Rooted in spiritual energy and centered in Black liberation, Afrofuturism, and feminism, Hersey's "Rest is Resistance" framework encourages deliberate rest practices as a personal necessity and a form of political resistance. Inspired by her work, we are a group of health professions education scholars from minoritized backgrounds using our lived experiences to illustrate the application of our "Rest is Resistance" framework. The demands of academic medicine, defined by productivity in clinical, scholarly, and educational domains, combined with personal obligations, run counter to rest. Enduring long hours and pushing oneself to exhaustion imply that needing to rest is a sign of weakness, and this so-called "grind culture" in medicine is pervasive. The expectations of a culture of self-sacrifice and dedication come at a cost to mental health and self-care. Minoritized faculty and trainees disproportionately experience the negative consequences of these expectations, including mental and racial battle fatigue. We introduce "Rest is Resistance"-a deliberate and necessary act of self-preservation against capitalism and structural injustices-and offer practices for individuals in the health professions to consider. The call for rest is not relegated to just physically resting our bodies. Rather, our call for rest is used metaphorically as a form of political, spiritual, and cultural resistance against oppressive systems, particularly capitalism and white supremacy, to promote a conscious slowing to reclaim individual agency and humanity. We hope that introducing "Rest is Resistance" as a framework in health professions education will promote well-being and support minoritized health care professionals and trainees, in particular, so that they can be fully present and create a sustainable healthcare culture that values everyone.
Phenomenon: Residency selection has traditionally emphasized cognitive measures such as Unites States Medical Licensing Examination (USMLE) Step 1, Step 2 Clinical Knowledge (CK), and clerkship grades, even though physician performance encompasses cognitive and noncognitive competencies. Situational judgment tests (SJTs) have emerged as a promising complement, demonstrating criterion-related validity and producing smaller subgroup score differences than cognitive measures. However, smaller mean differences do not establish fairness. The Standards for Educational and Psychological Testing distinguish between mean group differences and predictive bias. The latter occurs when an assessment systematically over- or underpredicts outcomes for certain groups regardless of true construct standing. Whether residency-focused SJTs demonstrate predictive bias has not been examined-an important gap, as unknown bias risks unfairness to applicants and could undermine efforts to build a more representative physician workforce. Approach: This multiyear study investigated whether a professionalism-oriented SJT demonstrated predictive bias by gender, underrepresented in medicine (URiM) status, or international medical graduate (IMG) status relative to Accreditation Council for Graduate Medical Education (ACGME) milestone performance. Using moderated multiple regression, we tested for intercept differences (predicted outcomes differ between groups at the same SJT score) and slope differences (the strength of the predictor-outcome relationship differs by group). The study included 24 residency programs and three fellowships at a single academic medical center. Predictive bias analyses included 422 residents; mean score analyses included 2,680 applicants; and background characteristic analyses used diversity survey responses from 1,659 interns. Findings: The SJT predicted year-end milestone performance across all subgroups (B = 0.14-0.17, p < 0.05), with no intercept or slope differences by gender, URiM status, or IMG status, indicating no evidence of predictive bias. Gender differences across selection measures were negligible (d = -0.08 to 0.23). URiM applicants scored lower than non-URiM peers on all measures, with larger gaps on cognitively loaded exams (Step 1: d = 0.74; Step 2 CK: d = 0.66) than on the SJT (d = 0.30) or milestones (d = 0.28). IMG applicants scored lower on the SJT (d = 0.45) and Step 2 CK (d = 0.29) but not Step 1 (d = -0.06). URiM interns reported greater structural disadvantage; IMGs were markedly less likely to report native English proficiency. Insights: This study provides initial empirical evidence that a professionalism-oriented SJT does not exhibit predictive bias by gender, URiM status, or IMG status in relation to residency milestone performance. These findings constitute a preliminary step toward a fairness evidence base for residency-focused SJTs, pending replication in applicant populations and operational selection settings. The SJT's smaller subgroup gaps relative to USMLE exams suggest value in holistic admissions, though this inference requires validation in samples not restricted by prior selection.
