医学教育致力于成为医疗保健专业教育领域的杰出期刊，并出版最高质量的材料，反映世界范围内或具有挑衅性的问题和观点。该杂志欢迎有关健康专业教育各个方面的高质量论文包括;-本科教育-研究生培训-继续专业发展-跨专业教育

Medical Education aims to be a leading journal in the field of healthcare professional education, publishing high-quality materials that reflect challenging issues and perspectives from around the world. The journal welcomes high-quality papers on all aspects of health professional education, including undergraduate education, graduate training, continuing professional development, and interprofessional education.

《Medical Education》致力于成为医疗保健专业教育领域的杰出期刊，出版高质量的材料，反映全球范围内或具有挑战性的问题和观点。该杂志欢迎关于健康专业教育各个方面的高质量论文，包括：本科教育、研究生培训、继续专业发展和跨专业教育。

Medical Education

The increasingly popular term 'problem-based learning' does not refer to a specific educational method. It can have many different meanings depending on the design of the educational method employed and the skills of the teacher. The many variables possible can produce wide variations in quality and in the educational objectives that can be achieved. A taxonomy is proposed to facilitate an awareness of these differences and to help teachers choose a problem-based learning method most appropriate for their students.

H. S. BARROWS

A taxonomy of problem-based learning methods

Context The human and financial costs of academic failure amongst medical students are extremely high. Often, remedial support is infrequently available or is available only for students failing their final examinations. We describe the design, implementation and preliminary evaluation of a remedial programme (RP) for students who experience academic difficulties. Methods A total of 24 students were identified from Years 4 and 5 of the undergraduate medical course at our medical school. Students invited to participate were identified following failure in summative and/or continuous assessment processes. Students underwent an individual educational diagnosis by means of free discussion and a semi-structured interview. Each negotiated a problem list, action plan and learning contract with course tutors. Of the 24 students, 16 received academic support and tutorials. Tutorial content was determined by individual students and took place over a 6–12-month period, initially individually and subsequently in pairs. Regular feedback and appraisal occurred. Information was delivered to the medical school academic progress review system. Student satisfaction was investigated and subsequent examination scores reviewed. Results The causes of academic failure were widespread and ranged from deficient study skills to financial, domestic and emotional problems. In contrast, the subjects in which students had difficulty were remarkably similar, in that they all related to core clinical skills and frequently involved communication skills. Students enjoyed the programme, reported improved motivation both for study and for their chosen career and demonstrated a greatly improved pass rate in subsequent examinations. Conclusions The causes of academic failure in undergraduate medical students are diverse and are often not academic in origin. Students can benefit from an individually tailored remedial programme and go on to success in subsequent parts of the curriculum. Provision of individually tailored remedial teaching is labour-intensive and requires full faculty support.

Melissa Sayer

Mark Chaput De Saintonge

Dason Evans

Diana Wood

Support for students with academic difficulties

支持学业困难的学生

Growth mindset is a motivation theory proposed by Carol Dweck that posits our beliefs about intelligence, and the ability to change mindsets can have impacts on how we approach challenges, respond to criticism challenges and orient our goals. This study characterised articles on growth mindset theory in health professions education to: summarise the aspects of growth mindset being researched, describe the discussed benefits of growth mindset theory and outline strategies discussed that may promote a growth mindset.A systematic review of the literature yielded 4927 articles-articles were reviewed and excluded if they were outside of health professions education and did not discuss Dweck's growth mindset theory. The final review yielded 14 research articles and 13 commentaries, which were characterised and analysed using content analysis.The included articles were published in 2016 and beyond; the articles represented a diverse context, participant type and approach. Most research studies measured participant mindsets and evaluated the correlation with other variables (eg grit, well-being, anxiety). Articles often highlighted benefits and strategies to promote a growth mindset at the learner, educator and organisation level. The most common learner benefits were to help them be more receptive to feedback as well as increased resiliency and perseverance, educator benefits focused on supporting collaborative relationships and safe learning environments. The most prevalent strategies discussed were teaching learners about growth mindset theory, shifting faculty feedback to emphasise effort and to prioritise feedback across the organisation.The growth mindset framework has been shown in other fields to help others manage educational challenges and enhance learning environments. Researchers are encouraged to explore how interventions such as teaching about and prioritising a growth mindset can support learners, health care professionals, educators and organisations.

