In the highly privatized United States primary care environment, physicians must attend to incommensurate logics of quality care. That is, they must attempt to holistically care for patients within a system that has been described as highly commodified and bureaucratically violent. I introduce the concept of institutional phronesis as a key component of the professional skills required to navigate this complex organizational environment. The article uses ethnographic insights garnered through 18 months at a rural medical center to demonstrate how primary care physicians experience disparate logics and seek to provide high-quality care through institutional phronesis in this setting. I close with recommendations for how institutional phronesis might be incorporated in physician professional development and continuing education.
A comment often made by reviewers (and editors) is that, despite having an interesting topic, an appropriate methodology, and interesting findings, the 'discussion' section of the manuscript they had to review was disappointing. Instead of offering a critical interpretation of the results or findings, the discussion section did not go beyond a summary of the results, such that the reviewer struggled to see what the study added to the existing body of knowledge. In this Q&Q, the discussion section in academic writing is placed under the spotlight. The role and purpose of this important part of an academic paper are explored, and ways in which authors can do justice to their findings considered.
In this editorial the editors consider asymmetries between review for the integrity of human ethics principles and review for theoretical integrity in health professions education scholarship.
Testing (i.e., the retrieval of information from memory) has been shown to improve retention of learning material in lab-based studies, classrooms, and in an array of medical education contexts. However, the magnitude of its effects are variable without full clarity regarding when or why stronger effects are found. This study explores the under-examined relationship between topic of study and the pedagogical benefits of testing across three research projects. Knowledge retention over a one-week interval was compared for those who undertook a test during learning vs. those who engaged in extended study in 3 separate experiments: (1) Renal and gastrointestinal materials, studied by N = 32 first year medical students; (2) Gastrointestinal materials presented with more or less effort towards integrating content, studied by N = 39 first year medical students; (3) Rheumatological materials that presented pathophysiology and clinical material in either integrated or separated fashion, studied by N = 109 undergraduate biology students. Across 8 distinct examinations of the mnemonic benefits of retrieval (with vs. without integration, with medical students or biology students, using a recall or a diagnostic accuracy outcome measure) test-enhanced learning effects were observed except for when gastrointestinal learning materials were studied. Various exploratory analyses were unable to account for why differences in topic were associated with differences in effect magnitude. While the literature exploring the effects of testing is justified in concluding it to be pedagogically beneficial, puzzles remain regarding the magnitude of effect that can be expected when learners study different topics. At worst it appears testing is innocuous, so its general advantage for learning justifies its continued use even while further research is needed to explore the extent of factors that influence retrieval-enhanced learning before best practices can be fully specified.
He et al. (2026) report that agreeableness and openness are indirectly associated with emotional intelligence (EI) through perceived group cohesion (GC) and perceived team emotional intelligence (TEI) among 344 health professions students completing an interprofessional education (IPE) course, and that attitudes toward IPE (ATIPE) moderate the GC→TEI path. This commentary raises three concerns. First, the estimated interaction is significantly negative in both models: the conditional association between GC and TEI, and the serial indirect effect, are strongest at low ATIPE and weakest at high ATIPE, as the Results correctly state. The Discussion nevertheless describes favorable attitudes as enhancing GC's impact on TEI (a directional contradiction), and the practical recommendations speak of maximizing and amplifying these effects in language that at minimum requires clarification. Second, assuming the supplementary appendices report conventional full-model F statistics for the analysis sample of 344, the R² and F values are numerically consistent with grade and discipline each entering the models as a single predictor, and cannot be reconciled with the stated dummy coding of a sample spanning seven disciplines; and the conditional effects are reproducible only under an unreported mean-centering of ATIPE. Third, statistical support for the TEI-only indirect effect is specification-dependent (present in Model 6 but not in Model 91), and the wording offered for the latter cannot explain the contrast between the two models. I outline why each point matters and which clarifications would resolve them.