Moral distress has been linked to burnout, emotional exhaustion, and intention to leave medicine. Although it has been widely studied in other health professionals, research into the experience of resident physicians, who work in unique sociocultural environments, is in the early stages. The objective of this scoping review is to identify, examine, and summarize the literature on moral distress in residents. Using the methodology described by Arksey & O'Malley, we queried five databases and screened and analyzed 2,991 articles. In the 36 included articles, authors' definitions of moral distress varied; however, external constraint was emphasized as a core feature. An analysis of quantitative, qualitative, and theoretical or commentary articles produced several key findings. First, conditions contributing to moral distress included tensions surrounding end-of-life care, hierarchical cultural norms, ambiguities associated with work-based learning, and structural factors in healthcare delivery. Second, frequency and intensity of moral distress were inconsistent across studies. Third, impacts of moral distress included callousness, burnout, depersonalization, and attrition. Fourth, residents employed a range of coping mechanisms such as seeking peer support, engaging in meaning-making, going above and beyond expectations, internalizing thoughts and emotions, or employing detachment and cynicism. Finally, suggested mitigation strategies included debriefing and reflection, culture change initiatives, and educational programming. The findings offer a unique analysis of how moral distress is defined in residency education and illuminate the interplay of relational, systemic, and sociocultural factors shaping residents' experiences. Further, the results provide a meaningful overview of the literature and identify important directions for future inquiry. .
Achieving equity in assessment remains a persistent challenge in medical education. While research has focused predominantly on psychometric approaches to fairness, exploration has been limited into how racial equity is embedded at foundational stages of assessment development. In particular, the influence of test developers' racial composition on assessment design has been largely overlooked. This study investigated how the racial makeup of test development teams impacts the incorporation of justice-oriented principles into assessment design. Guided by critical theory and a justice-oriented assessment framework, we employed Foucauldian Critical Discourse Analysis to examine the design processes of three groups of assessment developers (N = 16) purposefully sampled from the US academic medical education community. We grouped participants by racial identity: Group A (white-identifying, n = 5), Group B (non-majority-identifying, n = 5), and Group C (mixed racial composition, n = 6). Following an interactive session on equitable assessment principles, groups collaboratively designed a mock OSCE station assessing communication skills. The data collected included transcribed group discussions, the OSCE station, and participant group reflections on their experiences. Our findings reveal a pervasive gap between equity awareness and equity action. Despite demonstrating clear conceptual understanding of equity principles, participant groups struggled to operationalize these principles in practice. We identified four themes from the discourse analysis: an absence of explicit equity discussions despite the study's stated focus; the sanitization of assessment and weaponization of "culture" as a dividing practice; the treatment of learners as erased, ghostlike figures-homogenous and without agency-while patients were centered as diverse and significant; and the framing of equity as a weapon or curveball rather than a foundational design element. Participant groups frequently defaulted to traditional standardized approaches, expressing discomfort about incorporating equity without introducing stereotypes. Power dynamics and professional norms emerged as significant barriers, with participants deferring to clinical expertise and avoiding confrontation on equity-related issues. Notably, racial diversity among test developers alone did not substantially advance equity in the designed assessment. This study underscores that the test developer's equity awareness and racially diverse representation, while necessary, are insufficient for achieving justice-oriented assessment design. Without intentional structural changes and cultural shifts in how assessment is conceptualized, equity will remain peripheral rather than foundational. These findings offer actionable insights for national licensing bodies, medical schools, and residency programs seeking to embed equity more meaningfully into high-stakes assessment practices, suggesting that frameworks such as Design Justice may provide pathways for inclusive, community-centered approaches to assessment development.
