under what circumstances., Objective: The planned review aims to analyze how studies comparing motivational design strategies for web-based instruction in HPE support and advance models of motivational design by (1) controlling for established risks to internal validity, (2) leveraging authentic educational contexts to afford ecological validity, (3) drawing on established theories of motivation, (4) investigating a wide breadth of motivational constructs, and (5) analyzing mediators and moderators of strategy effects., Methods: The planned review will use database searching, registry searching, and hand searching to identify studies comparing motivational design strategies for web-based instruction, delivered to learners in HPE. Studies will be considered from 1990 onward. Two team members will independently screen studies and extract data from the included studies. During extraction, we will record information on the design characteristics of the studies, the theories of motivation they are informed by, the motivational constructs they target, and the mediators and moderators they consider., Results: We have executed our database and registry searches and have begun screening titles and abstracts., Conclusions: By appraising the characteristics of studies that have focused on the motivational design of web-based instruction in HPE, the planned review will produce recommendations that will ensure impactful programs of future research in this crucial educational space., Trial Registration: PROSPERO CRD42022359521; https://tinyurl.com/57chuzf6., International Registered Report Identifier (irrid): DERR1-10.2196/42681., (©Adam Gavarkovs, Rashmi A Kusurkar, Kulamakan Kulasegaram, Jeff Crukley, Erin Miller, Melanie Anderson, Ryan Brydges. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 09.11.2022.)

Objectives: Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply., Methods: A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach., Results: Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential., Conclusions: The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.

Introduction: Despite abundant research emphasising the value of mentoring for healthcare professionals, little is known about what motivates mentors. This study aimed to explore what motivated a group of internationally renowned health professions educators to accept informal, international and mostly online mentoring roles, and their approaches to that mentoring., Methods: Using a qualitative approach, we interviewed ten global educational leaders, who volunteered to serve as mentors in an initiative implemented by the Association for Medical Education in Europe in 2019, via Zoom. The hour-long interviews, conducted between May and October 2019, were audiotaped and transcribed on Zoom. De-identified transcripts were analysed for key themes., Results: The key themes identified could be mapped to three categories, Motivations - Why; Approaches - How, and Global and virtual mentoring - What. Themes under motivations included: (1) Nurturing relationships focussed on mentees' growth; (2) Pass on the benefit of one's experience; (3) For one's own continued growth . Themes under approaches included: (1) Provide a safe space; (2) Encourage mentees to take ownership of their professional development. Themes under global and virtual mentoring included: (1) Mentoring across geographical borders is still about relationships; (2) Virtual mentoring is not a barrier to relationship building., Discussion: Though mentors also saw own growth and ongoing professional development as an important benefit of mentoring, altruism or the desire to benefit others, appeared to be a key motivating factor for them. Finding ways in which to identify mentors who are passionate about strengthening the field in this way - for example through reflective narratives and critical conversations - could be key when implementing mentoring initiatives.

Background: Concerns exist about the role of selection in the lack of diversity in health professions education (HPE). In The Netherlands, the gradual transition from weighted lottery to selection allowed for investigating the variables associated with HPE admission, and whether the representativeness of HPE students has changed., Method: We designed a retrospective multi-cohort study using Statistics Netherlands microdata of all 16-year-olds on 1 October 2008, 2012, and 2015 ( age cohorts , N  > 600,000) and investigated whether they were eligible students for HPE programs ( n  > 62,000), had applied ( n  > 14,000), and were HPE students at age 19 ( n  > 7500). We used multivariable logistic regression to investigate which background variables were associated with becoming an HPE student., Results: HPE students with ≥1 healthcare professional (HP) parent, ≥1 top-10% income/wealth parent, and women are overrepresented compared to all age cohorts. During hybrid lottery/selection (cohort-2008), applicants with ≥1 top-10% wealth parent and women had higher odds of admission. During 100% selection (cohort-2015) this remained the case. Additionally, applicants with ≥1 HP parent had higher odds, those with a migration background had lower odds., Conclusions: Odds of admission are increasingly influenced by applicants' backgrounds. Targeted recruitment and equitable admissions procedures are required to increase matriculation of underrepresented students.

Introduction: Workplace-based assessment of competencies is complex. In this study, the validity of summative performance evaluations (SPEs) made by supervisors in a two-year longitudinal supervisor-trainee relationship was investigated in a postgraduate community pharmacy specialization program in the Netherlands. The construct of competence was based on an adapted version of the 2005 Canadian Medical Education Directive for Specialists (CanMEDS) framework., Methods: The study had a case study design. Both quantitative and qualitative data were collected. The year 1 and year 2 SPE scores of 342 trainees were analyzed using confirmatory factor analysis and generalizability theory. Semi-structured interviews were held with 15 supervisors and the program director to analyze the inferences they made and the impact of SPE scores on the decision-making process., Results: A good model fit was found for the adapted CanMEDS based seven-factor construct. The reliability/precision of the SPE measurements could not be completely isolated, as every trainee was trained in one pharmacy and evaluated by one supervisor. Qualitative analysis revealed that supervisors varied in their standards for scoring competencies. Some supervisors were reluctant to fail trainees. The competency scores had little impact on the high-stakes decision made by the program director., Conclusions: The adapted CanMEDS competency framework provided a valid structure to measure competence. The reliability/precision of SPE measurements could not be established and the SPE measurements provided limited input for the decision-making process. Indications of a shadow assessment system in the pharmacies need further investigation., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Rising mental health issues is a global problem among PhD students. This study aimed to identify stressors and energizers in PhD work., Methods: PhD students at a university medical center were asked to describe the top three stressors and energizers in their PhD work through a survey. The narrative answers were subjected to content analysis., Results: Three hundred and eighty-six PhD students participated. We identified five overarching themes: Research is challenging, Resources can be limited, Recognizing the value of work, Experience of autonomy, and Relationships are key to success. We found positive (energizers) as well as negative (stressors) comments for each theme., Discussion: Supportive supervision with open communication has been identified in the literature as the most important contributor to PhD student well-being, while work-life imbalance has been identified as the most important reason for psychological distress. With our study, we add energizers and stressors that fit into a theoretical framework (Self-determination theory). This helps to understand the problem better and provide specific recommendations., Conclusions: Optimal challenges, resources and supervision, autonomy and good relationships at work are perceived as energizers. Challenges in research beyond capability, limitations in resources, not being valued, autonomy restriction and poor relationships at work are perceived as stressors in PhD work.