Emotions play a central role in clinical decision-making, communication, empathy, and professional identity formation, yet medicine has traditionally privileged rationality and composure over engagement with emotional experience. Although health professions education has increasingly incorporated empathy, communication, and mindfulness-based interventions, these approaches tend to focus on discrete skills and behaviours without a coherent conceptual framework for understanding how clinicians interpret and respond to emotion. Meta-emotion may offer such a framework, but the construct remains inconsistently defined across philosophical, psychological, developmental, and educational literatures. This theoretical integrative review (TIR) examines how meta-emotion has been conceptualised across disciplines and explores its relevance to health professions education. Searches across eight databases identified literature addressing meta-emotion and related constructs. Selection focused on papers making substantive conceptual contributions, resulting in 34 studies included in the final synthesis. Analysis identified four broad paradigms conceptualising meta-emotion as experiential, evaluative, regulatory, or socialisation-oriented. Across these traditions, meta-emotion consistently involved reflexive engagement with emotional experience through processes of attention, interpretation, evaluation, and response. Rather than representing competing definitions, these paradigms appeared to reflect complementary dimensions of a broader phenomenon. The review proposes that meta-emotion is best understood as a socially and developmentally structured, belief-mediated system linking emotional awareness, interpretive frameworks, and regulatory responses. This formulation provides an integrative framework for understanding how clinicians make sense of emotional experience within professional and organisational contexts and offers a foundation for educational approaches that are attentive to emotional socialisation, reflexivity, and professional culture.
Health professions are experiencing a shortage of faculty, especially faculty from diverse ethnic and racial backgrounds. While research on recruitment and retention is well established, there is a gap in the evidence on the factors that influence the decision to pursue an academic career. This scoping review aimed to identify facilitators and barriers to choosing an academic career, identify findings specific to underrepresented minority (URM) populations, and identify theories and models used in this research. Following Arksey and O'Malley's scoping review framework, we searched four databases for articles (Arksey & O'Malley, 2005). We included empirical studies within higher education settings in English since 2000. We reviewed 119 publications, primarily from North America and Europe, spanning medicine, nursing, pharmacy, dentistry, engineering, and general PhD preparation. Examining facilitators and barriers, we identified the overarching concept of ecosystem with three themes: (1) opportunity, (2) value, and (3) productivity. Facilitators included organizational and interpersonal support, research and teaching opportunities, mentorship, and academic productivity. Barriers involved a lack of career pathway and insufficient support. Fluidity within the ecosystem across areas of opportunity, value, and productivity influenced learners' career decisions. Few articles focused on learners from underrepresented populations, although many noted this gap and identified it as an opportunity for future research. Most articles did not specify or utilize a theory or model. The model proposed can enable researchers to conduct research, especially to encourage underrepresented learners to consider academic careers and to build theory in this area.
Research in health professions education (HPE) frequently seeks insights from individuals who occupy senior positions of influence - leading scientists, clinicians, hospital executives, medical deans - whose decisions shape educational and institutional directions. Generating interview data with sufficient interpretive richness and depth in these settings can be challenging, and requires methodological approaches capable of moving beyond rehearsed organizational narratives to support nuanced, contextually situated accounts of decision-making, values and institutional processes. The HPE literature has limited practical, worked examples of how to conduct such interviews. Elite interviewing, a method widely used in political science and sociology, is a dialogic exchange designed to engage with influential individuals. In this paper, we examine elite interviewing as a methodological approach and, drawing on literature and a worked example of academic leadership in postgraduate medical education, we identify six interrelated elements: narrative framing, co-construction of knowledge, affective vulnerability, institutional critique, credibility building, and ethical reflexivity. While many of these elements will be familiar to researchers conducting high-quality interpretivist interviews, we argue they assume particular salience when interviewing senior academic leaders or other participants with institutional authority. Drawing on our worked example, we demonstrate how these elements shape the interview encounter and support depth, reflexivity and critical engagement during both the interview process and analysis. Our aim is to provide practical guidance for HPE researchers and demonstrate the potential of elite interviewing to enrich qualitative inquiry in contexts shaped by institutional authority, expertise and power.