Introduction: Clinically significant adverse events (CSAE) place medical students at risk for secondary traumatic stress, feelings of guilt, anxiety, failure, decreased confidence, and alterations of career trajectories and specialty choice. The CSAE literature focuses on clinicians or nursing students, leaving medical students relatively understudied. Understanding medical students' CSAE experiences, within the context of their role as a learner, is important because students may be uniquely vulnerable due to their relative lack of experience with adverse events, lower position in the medical hierarchy, and absence of formalized CSAE curricular or co-curricular support. Thus, the purpose of this study is to explore medical students' experience of CSAE and identify ways to support learning during the recovery process. Methods: We used a constructivist narrative approach to explore medical students' stories of CSAE holistically. From December 2024 through February 2025, we conducted semi-structured interviews with 16 second- through fourth-year civilian and military medical students in the United States. This study is constructivist in that both the authors' and the participants' experiences of CSAE are contextually specific realities where meaning is relational and often co-created. We elected to use a narrative approach, which is a story-centered methodology, because CSAE is a chronological phenomenon and stories are one way that humans make sense of traumatic events. We followed a chronological approach to develop the interview protocol and used narrative analysis to interpret the data. The Institutional Review Board at the Uniformed Services University of the Health Sciences in Bethesda, MD approved this research (DBS.2024.783). Results: Narratives highlighted intense emotional responses to CSAEs, including helplessness, guilt, fear, and grief, shaped by their limited power, inexperience, and pressure to perform. Their role as learners often left them excluded from care decisions, debriefings, and formal support, leading to feelings of invisibility within the medical hierarchy. While emotional and social support from faculty and residents was often absent, students sought help from peers, therapists, or medically trained family members. Informational and esteem support, especially when faculty explained clinical reasoning, helped students process events and regain a sense of competence. Conclusion: Medical students often feel unprepared for the emotional impact of CSAEs and face barriers to seeking support due to hierarchy and fear of negative evaluation. Participants described experiences of isolation, emotional distress, and invisibility within clinical teams but also identified moments of growth when supported by faculty and peers. These findings highlight the need for curricula that prioritize emotional preparedness and social support.
Problem: In Taiwan's hierarchical medical culture, postgraduate year (PGY) physicians face significant workplace challenges, exacerbated by Confucian values of hierarchical deference and collective harmony, which discourage open discussion of power imbalances. Approaches rooted in individualism, such as speaking-up initiatives and direct feedback pedagogies, encounter cultural barriers in this high-power-distance, collectivist context. While digital-native trainees increasingly use medical memes to express workplace frustrations, these community-generated expressions have not been systematically used for structured reflection in hierarchical medical education contexts. Intervention: In this pilot study, we designed a meme-based reflective learning curriculum integrating Kolb's experiential learning cycle, Palmer's "third things" approach, and Schön's mediating artifacts. Eight PGY physicians completed six monthly 90-minute sessions (January-June 2024), with follow-up interviews conducted six months post-intervention (December 2024). We curated memes from Taiwanese medical social media that depict workplace challenges, including hierarchical powerlessness, interprofessional tensions, emotional regulation, unclear workplace rules, time management, and patient-doctor communication. Sessions guided participants through Kolb's cycle: concrete experience (meme viewing), reflective observation (discussions), abstract conceptualization (consensus-building), and active experimentation (implementation). Context: The study was conducted at a medical center in Taiwan, where PGY physicians, competing for residency positions through an informal but widespread internal recruitment practice, faced intense pressure to maintain favorable impressions among seniors. This precarious status fostered reluctance to voice concerns as they navigated monthly rotations across departments with different cultures and unwritten rules. Impact: Participants demonstrated learning across all Kolb stages. Framed as an untested feasibility, the approach made previously unspeakable experiences discussable, creating resonance as participants recognized shared struggles. They developed practical strategies for emotional regulation and for navigating interprofessional relationships. However, encountering systemic barriers to implementation prompted an unexpected transformation: participants developed critical consciousness, shifting from seeking adaptation strategies to questioning the structures themselves. They articulated, "The problem isn't us. It's the whole unreasonable system," shifting the focus from coping to why this system exists. This evolution, which moves beyond an adaptation-focused curriculum toward Freire's dialogical education, emerged alongside a sense of powerlessness, as participants lacked the authority to enact structural change. Lessons learned: Drawing on Freire's concept of generative words, we theorize that community-generated memes functioned as generative artifacts: culturally embedded materials that fostered both workplace reflection and critical consciousness. This approach reframes Confucian collectivist orientations as empowering resources through what we term "safe subversion," in which humor's incongruity, ambiguity, and collective ownership keep critique within culturally tolerable limits. However, translating consciousness into structural change requires strategic alliances with educators who wield hierarchical authority in service of learning, bridging trainee awareness and institutional reform.
