Clerkship years form and re-form medical students' professional identities. Evidence suggests that students in longitudinal integrated clerkships (LICs) develop along a unique path, making the LIC model's impact on professional identity formation a rich area for discovery. This study explores the lived experience of former LIC students becoming a physician during the core clerkship year, across different LIC models and contexts. This qualitative study used a hermeneutic phenomenological frame. Former students of three different programs were invited to participate. Seventeen volunteers were interviewed using a semi-structured guide. The co-principal investigators read transcripts holistically, then analyzed them through regular discussion with each other and the study team, periodically returning to the transcripts to ensure the emerging narratives remained true to the participant Cognitive Load Theory provided a novel framework to interpret participants' descriptions of the LIC as the creation of space to learn and space to become. Longitudinal relationships allow teachers to tailor experiences for students and remove excessive pressure on students to perform optimizing intrinsic load and decreasing extraneous load. Relationship continuity with patients and teachers mitigates stress and burnout, further decreasing extraneous load. Optimizing intrinsic load and decreasing extraneous load each provides students with cognitive bandwidth (germane load) to reflect upon and develop their professional identity. LIC continuity principles, especially longitudinal relationships, are fundamental to professional identity formation across different LIC models/contexts through their impact on cognitive load.
Background: The challenge of providing timely, high-quality feedback to thousands of healthcare professionals enrolled in distance-based Family Medicine specialization programs in Brazil creates an opportunity for the implementation of artificial intelligence. This study evaluates the effectiveness of Large Language Models (LLMs) in assisting tutors with student assessment in these programs. Methods: We implemented GPT-4o to analyze student responses to practical challenges in a Family Medicine distance education course. The system was structured through dataset preparation (518 student responses), prompt engineering, fine-tuning, and Retrieval-Augmented Generation. Evaluation included: human expert assessment using a 5-item Likert questionnaire (n=26 responses); metrics-based analysis comparing text length between LLM and tutor feedback (n=104); semantic similarity analysis between tutor-and LLMgenerated texts (n=11); and comparison of scores assigned by tutors versus LLM (n=104). Results: Expert assessment showed high ratings for clarity (100% scoring "strongly agree") but lower scores regarding LLM's ability to replace tutors. LLM-generated feedback was significantly longer than tutors' (mean 190.11 vs. 109.69 words, p<.001). Semantic similarity between LLM and tutor responses was high (mean 85.92%). LLM-assigned scores differed slightly but significantly from tutor scores (mean 8.31 vs. 8.80, p<.001). Discussion: LLMs can generate clear, semantically aligned feedback and assign grades that approximate tutor scoring, offering a scalable enhancement to assessment in distance-based medical education. Nevertheless, they should be seen as a complement to human tutors rather than a replacement, especially where nuanced, contextualized guidance is required. Careful attention to regional language variation and domain-specific content will be essential for the safe, equitable integration of AI into continuing professional development. These findings are, however, limited by the use of data from a single Brazilian region and one course module, indicating the need for broader validation.
Background: Family Medicine (FM) residency training should include teaching on Indigeneity, Equity, Diversity, Inclusivity, Anti-Racism and Accessibility (I-EDIAA). Although lecture-style teaching sessions are a core component of residency training, little is known about how these sessions integrate principles of I-EDIAA. This research aims to explore how lecture teaching materials in a first year FM Residency Program integrate I-EDIAA. Methods: A qualitative descriptive study design was used. Data was collected from content of lecture teaching sessions for first-year residents at Queen's Department of FM Kingston and the Thousand Islands site for the 2023/2024 academic year. A content and thematic analysis was completed based on an equity style guide. Results: The sample included 54 lectures. 48 (89%) incorporated at least one key equity topic. Four themes emerged: 1) Diverse case representation, 2) Preferred language and terminology, 3) Identities as risk factors for health outcomes, and 4) Impact of identity on approach to clinical scenarios. Discussion: These findings highlight strengths in incorporating I-EDIAA in FM training, including diverse case representation and appropriate terminology. Areas for improvement are further inclusion of health equity considerations, in particular for Indigenous Peoples, and elucidation of structural factors relating to health equity and adverse health outcomes.
This manuscript describes the development, structure, and lessons learned at the Des Moines Area Interprofessional Education Collaborative (DMAIPEC). DMAIPEC is a regional, multi-institution partnership designed to prepare health professions students for collaborative, team-based care in an increasingly complex healthcare system. Grounded by the Institute of Medicine's call for improved teamwork and the Interprofessional Education Collaborative (IPEC) Core Competencies, DMAIPEC was formalized through a Memorandum of Understanding among five founding institutions in the Des Moines metropolitan area. The collaborative utilizes a shared governance model with rotating leadership, coordinated financial and in-kind support, and a centralized planning committee that designs and implements approximately 12 Interprofessional Education (IPE) activities that serves an average of 2,000 learners annually. Systematic processes align each activity with specific IPEC competencies and learner levels, incorporate structured reflection, and use common assessment items modeled for longitudinal use. Lessons have been learned and challenges have been met with collaborative solutions. DMAIPEC now represents a scalable, community integrated model of interprofessional education that operationalizes best practices in collaborative, patient-centered training and offers a framework for others to advance healthcare quality, safety, and workforce readiness through interprofessional learning.
Educators in the health professions are persistently exploring practical and engaging methods to introduce students to Indigenous health, aiming to cultivate curiosity, humility, and an understanding of structural issues. Traditional didactic sessions frequently fall short in adequately equipping learners for the emotional and intellectual challenges posed by topics such as colonization, inequity, and Indigenous experiences within the healthcare system. To tackle these obstacles, an interactive "pop-quiz" format was created as an introductory educational tool within a broader Indigenous health curriculum. While it is structured like a quiz, the primary goal of this approach is to ignite discussion, reveal underlying assumptions, and encourage reflective engagement rather than merely evaluate knowledge. Based on over ten years of experience with undergraduate medical students, residents, and faculty, this Practical Advice Paper illustrates how educators can implement a pop-quiz model to foster significant learning about Indigenous health. The paper details how to formulate questions that encourage reflection, create a safe learning environment, address learner resistance, and maintain a tone that balances seriousness with approachability. It provides recommendations for facilitating discussions, utilizing contextualized data, and wrapping up the session with organized self-reflection. The pop-quiz model is versatile and can be adapted to various teaching environments, proving to be an effective entry point for learners who may be unfamiliar with, apprehensive about, or resistant to Indigenous health topics. By anchoring the session in local contexts and adopting a relational facilitation approach, educators can develop initial learning experiences that invite students to engage more deeply with cultural safety, structural competency, and practices informed by reconciliation.