Clinical reasoning research has predominantly conceptualised reasoning as individual cognition, yet contemporary clinical practice distributes reasoning across teams, tools, and time. This study examines collaborative clinical reasoning (CCR) as a social practice constituted through observable interactional mechanisms. Examining ICU teams as an epistemic extreme case—where high stakes and time pressure amplify reasoning practices present but less visible elsewhere—we ask: through what mechanisms do clinicians construct shared clinical understanding? Video-based microinteractional analysis of 27 h of naturally occurring ICU interaction across 18 encounters, of which 12 episodes were analysed in depth, identified three interactional mechanisms through which CCR is accomplished. Progressive clarification is a mechanism of shared problem construction through layered, profession-specific contributions. Conditional alignment is a mechanism of epistemic negotiation enabling hypothesis exploration while preserving team cohesion. Situated coordination is a mechanism of material–interactional coupling whereby spatial positioning and artifacts structure participation. These mechanisms represent candidate practices that may be noticed, supported, and potentially coached; their learnability was not directly tested in this observational study. By shifting the unit of analysis from individual cognition to interactional accomplishment, this study provides an empirically grounded foundation for understanding how collaborative reasoning may be supported and sustained through participation in clinical work.
Emotional intelligence (EI) is a cornerstone of effective teamwork in healthcare, yet the factors associated with it within interprofessional education (IPE) remain underexplored. This study constructs and validates a moderated chain mediation model to elucidate how personality traits, perceived group cohesion (GC), perceived team emotional intelligence (TEI), and individual EI interrelate across individual and team levels in IPE settings. It investigates how personality traits relate to team dynamics and how these dynamics, moderated by attitudes toward IPE (ATIPE), are linked to individual EI. A cross-sectional study was conducted in February 2025 with 344 health professions students (Mage = 21.3 years; 187 females) from four universities in Hong Kong, mainland China, and the United Kingdom, representing seven disciplines (e.g., medicine, nursing, Chinese medicine). Participants completed a three-week IPE course in randomly assigned teams. Data on demographics, personality traits, GC, TEI, EI, and ATIPE were collected via validated questionnaires. Confirmatory factor analysis ensured measurement validity, while descriptive statistics, correlational analysis, and PROCESS Models 6 and 91 tested mediation and moderation models. Agreeableness and openness were significantly and indirectly associated with individual EI through GC and TEI (Bagreeableness−EI model = 0.021, 95
Reflective assignments represent an important component in the suite of health professionals' assessments, supporting professional identity formation, workplace learning, uncertainty tolerance and critical knowledge application. However, assessment is complex. Marking and feedback can be highly time-consuming, cognitive and emotional. Associated emotions (anxiety, stress, frustration), if unregulated, can detract from working memory, reducing cognitive capacity and compromising performance, with implications for marking quality. Different epistemological conceptions of criticality in reflection further compound quality of marking. Collaborative conversation was used to explore the experiences of seven experienced educators and their perspectives on marking reflective writing. This feminist research methodology is employed to improve practice through socially co-constructed understanding of that practice, achieved by analysing experiences, emotions and relationships. The purpose of the research was focused on improving examiners' experience, with the anticipation that this would improve their practice and enhance the quality of the assessment, for example improving reliability or feedback. Amongst the participants, marking reflection incited anxieties about personal workload, as well as students' emotional responses to grades and marks being 'wrong' or judged poorly by moderators; they responded by reading each essay multiple times and repeatedly revising feedback. All participants described a contrasting experience in a course in which collaborative paired marking was introduced. Marking and feedback were then viewed as both a shared task and as professional self-development, framing marking as a learning activity. Within examiner pairs, sharing interpretations of criticality in reflection and collaborating on feedback and grading widened individual examiners' interpretations of high-quality work, resulted in perceptions of fairer marking, reduced emotional load, and reduced perceived workload by removing the multiple rechecking of marks and feedback. A collaborative, open approach is therefore advocated to improve the practice of assessing reflective work, including perceptions of improved grading reliability and quality of feedback.
Interprofessional education (IPE) has been widely endorsed as essential to collaborative practice, yet decades of implementation have yielded only modest and inconsistent improvements in clinician behaviour and patient outcomes. This Reflection contends that the persistent knowledge gap reflects a deeper structural problem: educational interventions are being asked to do work that organisational and regulatory systems actively obstruct. Using comparative analysis of health systems in Asia, where interprofessional collaborative practice (IPCP) has emerged as an operational necessity in high-acuity settings, we examine the conditions under which IPCP becomes embedded in everyday practice rather than confined to training programmes. The analysis points to four structural enablers warranting attention: alignment between educational and service-level expectations; clarity in task-sharing and scope-of-practice arrangements; dedicated investment in IPCP processes and time; and accountability systems sensitive to context. Addressing these enablers requires not the adoption of a single model, but a reciprocal exchange of insights across health systems with different organisational histories and cultural resources.