Recent discussions of abolition have highlighted its promise in addressing many of the most pressing social inequalities of modern times. Yet, medicine and the medical education system remain ambivalent about the potential of incorporating abolitionist principles and praxis. Here, we draw from our lived experiences within the current US medical education system to 1) expand on existing definitions of abolition medicine, 2) highlight how educational approaches could incorporate abolitionist praxis into training healthcare workers, and 3) call for institutional investments in abolition medicine as both a discipline and practice. This work contributes to ongoing efforts to transform the medical education system and empower medicine to advance health justice.
Health professions education is increasingly called upon to prepare clinicians to provide equitable, patient-centered care; yet transgender and gender-diverse (TGD) health remains inconsistently integrated into formal curricula. Despite growing clinical literature, including evidence related to cardiovascular outcomes, educational integration of TGD health content remains limited across residency training programs. This disconnect between emerging evidence and curricular uptake raises questions about structural barriers that shape what is considered "core" knowledge. This study explored academic faculty perspectives on barriers to integrating TGD health content into residency curricula, using cardiovascular health as an illustrative case within Internal Medicine (IM) training. Drawing on a descriptive qualitative approach informed by Queer Theory, we conducted semi-structured interviews with 10 IM faculty members involved in curriculum development and teaching at a large Canadian academic institution. We purposively sampled participants to capture diversity in gender identity, academic rank, and clinical interest. We transcribed and analyzed interviews using NVivo. We performed a thematic analysis framed through a Queer Theory lens to identify how educational exclusion might reflect broader patterns of institutional cisnormativity. We constructed six themes from the data. While some participants cited lack of expertise or clinical exposure, others described structural forces-such as hierarchy-driven curriculum design, perceived niche status, and binary medical frameworks-that shape broader patterns of curricular inclusion and exclusion. When viewed through Queer Theory, these findings illustrate how the cisnormative image of the "default patient" renders some bodies and topics invisible to the curriculum, even when evidence and clinical need are well established. This exclusion of TGD health content, illustrated here through cardiovascular care, reflects cisnormative assumptions embedded within medical education. Just as the field has challenged the normative image of the physician, this study argues for a parallel interrogation of the patient. The same worldview that shapes which bodies clinicians are prepared to see also shapes what educators recognize as core content. Queer Theory exposes these exclusions and points toward structural work in curriculum design, faculty development, and institutional leadership required to address them.
