Introduction: Competency-Based Health Professions Education (CBHPE) is an outcomes-based approach to planning and conceptualizing the training of health professionals to serve population needs. Despite its uptake, ongoing debate persists regarding the assumptions underpinning CBHPE, its intended purposes, and how success should be defined and evaluated. This contributes to variable implementation and difficulty aligning core features with meaningful outcomes. To date, no published theory of change has articulated how CBHPE’s core components provide a framework for later evaluation of intended outcomes.Methods: Using Funnell and Rogers’ purposeful program theory, the authors, all members of the International Competency-based Education Health Professions Educators Collaborative (ICBHPE), developed a model theory of change. The authors conducted a broad review of CBHPE literature, supplemented by CBE frameworks from adjacent educational contexts to strengthen underdeveloped constructs in implementation and evaluation. Findings were iteratively synthesized into a program theory and refined through repeated cycles of large-group feedback, consensus building, and member checking within ICBHPE.Results: The authors developed a CBHPE Outcomes Theory of Change that articulates key assumptions, mechanisms of impact, and expected outcomes associated with CBHPE implementation. The framework specifies how van Melle’s CBHPE core components are theorized to function across phases of implementation and identifies proximal and distal outcomes that can reasonably be expected, based on intentional, deliberate program evaluation at each implementation and evaluation stage.Discussion: The CBHPE Outcomes Theory of Change offers scholars and implementers a practical guide to enhance the quality and fidelity of implementation, evaluation, and research efforts related to CBHPE worldwide. Using this guide as a framework, programs can plan, implement, and then examine whether the intended outcomes of CBHPE have been realized.
Background & Need for Innovation:Summer pathway programs are designed to support students from under-resourced communities aspiring to enter healthcare professions. This study evaluated the effectiveness of a program containing strengths-based components within the UCLA Pre-Med Enrichment Program (PREP), a six-week academic enrichment initiative. PREP aims to highlight and support the individual strengths students bring to the profession while reducing psychological barriers to success. Goal for Innovation:Strengths-based components were incorporated into the 2022-2024 PREP curriculum to improve outcomes. Steps Taken for Development and Implementation of Innovation:Students participated in workshops focused on identifying and developing the strengths and experiences they bring to medicine, alongside traditional deficit-based activities emphasizing what students lack. Drawing from psychological literature, the additional curriculum was designed to shift mindsets and reduce barriers related to self-efficacy, stereotype threat, and imposter syndrome. Outcomes of Innovation:The strengths-based components yielded positive outcomes. Post-program assessments found significant reductions in imposter syndrome and stereotype threat, and increased self-efficacy. No significant changes were found in gender identity, ethnic stigma consciousness, or math identification. Critical Reflection on your Process:Strengths-based components should be considered for pathway programs and may also hold value for undergraduate medical education. Integrating curricular elements that highlight students' strengths and promote positive self-perceptions can help reduce psychological barriers to academic and professional success. Future research should explore strategies to engage pre-medical students with low self-efficacy to help reduce attrition among aspiring medical professionals.
Introduction:The combination of patient and public involvement (PPI) and interprofessional education (IPE) is promising to help students delineate roles based on real patients' needs; however, their integration in practice remains limited. Although the individual concepts have been studied, little is known about how stakeholders perceive PPI in IPE, leaving gaps in designing effective educational strategies. Therefore, this study aims to explore the experiences and perspectives of key stakeholders - students, academic staff members, and patient representatives - on the feasibility, (intended) learning outcomes, and requirements for the successful implementation of PPI in IPE in undergraduate healthcare education. Methods:We qualitatively explored the experiences and perspectives of each stakeholder group in separate focus groups. In total, 15 focus groups were conducted across four European countries, involving 27 academic staff members, 27 students, and 24 patient representatives, all with diverse backgrounds. Data were analyzed using thematic analysis. Results:Themes were structured by organizational levels within educational institutions to optimize uptake in practice. As for strategic considerations (align), participants noted compounded organizational complexity, which may lead to inertia - especially without institutional support. At the same time, PPI in IPE should be valued equally compared to biomedical subjects. With respect to educational design considerations, PPI in IPE helped students bridge theory and practice and decreased hierarchy. Lastly, regarding operational considerations (execute), the compounding complexity of organizing patient involvement in interprofessional education also holds true for facilitating it, as facilitators must role-model both person-centered communication and interprofessional collaboration. According to participants, learning from PPI in IPE is about unifying what cannot be separated. Discussion:Despite strong rhetorical endorsement, a lack of institutional support persists. Our findings suggest PPI in IPE as a powerful means of addressing epistemic injustice by promoting epistemic symmetry between future professionals and patients, reducing interprofessional hierarchies, and grounding interprofessional learning in real-world experiences. Strategic use of these levers may unlock the necessary institutional resources, acting as Alexander's sword to overcome barriers and ultimately slice through the Gordian knot.