Michael D. Wolcott

Jacqueline E. McLaughlin

Alice Hann

Amelia Miklavec

Gary L. Beck Dallaghan

Denise H. Rhoney

Meg Zomorodi

Med Educ

A review to characterise and map the growth mindset theory in health professions education

Abstract Background Interviews are among the most familiar strategies for collecting qualitative data. The different qualitative interviewing strategies in common use emerged from diverse disciplinary perspectives resulting in a wide variation among interviewing approaches. Unlike the highly structured survey interviews and questionnaires used in epidemiology and most health services research, we examine less structured interview strategies in which the person interviewed is more a participant in meaning making than a conduit from which information is retrieved. Purpose In this article we briefly review the more common qualitative interview methods and then focus on the widely used individual face-to-face in-depth interview, which seeks to foster learning about individual experiences and perspectives on a given set of issues. We discuss methods for conducting in-depth interviews and consider relevant ethical issues with particular regard to the rights and protection of the participants.

Barbara DiCicco-Bloom

Benjamin F Crabtree

The qualitative research interview

定性研究访谈

Objective To determine the impact of adding audio-feed to an online lecture on screening given to medical students who were participating in an outpatient clerkship. Design Prospective, randomised, controlled study. Setting Vanderbilt University School of Medicine, Nashville and Wake Forest Medical School, Winston-Salem. Participants A total of 59 Years 3 and 4 medical students. Main outcome measures Students' use of time, satisfaction with the lecture experience, and knowledge. Educational intervention The online lecture was developed at Vanderbilt University. At Vanderbilt, 16 Year 4 medical students were randomised to the lecture on screening with audio and 17 Year 4 medical students were randomised to the same lecture without audio. At Wake Forest, 13 Year 3 medical students were randomised to the lecture on screening with audio and 13 Year 3 students were randomised to the same lecture without audio. Results The audio lecture required 20 more minutes to complete than the non-audio lecture. Students in the audio group were more satisfied with their experience than students in the non-audio group. Students in the audio-feed group achieved a trend for higher post-intervention knowledge scores, with the difference attributed to the students at Vanderbilt. Conclusion Audio narration is an important aspect of an online lecture. The distribution of online lectures to students at different sites and different training levels requires further study.