Medical education increasingly recognizes the need to prepare future physicians not only with biomedical expertise but also with the professional identities, skills, and reflexive capacities required to navigate uncertainty, complexity, and emotionally demanding clinical encounters. Drawing on scholarship on professional socialization and the emerging field of Graphic Medicine, this qualitative study explores how comics-enhanced education contributes to medical training. The paper reports findings from semi-structured, in-depth interviews with 14 North American medical and health professions educators who incorporate comics and graphic narratives into their teaching practices. Using a constructivist approach and template analysis, we examine educators' perspectives on the pedagogical value, limitations, and institutional challenges associated with comics-based teaching. Analysis revealed three interrelated themes describing the contribution of comics to medical education: Professional Identity formation, Professional Skills development, and Professional Implementation in clinical practice. Educators described how reading and creating comics supports students' reflection on their emerging professional identities, including emotional processing, ethical awareness, and coping with failure and uncertainty. Comics-based activities were also reported to enhance key professional skills such as empathy, communication (verbal and nonverbal), self-reflection, and awareness of bias and stigma. Finally, educators highlighted the potential of comics to improve professional practice by supporting patient-centered communication, health literacy, informed consent, and the destigmatization of illness.Despite challenges related to student resistance, institutional bias, and limited empirical evidence on outcomes, participants viewed comics as a valuable complement to traditional biomedical teaching. Overall, the study suggests that comics-enhanced education offers a creative and meaningful approach to fostering reflective, empathetic, and socially attuned medical professionals.
Research-based theatre (RbT) integrates research findings with performing arts to deliver a performance that informs, translates, and engages learners or audiences. Although not a new concept, RbT is growing in popularity within health professions education (HPE). A scoping review was conducted to map available literature regarding the methods used to inform RbT in HPE activities, as well as how they are used within education, training or curricula. The review followed Arksey and O’Malley’s six-stage framework and the Joanna Briggs Institute methodology. Studies that report on the use of RbT (concept) as an educational intervention (context) among health professionals or students (participants) were included. Multiple databases were searched (CINAHL, MeDLINE, PsycINFO, AMED, ERIC, Scopus, EMBASE, International bibliography of theatre and dance, and Web of Science). A total of 286 studies were retrieved. Following title and abstract screening, 71 studies were retrieved for full text review and 31 were included in the final review. Results were analysed and synthesised narratively. Most RbT interventions were aimed at qualified health professionals (HP) across 13 different professions. Performances were delivered to diverse audiences, including HP students, the public, and were often accompanied by post-performance discussion. Educational impact was widely reported, including increased awareness, empathy, and critical reflection, though learning measurement approaches varied. Research-based theatre has significant potential as an innovative tool for HPE, translating research findings into accessible, engaging educational formats. However, implementation is often obstructed by ambiguous terminology and a lack of transparent methodology available to HP researchers. Addressing these challenges by highlighting sustainable strategies, such as consistent terminology, opportunities for digital dissemination and collaborative design, is vital to maximizing reach and educational impact.
This essay challenges the assumption that high-stakes decisions in programmatic assessment for learning (PAL) are inherently intractable. We argue that much of their felt difficulty is diagnostically informative: it signals specific, and in principle modifiable, conditions of implementation. Two conditions are frequently under-developed: the narrative synthesis of assessment information, and the anticipation that decisions emerge from a documented trajectory rather than an isolated event. Where both are met, much of the difficulty specific to programmatic decision-making recedes. This is a position rather than a settled fact, and decisions can remain emotionally, relationally, and institutionally heavy even when well designed. We critique a measurement paradigm that treats competence as a single number and advocate a constructivist alternative in which competence is read as a narrative, while engaging rather than dismissing the psychometric tradition. We identify five institutional domains (value proposition, language, expectations, transparency, and integration) whose cultural transformation realises PAL's potential, while recognising that workload, infrastructure, governance, and faculty development bound what is feasible, as the uneven history of competency-based medical education warns. Generative AI is the essay's exigence: by making single-performance assessment newly fragile, it exposes the category error we describe and points to programmatic assessment as a structurally appropriate response. We close with five research priorities, from the phenomenology of non-surprise decisions to the assessment of human-AI collaboration.