Purpose: Clinical reasoning struggles are a leading cause of remediation referrals in postgraduate medical education. Most remediation efforts, like much of the clinical reasoning literature, focus on diagnostic reasoning. Errors in management reasoning can have serious consequences for patients, yet no framework exists for recognizing how learners struggle in this domain or for guiding remediation when they do.Methods: We conducted a multi-institutional qualitative interview study within a constructivist paradigm using the critical incident technique to explore how postgraduate medical trainees struggle with management reasoning in clinical practice, how those struggles are recognized, and how programs respond. Participants were residency program directors and clinical competency committee chairs from U.S. internal medicine and pediatrics programs. Data were analyzed using a systematic cross-case approach to identify phenotypes of management reasoning struggle.Results: We interviewed 20 program directors and clinical competency committee chairs from 15 programs about 15 trainees remediated for management reasoning difficulties. Cross-case analysis identified four phenotypes: (1) limited management scripts (inability to generate or contextualize a plan despite reaching a diagnosis), (2) can’t change course (inability to integrate new clinical information into an existing management plan), (3) impaired task triage and execution (difficulty prioritizing and coordinating management within a complex clinical environment), and (4) failure to calibrate (misjudgment of how much intervention a situation warrants). Contextual (i.e., situational) factors including clinical complexity, patient acuity, diagnostic uncertainty, and reduced supervision increased the likelihood of these phenotypes, and team structures often compensated for struggles before they were recognized. Struggles were frequently misattributed to problems with time management, organization, or communication, and remediation strategies were largely nonspecific across phenotypes.Conclusion: These four phenotypes offer program leaders and frontline educators an empirically grounded vocabulary for recognizing patterns of management reasoning struggle earlier and designing more targeted support.
Introduction:The quality of face-to-face teaching (F2FT) of eye-examination is often suboptimal amidst busy clinics as it demands faculty time for teaching and feedback. Flipped Classroom (FC) and Mental Rehearsal (MR) are established methods to teach clinical skills. A learning module (Supplementary Clinical Ophthalmology Preparatory E-learning [SCOPE]) that combines FC and MR may address this practical problem. This quasi-experimental study compared the efficacy and Faculty Contact Time of SCOPE against F2FT in teaching fourth-year medical undergraduates eye-examination. Method:The SCOPE group (n = 95) received the same content as F2FT but delivered in deliberate sequence: e learning (instructional videos and Video Modelling Examples), followed by structured, audio guided MR, then face-to-face practice with feedback. The F2FT group (n = 51) learned in a single face-to-face session with live faculty demonstration and Video Modelling Examples, without instructional videos or MR. Results:Baseline pre-intervention mean Multiple Choice Questions (MCQ) scores were comparable (22.31 versus 22.24, independent t-test, p = .94). Post-learning cognitive assessments found the SCOPE group to have greater gain in total MCQ scores with higher estimated marginal means (p < .001), and higher mean End-of-Rotation Test scores (43.37 versus 40.85, independent t-test, p = .048). On psychomotor assessments, the SCOPE group had superior Micro-CEX performances (three skills, all p < .001, Fisher's Exact test). SCOPE also shortened Faculty Contact Time, saving on average 57.48 minutes (p < .001, independent t-test). Discussion:SCOPE improved psychomotor and cognitive performances, and was more faculty time-efficient than F2FT in teaching eye examination skills. These positive results may be attributed to the synergistic effects of its multiple learning components. SCOPE, which combined FC and MR, may better facilitate clinical skill development through deliberate practice than F2FT.