Anderson Spickard

Jeffrey Smithers

David Cordray

Joseph Gigante

James L Wofford

A randomised trial of an online lecture with and without audio

在线讲座有无音频的随机试验

Jeff Myers

The nature of a specialty

专业本质

Clinician teachers (CTs) play a pivotal role in medical student education. Medical schools depend on them to deliver their clinical curriculum and, thus, spend significant time and effort on recruitment and retention. The dual role of CTs as practicing physicians and medical educators, however, brings both opportunities and challenges.1 CTs are expected to seamlessly integrate their clinical and educational roles in clinical settings that seem to have ever-increasing demands. Unfortunately, the circumstances and contexts that would allow them to do so, or would foster success more generally, remain unclear. It is highly welcomed, therefore, that Brouwer et al., through the lens of boundary theory,2 present work in this issue of Medical Education3 that sets out to understand the contexts and processes that help CTs create value for students, colleagues, and the medical school. The researchers perceived boundaries between the clinical and educational contexts that CTs have to adeptly reconcile to be able to harmonize their clinical and teaching responsibilities and legitimize their value as CTs. To bridge the two contexts, CTs often use boundary objects,2 such as teaching a student about the treatment of hypertension while taking care of a patient who presents in clinic with elevated blood pressure. The harmonization of the clinical and teaching roles brings credibility and value to CTs' roles and nurtures a safe learning environment where students feel appreciated and empowered to actively engage. During these patient encounters, CTs role-model behaviours, compassion, empathy, and communication skills that can influence students' professional identity formation and career choices.4 CTs have to harmonize their clinical and teaching responsibilities and legitimize their value as CTs. Equally important, however, is CTs recognizing and admitting their own limitations and uncertainties about patient care to learners. Acknowledging and accepting vulnerability can be a powerful tool for teachers,5 nurturing a safe learning space where learners feel legitimized to express their own limitations. Commitment to self-reflection, self-improvement, and lifelong learning, therefore, are not only fundamental milestones in CTs' personal and professional growth as clinicians, but they strengthen CTs' value as teachers.6 Beyond individual benefits, such commitment can be a catalyst for establishing an institutional culture of community where collaboration, mutual trust, and support prevail.7 In such communities of practice, clinicians and CTs can develop informal or formal channels for peer mentorship and sharing of teaching recommendations that create value for junior CTs with less experience.8 Commitment to self-reflection, self-improvement, and lifelong learning strengthen CTs' value as teachers. Thinking through how to establish such a culture, it is noteworthy that the study3 also highlighted the importance of institutional support and resources for CTs' success. Support becomes increasingly important in CTs' efforts to bridge the clinical and educational contexts under time constraints, competing priorities, and increasing demands for clinical productivity. Sufficiently allocated time, equipped space for teaching, and faculty development resources are essential to fostering clinicians as teachers and legitimizing their value. Formally recognizing CTs' contributions to the clinical and educational mission through awards, appreciation events, promotion, and other incentives (e.g., stipends and funds for professional development) can validate their credibility and empower them to maximize their full potential in their dual role. Many CTs feel undervalued and disengaged from the medical school, but continue to teach because of inspirational role models encountered during their own medical training as well as the sense of self-fulfilment that comes from giving back to the profession.1 CTs who feel valued, however, are more satisfied and willing to continue teaching.9 Given the increasing difficulties in recruitment and retention of CTs, it is critical for medical schools to allocate resources strategically to prioritize and support CTs' needs. Formally recognizing CTs' contributions can empower them to maximize their full potential in their dual role. Given that the study3 focused on CTs with educational responsibilities either in the classroom or clinical settings where teaching occurs outside of direct patient care delivery it is also important for medical schools to be mindful of the increasingly diverse characteristics and experiences among CTs. Much of clinical teaching now takes place in busy clinical settings that are geographically isolated from the main campus. As a result, many CTs practice in remote locations, which can leave them feeling disconnected, with limited opportunities for engagement in the medical school and faculty development programs.1 Many CTs, in turn, have limited guidance on teaching expectations or feedback on their teaching performance from the medical school.9, 10 The Alliance for Clinical Education, which represents US national medical education organizations in eight specialties offering clinical clerkships, has called this issue a crisis, thereby emphasizing how concerning this state should be.11 It is also important for medical schools to be mindful of the increasingly diverse characteristics and experiences among CTs. Considering the increasing number of medical schools that establish regional campuses and use community-based clinical settings for student training, resources to foster CTs' growth as teachers becomes even more important because community-based CTs often face greater challenges in bridging the educational context with their own busy and remote clinical practice.1 Faculty development can be a way for medical schools to better engage their community-based CTs in their community of medical educators, offering mentorship and educational sessions that are flexible and adaptable to CTs' needs.10 CTs who attend faculty development programs have self-reported improvement in their teaching skills, confidence, and self-efficacy.12 Bouwer et al. push us to think further though by emphasizing the importance of CTs challenging educational thinking and practice, of bringing about curricular change and innovation while increasing their own educational expertise to truly gain a sense of belonging as a clinician educator. To do that effectively, CTs need to be empowered and trusted. Therefore, faculty development should offer more than workshops, but must prioritize opportunities for CTs to challenge their assumptions about their professional roles and identify how they can create value for their clinical practice, learners, peers, and the medical school through their educational engagement. Faculty development must identify opportunities for CTs to create value for their practice, learners, peers, and medical school through their educational engagement. While the present study illustrates the value of holding leadership roles in the medical school or the healthcare system in terms of creating opportunities for active engagement and self-perceptions of value, the multitude of roles that CTs hold suggests a need for future research exploring the value of CTs beyond the clinical and educational spaces if we are to fully understand how these additional roles interact and impact CTs' value and credibility as teaching clinicians. Frameworks, such as the Clinician Educator Milestones,6 may offer additional ways to evaluate and better understand the value CTs bring to stakeholders and the medical school mission, but it is critical that we realize we are so far just scratching the surface. The author has nothing to report. The author declares no conflicts of interest. The author has nothing to report.