Simulation-based healthcare education presents complex sensory, social, and cognitive demands that may systematically disadvantage autistic learners. Although contemporary research acknowledges autistic professionals' presence in healthcare practice, the literature remains conspicuously silent on how autistic learners actually experience simulation-based environments. Without understanding these lived experiences, we risk perpetuating educational practices that exclude neurodivergent talent and missing insights that could improve simulation design for all learners. This study aimed to explore the lived experiences of autistic healthcare learners in simulation-based education and understand how they make sense of these experiences. This interpretative phenomenological analysis explored the lived experiences of seven autistic healthcare learners from the UK and Europe. Participants included medical students and qualified doctors with simulation experiences spanning undergraduate curriculum-based training, postgraduate education, and professional development activities. We conducted semi-structured online interviews lasting approximately 60 minutes between February and May 2025, with interviews progressing from descriptive accounts to reflective consideration of ideal simulation experiences. Data analysis followed established interpretive phenomenological analysis (IPA) procedures, developing emergent themes and identifying patterns across participants whilst preserving individual voices. We developed four interconnected themes from participants' accounts. First, "Navigating Artificial Realities" captured how participants developed strategic, performance-based approaches to simulation's predictable structure, often prioritising technical success over genuine skill development. Second, "The Social Minefield of Group Learning" revealed how group composition and social dynamics served as gatekeepers to meaningful engagement. Third, "The Cognitive Burden of Dual Processing" described participants' exhausting experience of simultaneously managing clinical learning and social monitoring, with educational engagement competing against social performance demands. Fourth, "Communication as a Structural Barrier" highlighted participants' need for clear, direct instruction and feedback across all simulation phases. Our findings suggest that autistic learners may experience well-documented challenges in simulation-based healthcare education with particular intensity, revealing how simulation learning environments that appear inclusive may present challenges for autistic learners through design failures rather than learners' individual limitations.
This article explores the role of comics as a sustained pedagogical practice within medical education, presenting findings from a longitudinal qualitative study conducted at Penn State College of Medicine, United States. Over two pre-clinical years, a self-selected group of medical students-known as the Comics Cohort-were given comics-making assignments to integrate into their required Humanities curriculum. Through focus groups, individual interviews, and visual narrative analysis of students' drawings, the study investigated how engaging with comics over time shaped medical students' ways of seeing, learning, and becoming. We identified three main thematic domains: 1) students learn more deeply when they engage visually; 2) the personal reflection and vulnerability that arise from making comics can be challenging but are also tools for growth; and 3) making and sharing comics creates community and connection. Building on participants' accounts of repeated comics-based practices, this article conceptualizes drawing as a form of reflective engagement that shapes how students attend to clinical encounters. The act of drawing-repetitive, situated, and open-ended-functioned as a reflective tool through which students developed what we conceptualize as visual attunement: an ethically engaged perceptual stance that integrates attention to bodies, silences, emotions, and context. Rather than using art as an occasional creative supplement, this study found that drawing comics can serve as both a medium and method through which students cultivate professional identity, visual thinking, and critical reflection.
This evaluation study investigated the extent to which a medical school curriculum fostered cognitive integration in learners. The Active-Learning, Competency-Based, Excellence-Driven (ACE) curriculum was designed to present basic science content through a clinical lens to support students' ability to make connections between clinically relevant symptoms using basic science mechanisms. We included the graduating classes of 2023-2025 from the University of Kansas School of Medicine (KUSOM) (N = 630) in this study. A structural equation model assessed the mediating role of developmental clinical skills on the relationship between foundational knowledge, as demonstrated by course summative exam performance, and an end-of-third-year clinical skills assessment. Using a theory-driven (cognitive integration) evaluation approach, we predicted that, if cognitive integration was achieved, foundational knowledge during the first two years of medical school would have a direct relationship to clinical skills and that developmental clinical skills would partially or fully mediate that relationship. We also assessed the mediating role of developmental clinical knowledge, as demonstrated by NBME Subject Exam performance, on the relationship between foundational knowledge and clinical knowledge (United States Medical Licensing Exam Step 2 Clinical Knowledge exam (USMLE Step 2 CK) scores. Foundational knowledge had a strong relationship with a comprehensive clinical skills assessment, which was fully mediated by developmental clinical skills. Foundational knowledge also had a strong relationship with USMLE Step 2 CK scores, which was fully mediated by developmental clinical knowledge. Students who demonstrated greater foundational knowledge tended to score higher on a comprehensive clinical skills assessment at the end of the third year. This suggests that foundational knowledge acquired in the first two years of an integrated curriculum is strongly related to clinical skills and clinical knowledge in the clerkship year. Although this is not a causal test, the structural relationships suggest the ACE curriculum was successful in promoting cognitive integration in students.