Introduction:Research shows that medical students from certain minoritised backgrounds often face discrimination and reduced belonging, harming wellbeing and performance. However, such research rarely justifies its focus on these backgrounds, taking the selected categories of minoritized students for granted, even though categorisation itself is neither neutral nor harmless. To offer an alternative perspective, we used theoretical perspectives of categorisation to examine categories students construct for themselves and others, what meanings they attribute to these constructions, and how this affects their study experiences. Method:Using a constructivist approach, we conducted semi-structured interviews with 11 students from two Dutch medical programmes. Students reflected on experiences from application to clinical rotations. Transcripts were coded using theoretical concepts of categorisation. The analysis focused on how and when students invoked categories, their attached meanings, and impact. Findings were synthesized into three crafted stories illustrating students' experiences. Results:Students described categorising themselves and others fluidly, shifting across time and context. Categories became salient when students deviated from an implicit norm (e.g., identifying as lesbian in heteronormative environments or Black among white peers). Students and others valued each other positively, yet sometimes overemphasized categories and negatives. Such dynamics shaped feelings of belonging and exclusion and, sometimes, contributed to dropout. Discussion:Improving students' learning experiences requires acknowledging categorisation's omnipresent nature and its interconnected dynamics. Focusing on individuals' experiences and implicit norms - rather than standard categories - in all stages of educational practice and research is essential for fostering diversity and inclusion in the learning and healthcare environment.
Introduction: Academic health centers have invested in academies to promote health professions education scholarship, yet many struggle to sustain vibrant scholarly communities. We aimed to identify practices that support their development and long-term sustainability. Methods: Using a constructivist approach, we conducted a qualitative interview study in 2025 with leaders from all four geographic regions of the U.S. Inclusion criteria required that participants direct an academy or analogous institutional structure intended to promote educational scholarship, and that they could speak to building and sustaining this community in their local context. The Communities of Practice (CoP) framework informed interview guide development and data interpretation. Results: Twenty-one academy leaders described five interrelated forms of leadership work that shaped sustainable scholarly communities: (1) building foundations that legitimize educational scholarship by securing institutional investment, leadership buy-in, and succession planning; (2) cultivating scholarly sanctuary to counter isolation through psychologically safe, inclusive communities; (3) making scholarship feasible under constraints by creating low-barrier entry points, translating value to leaders, and addressing barriers; (4) tending growth through layered, incremental development, including cohort programs, consultation, mentoring, grants, and flexible participation; and (5) making educational scholarship visible and valued through recognition, dissemination, and outcome tracking. Discussion: Viewed through the CoP framework, the themes illuminate how leaders cultivated a shared domain of legitimate educational scholarship, a community of relational support, and a practice of tools, routines, and developmental infrastructure. The themes also reveal that sustainable communities of practice do not emerge from any single academy model, but from context-sensitive alignment of structure, culture, and incentives.
Introduction: Medicine often privileges extroverted traits such as confidence, assertiveness, and decisiveness. This ‘extrovert ideal’ may disadvantage introverted trainees and physicians, increasing vulnerability to imposter phenomenon (i.e., persistent feelings of inadequacy and self-doubt). However, the relationship between introversion and imposter phenomenon remains poorly understood, particularly among marginalized demographic groups who may already be more susceptible to imposter feelings. This study explored associations between introversion, imposter phenomenon, and demographic factors among Canadian undergraduate medical students (UGME), postgraduate residents (PGME), and practicing physicians. Methods: We conducted a cross-sectional survey. Introversion was measured using the McCroskey Introversion Scale and imposter phenomenon using the Clance Imposter Phenomenon Scale (CIPS). Demographic variables included gender, disability status, race/ethnicity, sexuality, first-generation medical student status, and training level (UGME, PGME, and practicing physicians). Results: The final sample included 578 participants. Multiple linear regression showed that higher introversion scores were associated with higher CIPS scores (B = 0.68, 95% CI [0.52, 0.84], p < 0.001). Participants identifying as women (B = 6.18 [3.28, 8.80], p < 0.001) or disabled (B = 4.93 [1.91, 7.95], p = 0.001) also reported higher CIPS scores. UGME students reported higher CIPS scores than practicing physicians (B = 3.74 [0.46, 7.01], p = 0.03). No significant interactions were observed between introversion and demographic variables. Discussion: Higher introversion was associated with greater imposter phenomenon across all stages of medical training and practice. Women, individuals with disabilities, and UGME trainees also reported greater imposter phenomenon. These findings highlight the need for further research into factors underlying the relationship between introversion and imposter phenomenon in medicine, and how professional cultures may shape imposter phenomenon experiences across diverse groups of trainees and physicians.