Irene Alexandraki

Exploring the boundaries between clinician and teacher

探索临床医生与教师之间的界限

We read with great interest the recent publication by Kruskie et al.1 on the aetiology and experiences of impostor phenomenon (IP) in medical students. The concerning prevalence of IP and its links to burnout, amongst other negative outcomes, makes their work timely and important.2 Using social identity theory, the authors compellingly identified sources of IP, including ideal notions of medical students and physicians, comparisons to others, and concerns about image. Their conclusion, emphasising the interplay between individual and contextual factors, aligns with existing literature and invites a deeper exploration. Building on these findings, we highlight the critical role of the clinical learning environment in shaping trainees' experiences of IP. A complementary perspective emerges from applying Self-Determination Theory's (SDT) motivation framework, where IP has been linked to burnout, with a focus on the moderating role of general causality orientations—individual differences in how people perceive their environment and regulate their behaviour in response.3 An autonomous orientation (seeing opportunities for choices and engagement, based on interest and enjoyment) mitigated the negative impact of IP on burnout. Conversely, a controlled orientation (feeling pressured to act because of rewards/punishments or desires to avoid negative emotions like guilt/shame) and impersonal orientation (seeing outcomes as uncontrollable and thus feeling anxious and incompetent) exacerbated this relationship. These findings complement those of Kruskie et al.1 and help explain why some trainees with IP develop burnout while others remain more protected. They also provide practical strategies for fostering supportive learning environments, based on SDT, that buffer against the negative effects of IP. To cultivate an autonomous orientation, and not the other two orientations, training programmes should aim to provide meaningful rationales, offer structured yet flexible guidance, and acknowledge trainees' perspectives and emotions, while minimising the use of contingencies of reinforcement to motivate trainees. These actions are critical because each orientation can be socialised and readily 'brought forward',4 thereby enhancing or hindering trainees' autonomous motivation and ability to navigate challenges with self-efficacy and resilience.5, 6 This theory-informed approach, based on frameworks such as social identity theory and SDT, extends beyond interventions targeting individuals, emphasising the role of systemic and contextual factors in shaping trainees' IP experiences. By creating autonomy-supportive learning environments, programmes can prime trainees' autonomous orientation, ultimately reducing the burden of IP and its associated risks of burnout and disengagement. We advocate for further exploration of these strategies to promote well-being and sustainability in medical education. Cesar Orsini: Conceptualization; writing—original draft; project administration; investigation; methodology; visualization. Adam Neufeld: Conceptualization; writing—original draft; project administration; investigation; methodology; visualization. The authors have no acknowledgements to disclose. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this letter. The authors have no ethical statement to declare. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Cesar Orsini

Adam Neufeld

Navigating impostorism: The role of clinical learning environments and trainees' general causality orientation

导航冒名顶替症候群：临床学习环境与受训者一般因果取向的作用

Tal Jarus

Yael Mayer

Retention beyond representation: A call for structural inclusion in health professions education

Abbreviation	Med Educ
Journal Impact	5.06
Quartiles(Global)	HEALTH CARE SCIENCES & SERVICES(Q1)

ISSN	0308-0110, 1365-2923
h-index	162
Top Journals	Yes

Publication Information	Publisher: John Wiley and Sons Inc，Publishing cycle: Bimonthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1966，Proportion of original research papers: 86.73%，Self Citation Rate:18.40%， Gold OA Rate: 41.92%
Average review cycle	网友分享经验：偏慢,4-8周
Average recruitment ratio	网友分享经验：较难

Medical Education

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