Despite growing commitments to disability inclusion, ableism remains entrenched in medical education. Too often, proposed solutions emphasize inclusion without addressing the structural forces that perpetuate exclusion. In this article, we seek to bridge this gap, drawing on Disability Justice and decolonisation to challenge the norms that define success against ableist standards. At the intersections of these theories, we illustrate how colonialism and capitalism operate to drive the systematic exclusion of disabled learners in medicine. Drawing on Jain's concept of the "capability imperative," we make these comparisons explicit as we interrogate the notion of competency in clinical assessment, specifically in Observed Structured Clinical Examinations (OSCEs). This lens challenges us to consider how colonial capitalist norms shape definitions of competence and how this affects what is valued (or devalued) in our assessment practices. Offering a series of reflexive questions to prompt collective inquiry, we invite readers to begin to re-imagine learning environments and challenge the ableist paradigms that influenced the curricula under which our healthcare leaders trained. We seek to understand: are efforts to include disabled learners predicated on simulations of work in understaffed and underfunded healthcare systems? If so, are we replicating systems that not only exclude disabled doctors but demand sacrifice in the name of conformity and minimising disruption to safeguard productivity? Finally, what does this tell us about the power structures at play when it comes to assessing competency in medical education?
Purpose: International medical graduates (IMGs) have long sustained the US healthcare system. In the US, 25% of practicing physicians are IMGs, who are pivotal for delivering primary and preventive care and for tending to first-generation immigrants. Despite their contributions, studies primarily have focused on individual challenges and difficulties of IMGs. In contrast, structural barriers-and their impact on IMGs' private lives and emotional wellbeing-are rarely discussed. Using the example of Asian IMGs in the US, we explored structural barriers that complicate everyday thriving, including family wellbeing, work conditions, and emotional life. Method: We conducted a constructivist, qualitative interview study with 20 IMG physicians (60% female) in 2023. We purposefully sampled across multiple specialties, clinical settings, and geographic areas. The average time serving as an attending was 11.8 years. We recorded and transcribed semi-structured interviews, which lasted 45-60 minutes. With attention to IMGs' positionality, we applied reflexive thematic analysis and Burgess-Proctor's strategies for engaging with and empowering participants. We also drew on Ahmed's theory of the politics of emotions to inform our interpretation. Results: IMGs described interconnected structural barriers rooted in the US visa system, including financial hardship, prolonged family separation, and sponsorship-dependent career precarity. Beyond these constraints, participants also encountered institutional selection bias and professional gatekeeping, including an invisible ceiling, tokenization, and limited recognition of IMG status within broader diversity discourse. While expressing gratitude for US career opportunities, participants reported a significant emotional toll characterized by guilt and shame tied to outsider positioning and pressures to justify their legitimacy in US training. Discussion: Structural barriers have a profound impact on IMGs' relational and emotional lives. What might appear as a personal hardship-such as family separation-is in fact a consequence of structurally imposed constraints. Participants pointed to concrete areas where institutional practices could change, including formalized mentorship structures, stronger institutional accountability, more explicit inclusion practices, and policy advocacy. Addressing these inequities will require institutional engagement, with implications for sustaining the US physician workforce.