Introduction:Problematic polypharmacy (PP) is associated with risks and burdens for patients, and waste for healthcare systems. To overcome this challenge, clinicians must be able to tailor clinical decisions to patients' individual circumstances by integrating biomedical with biographical accounts of illness. This skillset has not been well defined or taught. Medicines optimisation (MO) is a key clinical activity in tackling PP and can exemplify the practical wisdom required for this integration. How and why MO education works is poorly understood. Our previous work, a realist review of published interventions, addressed this gap by explaining how undergraduate MO education could work but was limited by the thin descriptions available. Here, we develop and refine our explanatory model using primary data. Methods:This realist evaluation develops the programme theory from our review using primary data from individual realist interviews of clinical and educational MO experts. A realist configurational approach to analysis was employed. The study is conducted and reported in-keeping with RAMESES II standards. Results:Sixteen experts were interviewed; data were used to refine or refute our previous theorising. Analysis showed MO education which seeks to integrate interpretive practice into clinical decision-making must be sufficiently valued by stakeholders at all levels to garner the allocation of resources required for meaningful engagement with this education. Learners must feel they have permission to practice interpretive medicine when healthcare structures are organised to the contrary, this permission should be actively scaffolded by institutional and workplace context. A perception of critical mass within a community of practice may facilitate the required security in decision-making for ongoing practice. Discussion:We describe how and why undergraduate MO educational programmes can work to produce important outcomes in tackling the challenge of PP. We suggest how MO educational programmes may also act as practical gateways to routine interpretive practice in broader clinical areas.
Background: Virtual Patient (VP) systems are widely used in medical education, yet evidence on how they support near and far transfer remains limited. This study investigates integrating VPs with role modelling, varied case practices, and “what-if” discussions. It aims to measure the students’ overall experience with the intervention, improvement in performance scores on near- and far-transfer cases, and to explore how and why the intervention is perceived to enhance transfer. Methods: An exploratory mixed-methods study was conducted with 21 second-year undergraduate medical students enrolled in the course “Personalised Medicine in Cancer Treatment and Care”. Students engaged in role modelling performed by an oncologist, worked through authentic cases with varying patient characteristics, and participated in structured “what-if” discussions. Perceptions about the overall experience were gathered through a 19-item survey (n = 21). Performance scores were evaluated using pre- and post-assessments involving VPs and paper-based cases designed to measure near transfer (Case D) and far transfer (Case E) (n = 21). Group interviews (n = 8) provided deeper insights into enhancing transfer. Results: Survey results revealed positive student perceptions of role modelling (M = 4.44), varied case practices (M = 4.35), and “what-if” discussions (M = 3.76). Significant improvements were observed in tumour-stage reasoning for both near and far transfer (p < .001), in initial patient impressions (p = .007) for far transfer, and in the total score (p = .018) for far transfer. Thematic analysis indicated that students benefited from a stepwise build-up in case complexity, recognition of similar reasoning steps across cases, reflective “what-if” discussions that highlighted underlying principles, and peer dialogue around VP feedback that supported concept abstraction. Conclusions: Students evaluated the VP session positively and performance data indicated significant improvements, suggesting that the intervention enhanced near and far transfer. Reflection through “what-if” discussions was perceived to deepen understanding of the underlying principles enabling transfer.
Introduction:Intraprofessional collaboration (IntraPC) competencies are invaluable in the care for older adults with complex care needs, but these competencies are not acquired automatically. IntraPC learning requires explicit attention in postgraduate training, where learning usually occurs in the workplace. However, both residents and supervisors struggle with how to incorporate IntraPC learning into daily practice. This study explored how and to what extent current resident-supervisor dialogues (RSDs) provide opportunities for IntraPC learning and explored barriers to IntraPC workplace learning. Methods:In this focused ethnography, we observed RSDs in the geriatric medicine department of a Dutch university medical center, focusing on opportunities for learning about IntraPC in the workplace. After each observation, both the resident and supervisor participated in in-depth interviews to reflect on the observed behavior. Data were then analyzed through inductive coding followed by thematic analysis. Subsequently, themes were discussed during two focus groups to enable collective reflection with research participants. Results:Although ample IntraPC learning opportunities were observed in the current RSDs, they remained underutilized. Participants reported dynamics between residents and supervisors that could obstruct IntraPC learning, including perceived time constraints, feedback misalignment between resident and supervisor, monitoring-focus, and the struggle for entrustment. Discussion:IntraPC learning opportunities in RSDs often remain implicit, even though addressing IntraPC learning does not necessarily require additional supervision time. This implicit learning limits reflection on current collaborative practices. Moreover, dynamics between residents and supervisors may hinder the explicit development of IntraPC competencies. To support improvements in IntraPC learning, supervisors and residents are encouraged to regard IntraPC practices as an important learning topic within RSDs.