Background: Active learning relies on students' engagement with teachers, study materials and/or each other. Although medical education has adopted active learning as a core component of medical training, teachers have difficulties recognising when and why their students engage or disengage and how to teach in ways that optimise engagement. With a better understanding of the dynamics of student engagement in small-group active learning settings, teachers could be facilitated in effectively engaging their students., Methods: We conducted a video-stimulated recall study to explore medical students' engagement during small-group learning activities. We recorded one teaching session of two different groups and selected critical moments of apparent (dis)engagement. These moments served as prompts for the 15 individual semi-structured interviews we held. Interview data were analysed using Template Analysis style of thematic analysis. To guide the analysis, we used a framework that describes student engagement as a dynamic and multidimensional concept, consisting of behavioural, cognitive and emotional components., Results: The analysis uncovered three main findings: (1) In-class student engagement followed a spiral-like pattern. Once students were engaged or disengaged on one dimension, other dimensions were likely to follow suit. (2) Students' willingness to engage in class was decided before class, depending on their perception of a number of personal, social and educational antecedents of engagement. (3) Distinguishing engagement from disengagement appeared to be difficult for teachers, because the intention behind student behaviour was not always identifiable., Discussion: This study adds to the literature by illuminating the dynamic process of student engagement and explaining the difficulty of recognising and influencing this process in practice. Based on the importance of discerning the intentions behind student behaviour, we advise teachers to use their observations of student (dis)engagement to initiate interaction with students with open and inviting prompts. This can help teachers to (re-)engage students in their classrooms., (© 2021 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Introduction: Pharmacy practice in many middle to low-income countries has slowly transitioned from being product-focused to a more patient-focused clinical practice. Lack of motivation is one of the factors contributing to the scarcity of pharmacists in the wards. As little is known about motivation in clinical pharmacists, this study aimed to obtain insight into the quantity and quality of their work motivation and factors associated with it. Methods: Self-determination Theory, used as the framework, describes autonomous motivation as being generated from within or through personal endorsement and controlled motivation as originating from external factors. An online questionnaire including the Academic Motivation Scale to measure autonomous motivation, controlled motivation and amotivation, was sent to clinical pharmacy graduates from 2000 to 2020 across South Africa, followed by interviews to explain some results. Independent t -test was used to analyze differences in motivation of clinical pharmacists to perform clinical services based on personal and environmental factors. Interview data were transcribed and analyzed to explain significant quantitative findings. Results: Higher amotivation was found in graduates who are currently not practicing in dedicated clinical pharmacist positions, as well as in graduates who do not receive additional financial benefits for clinical services. We found no significant differences in the work motivation of clinical pharmacists based on their gender, age, current practice setting, work experience and additional training received. The interviews revealed that relatedness and autonomy are the most important factors for clinical pharmacists' work motivation. Discussion: Overall participants had a high mean autonomous motivation, a high mean controlled motivation and low mean amotivation. In line with Self-determination Theory literature, considering the basic psychological needs for relatedness and autonomy could assist with designing interventions, like creating a supportive work environment, to optimize motivation. This could improve professional wellbeing, service implementation and prevent possible adverse events. Future research is necessary to understand barriers and facilitators of clinical pharmacists' work motivation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Crafford, Wouters, Bronkhorst, Gous and Kusurkar.)

Background: To prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education., Methods: Twenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach., Results: Four conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning., Conclusions: Those directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one's own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development., (© 2021. The Author(s).)

Introduction: Adequate representation of ethnic minority groups in the medical workforce is crucial for ensuring equitable healthcare to diverse patient groups. This requires recruiting ethnic minority medical students and taking measures that enable them to complete their medical studies successfully. Grounded in self-determination theory and intersectionality, this paper explores the experiences of ethnic minority medical students across intersections with gender and other categories of difference and how these relate to students' motivation., Methods: An explorative, qualitative study was designed. Six focus groups were conducted with 26 ethnic minority students between December 2016 and May 2017. Thematic analysis was performed to identify, analyse and report themes within the data., Results: The findings were categorized into three main themes: the role of autonomy in the formation of motivation, including students' own study choice and the role of their family; interactions/'othering' in the learning environment, including feelings of not belonging; and intersection of ethnic minority background and gender with being 'the other', based on ethnicity., Discussion: Ethnic minority students generally do not have a prior medical network and need role models to whom they can relate. Ensuring or even appointing more ethnic minority role models throughout the medical educational continuum-for example, specialists from ethnic minorities in teaching and/or mentoring roles in the education-and making them more visible to students is recommended. Moreover, a culture needs to be created in the educational environment in which students and staff can discuss their ethnicity-related differences., (© 2021. The Author(s).)