When we began our first year of medical school at a US MD-granting institution, we were elected as head Course Representatives (Course Reps) in a longstanding, Feedback-Driven representation model. In this reflection, we explore how serving in this role shaped students' engagement and sense of belonging in our institution through the lived experience of representation. Drawing on Student Engagement Theory as an organizing lens, we analyze our experience and those of our peers across behavioral, emotional, and cognitive dimensions of engagement. Behaviorally, engagement was reinforced when student feedback led to visible and timely changes, demonstrating the legitimacy of the student voice and validating institutional responsiveness. Emotionally, representation functioned as a belonging cue as peers reported greater trust and psychological safety when concerns were voiced by fellow students rather than faculty. Cognitively, opacity (what students described as the "black box" of decision-making) provoked curiosity about institutional constraints and trade-offs, fostering systems-level thinking about curriculum design. Equally meaningful were the lessons we learned about ourselves. Serving as Course Reps required emotional labor we had not anticipated, including navigating the weight of peers' frustrations and advocating for diverse viewpoints we personally did not hold. Through this work, we discovered that representation can transform the representatives as much as those they represent, deepening our own sense of belonging, purpose, and agency. Our understanding evolved through sustained dialogue with classmates and our faculty mentor. By situating our lived experiences within the literature on student governance and belonging, we argue that Feedback-Driven representation systems do not just fix student concerns: they shape how students perceive their legitimacy and connection to their institution. Learners are important stakeholders whose insights and engagement meaningfully shape their educational experiences. When students are invited into authentic collaboration with faculty, they gain a sense of ownership in their education. For us, that sense of agency and belonging has been one of the most enduring lessons of medical school.
Engagement with interprofessional education (IPE) is essential to prepare health professions students for collaborative practice, yet the behavioral determinants shaping students' active participation remain insufficiently understood. This review conceptualizes engagement as a proximal behavioral construct reflecting students' cognitive, affective, and behavioral involvement in IPE activities. We employed the Theoretical Domains Framework (TDF) as it synthesizes behavior-change constructs into modifiable domains, enabling systematic identification of determinants and theory-informed targets for intervention. We searched six databases (PubMed®, Medline®, EMBASE®, CINAHL®, ProQuest®, and ERIC) for articles published between January 2010 and October 2024, with updates conducted to January 2026. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Crowe Critical Appraisal Tool. We synthesized reported enablers and barriers influencing student engagement using deductive content analysis and mapped them to TDF domains. We included 30 studies. We identified determinants of student engagement with IPE across 12 of the 14 TDF domains. The most commonly identified enabler was Social/Professional Role and Identity, particularly through role clarification, understanding of professional responsibilities, and recognition of complementary contributions within teams. Other frequently represented enablers included Environmental Context and Resources (e.g., structured clinical exposure, immersive placements, simulation, and repeated opportunities for interaction), Social Influences (e.g., facilitator support, peer relatedness, mentoring, and encouragement), Knowledge, Skills, Beliefs about Consequences, and Beliefs about Capabilities. We mapped barriers to nine TDF domains, with Social Influences emerging as the most common barrier, particularly through hierarchy, dominance of some professional groups, isolation, and lack of authority to speak up. Other common barriers included Environmental Context and Resources (e.g., limited time, scheduling conflicts, short placement duration, and workload pressures), Emotions (e.g., anxiety, defensiveness, and embarrassment), Knowledge (e.g., unclear expectations and limited understanding of other professional roles), and Beliefs about Capabilities (e.g., low self-confidence in contributing to interprofessional discussions). Student engagement with IPE is shaped by modifiable cognitive, affective, and contextual determinants. Mapping these influences through the TDF clarifies the behavioral mechanisms underpinning engagement and identifies theory-informed targets for the design and delivery of IPE interventions.
Medical education's pursuit of excellence often inadvertently fosters a "hidden curriculum" of perfectionism and shame. This culture can transform adaptive striving into maladaptive perfectionism, where a fear of failure leads learners to view mistakes not as growth opportunities but as evidence of moral failings and personal inadequacy. When errors inevitably occur, the potential result is shame or an identity-focused belief that "I am bad." The resulting isolation and self-doubt potentially can lead to imposter syndrome, burnout, and depression. This paper explores the critical role of shame-informed mentorship, an approach that recognizes how shame influences learner behavior and development. By responding with intentional strategies that preserve dignity, mentors can mitigate shame's potential impact and transform it into a catalyst for professional growth. We argue that by helping learners distinguish between corrosive shame ("I am the problem") and productive guilt ("I did something wrong"), mentors can facilitate behavioral change without damaging the learner's core identity. The paper offers practical, evidence-based strategies organized into three themes: Recognition-identifying "shame primers" such as perfectionistic histories and "shame triggers" like public questioning; Navigation-using validation, self-compassion, and the practice of "failing forward" to process active shame events; Cultivation-building long-term resilience through intellectual humility and the normalization of shared narratives. Collectively, these strategies provide a framework for intentionally building psychological safety and normalizing mistakes. By equipping mentors with tools to recognize and respond to shame, and by creating a culture that prioritizes formative feedback and a growth mindset, mentors can help transform shame from a destructive force into a catalyst for professional identity development and sustainable practice.