Introduction:Academic interest in ethical guidance for medical students from High-Income Countries (HICs) undertaking clinical electives in Low- and Middle-Income Countries (LMICs) has increased. Earlier ethical frameworks laid important groundwork but predate contemporary debates on social justice in global health. This study reviews recent literature to assess how these debates shape and produce ethical guidance, distinguish between ethical student conduct and elective programs, and how such guidance is translated into practice. Methods:A systematic review was conducted on ethical guidance for HIC medical schools and students regarding LMIC electives. Articles published between January 2018 and October 2023 were identified from PubMed, Embase, and Global Health. Thematic synthesis was combined with analysis of authorship (pose) and intended audience (gaze). Results:Of 711 articles, 24 met inclusion criteria. Five interconnecting themes emerged: humility, reflection, local embeddedness, equitable partnerships, and student health and well-being. While these align with existing frameworks, guidance remains largely conceptual, with limited attention to implementation and accountability across ethical student conduct and program design, with responsibility predominantly located at the level of HIC students. Pose and gaze analysis revealed epistemic imbalances in authorship and intended audiences. Most articles reflected HIC-based perspectives, with North American authors overrepresented and no solely LMIC-authored articles. Discussion:Ethical guidance remains dominated by HIC perspectives and focused on student conduct rather than program structures. By distinguishing between individual and institutional ethics, this study highlights the need for actionable, co-created frameworks that address accountability, equity, and sustainability in LMIC electives, including attention to institutional responsibility and LMIC perspectives.
Introduction:Inequitable assessments in medical education disproportionately affect historically marginalized trainees and undermine development of a diverse physician workforce. With programs around the world incorporating competency-based medical education (CBME), understanding whether assessment disparities exist in specialty-specific competency frameworks is critical. This study examined disparities in program-reported performance assessments of pediatric residents across demographic groups in two pediatric-specific competency frameworks: the General Pediatrics Entrustable Professional Activities (EPAs) and Accreditation Council for Graduate Medical Education (ACGME) pediatric milestones. Methods:This prospective cohort study was conducted at 15 pediatric residency programs in the U.S. across the 2021-22, 2022-23, and 2023-24 academic years. Clinical Competency Committee-assigned entrustment-supervision levels for 5 EPAs and all milestone levels were collected twice yearly. Residents self-reported ethnoracial group and sex, analyzed as exposure to systems of racism and sexism. Time-to-event analysis and growth curve modeling with intersectional analytic approaches examined disparities across demographic groups. Results:475 of 803 (59%) residents completed demographic surveys, including 17.3% underrepresented in medicine (URiM), 22.9% Asian, 56.4% white, 70.7% female, and 27.8% male. Time-to-event analyses revealed significant differences for Asian and Asian female residents in reaching the highest EPA supervision level across all EPAs. Growth curve analyses showed Asian males had significantly flatter growth trajectories for EPA 15 (Lead an Interprofessional Team), resulting in lower estimated scores at graduation. URiM female residents had significantly lower scores on EPA 16 (Facilitate Handovers) at graduation. URiM residents showed lower Milestone growth curves for interpersonal communication, and Asian residents for systems-based practice. Discussion:Subtle but meaningful disparities exist in program-reported assessments of pediatric residents, with distinct patterns affecting Asian and URiM residents across both frameworks. These findings highlight the need for proactive attention to equity in competency-based medical education assessment systems.