This study examines the working and learning dynamics between resident doctors and senior nurses, with a focus on identifying factors that influence how resident doctors can learn more effectively from experienced nurses to enhance their training. A scoping review of current literature related to working experience between resident doctors and nurses was conducted using the PRISMA2009 checklist. This scoping review followed the JBI Preferred Reporting for Systematic Reviews and Meta-analysis for Scoping Review Checklists. Medline, CINAHL, PubMed and Scopus databases were searched. The review used key terms around junior doctors/resident doctors/trainee doctors, nurses, and interprofessional collaboration and learning. 22 articles across different country settings spanning 9-years were included in the final review. Critical realism-informed thematic analysis was used, and three themes were developed regarding forces shaping learning between resident doctors: organisational factors, professional factors and personal factors. These findings suggest that interprofessional workplace collaboration, learning and mentoring can take place between resident doctors and experienced nurses. However, the findings suggest that in order to be most effective, programmes should be formalised, should take workload and emotional labour into account, and should critically examine the professional norms and intersectional factors which might be detrimental to learning relationships.
BACKGROUND:Health professions education researchers have long emphasized evaluation, reform, and innovation, yet have paid comparatively little attention to the historical conditions under which educational practices, institutions, and forms of knowledge emerge and persist. Recurrent calls to historicize academic medicine signal recognition of this gap, but historical inquiry remains unevenly integrated into mainstream health professions education research (HPER). PURPOSE:This paper argues that historical research constitutes a distinct and valuable analytic approach for understanding contemporary challenges in health professions education. It further argues that historical inquiry can function as a strategic resource, informing institutional strategy, governance, and responses to disruption. APPROACH:Drawing on historiographic traditions attentive to context, power, and change, including genealogy and the history of the present, this article attempts to clarify what historical inquiry entails in health professions education research. It synthesizes prior calls for historical engagement, outlines key methodological features, and illustrates what historical analysis makes visible that present-focused qualitative or evaluative approaches often obscure. KEY INSIGHTS AND CONCLUSION:Historical analysis offers a valuable and complementary lens for HPER scholars. While historians have examined the institutions and people of health professions education, relatively little work has addressed the granular domain of HPER itself, leaving significant opportunities for future scholarship. As both an analytic and strategic resource, historical inquiry strengthens HPER's capacity for institutional learning, more grounded decision making, and future-oriented change. The argument is illustrated through an institutional case in which historical analysis informed a major self-study and strategic review.
The phrase, "Those who cannot remember the past are condemned to repeat it" is an argument for the study of history in medical education and learning lessons conveyed by past events. However, many in our health professions education (HPE) research community may not know how to approach research in this way, thus frequently excluding historical analyses in their work. In this article, we describe how HPE researchers could incorporate a basic historical analysis using a historiographical approach. Our goal is to make this research method accessible to scholars in HPE. The process is broken down into four key steps: chronicling sources, gathering and evaluating both primary and secondary sources, applying theoretical lenses to formulate an argument, and identifying the topic's relevance to contemporary issues. The article uses the historical case of "resurrectionists," or grave robbers, who supplied cadavers to medical schools for their anatomy labs, as a worked example to illustrate each step.
The article critically examines Georg Lind's Moral Competence Test, which is often used to assess the moral abilities of healthcare professionals and students. Test results have purportedly shown that students' moral competence declines during their studies; they have also failed to demonstrate the effectiveness of most ethics education methods. Based partly on Kohlberg's theory of moral development, the test presents moral dilemmas followed by arguments for and against the protagonists' decisions. Each argument corresponds to one of Kohlberg's stages of moral development. Participants rate how acceptable each argument is. They are assumed to have high moral competence if they rate arguments from the same stage similarly. The article argues that the test is valid only if three conditions are met: first; the stages of arguments are clearly identifiable; second, rating arguments of the same stage similarly is necessary to be consistent; and third, the scoring method avoids arbitrary effects and reflects the underlying theory. The discussion raises serious doubts about whether these conditions are met. Kohlberg himself noted that stages are often difficult to identify from brief statements. In addition, an analysis of the arguments using informal logic reveals that rating arguments of the same stage similarly is often inconsistent or not required. Lastly, the scoring method is overly sensitive to insignificant changes and insensitive to significant ones. These findings call into question many studies that have used the test to evaluate healthcare students' moral competence or to assess ethics teaching methods.