Medical students increasingly rely on third-party resources, or study tools developed outside of formal medical education institutions, to study for the US Medical Licensing Exams (USMLE). One such third-party resource is Anki, an online flashcard platform, and the AnKing, a premade deck created by a group of medical students. While prior scholarship has begun to analyze the content and benefits of such third-party resources, few have considered how not only the content but also the design and usage patterns of such resources may perpetuate medical knowledge that is harmful to patients. Trained in both medicine and history as an MD/PhD student, the author considers how expertise from the social sciences can inform our analysis of the process by which historical medical knowledge on race, health, and disease is developed, maintained through historical change, and passed down to current medical students. Sociological methods in Science and Technology Studies informed the analysis of Anki as a political technology, where social values are embedded in its design, typical use by students, and repair mechanisms, or how the technology is maintained and updated. The author accompanies her experience studying with AnKing from 2020 to 2022 with a systematic content analysis of AnKing's training videos and social media posts (March 2025-February 2026) and of the race-based medical content in the AnKing deck (Update #14, March 2025). Historical literature on race-based medicine informed analysis of emerging themes in the deck. Anki's design with a distinct question-and-answer format and its embedded values of speed and volume in usage patterns help form implicit associations, including between race and disease risk. Its repair mechanism via mass collaboration and self-reference to other third-party resources contribute to the perpetuation of historical concepts of race-based medicine. In AnKing, 0.5% of flashcards (202/42,629) contained references to differing diagnosis and treatment patterns among racial groups. Three major definitions of race appeared: racial groups as defined by differing prevalence of disease, race as a shortcut for genetic heritability, and race as a risk factor for disease. AnKing defines clearly demarcated biological racial categories as an individual patient characteristic that increases risk of disease, lacking the historical and social context which reveal the structural role of racism in health. By considering one popular third-party resource through the lens of the history and sociology of medicine, the author demonstrates how insights from the social sciences inform how medical knowledge develops, transforms over time, and continues to perpetuate within the contemporary educational environment.
Caregiving is a role students may have to fill while pursuing their medical degree. The scope of institutional support for US medical students who serve as caregivers has not been evaluated. This exploratory study's purpose was to evaluate and describe institutional support for student caregivers, identify gaps, and provide insights to support this student population. We assessed institutional support by searching the publicly available websites of 170 Association of American Medical Colleges (AAMC) accredited medical schools (and their associated university, as applicable) from January 2023 to April 2023 for caregiving support resources. We iteratively assigned a code to each identified resource and sorted codes into categories according to caregiving type: parenting, non-parental, and inclusive (parenting and non-parental caregiving). Out of the 170 medical schools evaluated, 87% (N = 148/170) had at least one resource of any category, 87% (N = 148/170) had at least one resource for parental caregivers, 6% (N = 10/170) had at least one inclusive resource, and 2% (N = 3/170) had at least one resource for non-parental caregivers. Further analysis of the resources revealed that across AAMC schools, there were 19 unique types of support provided. Although most US medical schools offer some support for caregiving students, available resources are predominantly parent-focused and do not adequately address the full range of caregiving roles. Lactation spaces, on-campus childcare, and support groups were most commonly offered, while resources for non-parental caregiving students were limited and inconsistently available. Our findings highlight current gaps in institutional support provided to caregiving medical students. Addressing these gaps is critical for promoting student success and retention and may be achieved through the development, implementation, and evaluation of inclusive caregiving resources.