Background and Need for Innovation: Coaching has many benefits in medical education, but large-scale implementation is constrained by faculty bandwidth, scheduling, cost, and power differentials. Artificial intelligence (AI), specifically large language models (LLMs), offers potential solutions to augment coaching, but limitations remain and refining performance is necessary to create valuable coaching conversations. Steps taken for Development and Implementation of Innovation: The authors created Coaching with AI-Reinforced Education (CAR-E), an AI coaching agent built using an LLM. Using layered architecture, CAR-E couples real-time speech input and output, retrieval-augmented generation (RAG) for evidence-based coaching, and dual memory system (short-term context and long-term history) to sustain longitudinal dialogue. An iterative design refined CAR-E with users who voluntarily engaged in coaching conversations and provided feedback. Transcripts and user feedback were analyzed to improve CAR-E. Evaluation of Innovation: During the pilot, 37 medical trainees and faculty engaged in coaching conversations. Transcripts showed diverse topics discussed and many strengths and opportunities for improvement. Users reported that CAR-E facilitated self-reflection, clarified goals, and broke complex problems into actionable steps. They also noted formulaic questioning that felt repetitive, superficial attempts to display empathy and difficulty moving conversations forward. Many users were frustrated by CAR-E’s strict adherence to coaching competencies, which prevented it from giving advice or suggestions. Critical Reflection on your process: Unlike generic LLMs that default to broad, solution-oriented dialogue, CAR-E was designed for coaching in medical education. Its design incorporates evidence-based knowledge retrieval with curated coaching resources, structured memory to support longitudinal conversation, institutional oversight, and speech integration. These features exemplify responsible AI use in medical education. Despite this architecture, many improvements are planned to create reflective, growth-oriented conversations that augment coaching in medical education.
Introduction: Competency-based and data-driven frameworks increasingly shape postgraduate anaesthesia training, yet much of professional learning occurs through unspoken cultural and relational influences—the implicit curriculum. This study examines how anaesthetists perceive and navigate these tacit aspects of learning. Methods: We conducted a phenomenographic analysis of 29 semi-structured interviews with anaesthetists from teaching hospitals in Sweden and England. Participants represented diverse training stages and educational backgrounds. Through iterative comparison and interpretation, we identified qualitatively different ways anaesthetists conceptualised learning within the social and emotional contexts of clinical work. Results: Three conceptions were identified: Orientation toward the explicit curriculum, where learning is framed by formal structures and supervision; Awareness of the implicit curriculum, where unstructured and relational learning become visible; and Engagement with the implicit curriculum, where anaesthetists actively integrate unspoken norms, values, and emotions into professional practice. Variation across five dimensions—communication, collaboration, decision-making, autonomy, and emotional intelligence—illuminated how awareness of the implicit curriculum underpins professional growth. Discussion: The implicit curriculum emerges as a lived, relational dimension of anaesthesia training rather than a hidden layer of influence. Recognising these distinct ways of understanding offers educators a framework to make tacit learning visible, foster reflective dialogue, and support the development of adaptive, self-aware professional identities across postgraduate medical training.
Introduction:Academic Hospitalists (AHs) in internal medicine who are practicing in the United States (U.S.), are physicians whose inpatient clinical work is integrated with teaching, quality improvement, and research. Over 90% of US and Canada internal medicine programs rely on AHs as primary inpatient teaching attendings for medical students and residents. However, AH experience disproportionate burnout despite younger career stage, suggesting that structural and identity-related factors beyond typical career progression may drive dissatisfaction. This study explores how AHs construct their professional identity and how they view their role in the academic enterprise. Methods:Using identity theory as a conceptual framework this constructivist qualitative study used semi-structured interviews with 20 academic hospitalists across nine U.S. academic institutions during 2024-2025, selected using information power sampling to ensure sufficient data depth. Interviews explored professional roles, identity within those roles, and identity formation across distinct domains. Transcripts were coded and analyzed iteratively using Braun and Clarke's thematic analysis. Results:Four interconnected themes were identified reflecting identity ambiguity, role strain, developmental needs, and recognition gaps among academic hospitalists: (1) the absence of consensus: defining what it means to be an Academic Hospitalist; (2) identity non-verification: the mismatch between self-perception and external recognition; (3) competing responsibilities, tensions, and burnout; and (4) mentorship and professional growth. Conclusion:AHs construct identity amid structural ambiguity and institutional non-recognition of salient professional roles. Institutions should clarify role expectations, provide non-negotiable protected time for academic engagement, establish robust mentorship infrastructure, and formally recognize educational contributions through performance metrics and compensation structures. These systemic changes are essential for supporting professional identity formation, enhancing career satisfaction, improving retention, and strengthening academic medicine's educational mission.
Introduction: Personalization is increasingly emphasized in postgraduate medical education. While competency-based medical education (CBME) is theoretically positioned to support personalization, practical challenges such as fixed learning outcomes, workplace constraints, time-fixed rotations, and assessment requirements, often limit its realization. This case study aimed to explore how residents experience and make use of individualized development trajectories within a program that combined fixed outcomes with flexible program components. Method: We conducted a case study using semi-structured interviews and template analysis. The study was situated in the Dutch national Obstetrics and Gynecology residency program, which includes formally embedded individualized development trajectories with open-ended learning goals and no pre-determined assessment. We interviewed 12 residents and discussed their portfolios. Results: All participants engaged in individualized development trajectories. The level of engagement varied and motivation sprang from: personal interest, moral values and dilemma’s, clinical exposure, role models, and workplace possibilities. Three interacting factors enabled this: 1) formal program structure legitimized and fostered engagement; 2) time and workplace exposure allowed participants to recognize personally meaningful goals; 3) program directors’ support facilitated engagement. Program directors varied in their guidance: some coached, endorsed, or role-modeled; others merely monitored activity; and a few did neither. Participants engaged with the individualized development trajectories, despite the absence of assessment. Conclusion: Structured autonomy, workplace exposure and personal motivation can support personalized learning in CBME. Personalization requires intentional design, supportive structures, trust towards residents, and coaching attuned to the individual learner.
Competency-based medical education (CBME) is widely adopted in numerous countries, but many programs struggle to translate its conceptual promises into routine educational and clinical practice. Entrustable Professional Activities (EPAs), a key mechanism to operationalize CBME, have been implemented in different ways with substantial variation across contexts. While implementation challenges are well described, the field lacks explanatory approaches to understand why such variation occurs and how it shapes practice. In this Show-and-Tell contribution we apply Normalization Process Theory (NPT), an implementation theory, to analyze how EPA-based curriculum reforms are taken up, enacted, and sustained across settings. We conducted a comparative, theory-informed analysis of implementation experiences from five regions (in Latin America, Asia, North America, Europe) drawing on materials from an international EPA symposium (Barcelona, 2025). Data sources include a pre-symposium survey, invited presentations, transcripts of plenary discussions, and follow-up reflections. Using NPT’s four core constructs (coherence, cognitive participation, collective action, and reflexive monitoring), we examined how stakeholders make sense of EPAs, engage with implementation, integrate practices into clinical routines, and adapt them over time. The analysis revealed recurring mechanisms shaping implementation across contexts. Challenges included conceptual ambiguity, variable engagement, workflow pressures, and misalignment with existing practices. At the same time, enabling conditions emerged across settings: clear communication of purpose, phased implementation strategies, coordinated faculty development, leadership support, and context-sensitive adaptation. By foregrounding implementation mechanisms rather than outcomes alone, NPT offers a transferable analytic lens to guide, evaluate, and refine curriculum reforms.
Introduction: The Scholarship of Teaching and Learning (SoTL) is the practice of critically examining student learning to improve teaching and then disseminating insights from this work for others to build on. SoTL often justifies faculty members’ careers in health professions education (HPE); however, SoTL is not universally understood or acknowledged in promotion and tenure (P&T) decisions across HPE institutions. We conducted a scoping review of the published literature to map how SoTL has been conceptualized, realized, and described as institutionally recognized by P&T committees. Methods: In July 2024 (updated in July 2025 and April 2026), the authors searched 7 databases for peer-reviewed publications referring to any scholarship relating to education, teaching, and/or learning in HPE in the United States. We followed Arksey & O’Malley’s scoping review methodology and incorporated stakeholder feedback. Articles were grouped by discipline: medicine and other health professions. Results: Of the 4,588 articles identified, 130 were included for full review, with 52 reporting on SoTL activities in medical education (40%) and 78 in other HPE domains (60%). While articles shared core SoTL concepts, SoTL was operationalized in a variety of ways, many blurring the distinction between scholarly teaching and SoTL. The articles demonstrated that SoTL has been inconsistently recognized by P&T committees. Conclusion: Using Institutional Logics to support analysis, we found that the recognition of SoTL in HPE organizations varies with the degree of alignment between the logics of research and teaching. We propose strategies for increasing this alignment and provide literature-based distinctions between scholarly teaching, SoTL and educational research to support this goal.
