Introduction: Understanding how physicians interpret their societal and institutional contexts remains crucial for addressing the complexities of professional identity. This study explores professional identity formation (PIF) in clinical medical education through learners’ narratives and the perspectives of their role models. Methods: Using a multi-center qualitative narrative design, data were collected from clinical-year medical students across accredited state and private medical faculties representing diverse geographical regions. Reflective narrative writing and in-depth interviews were analyzed through a staged contextual qualitative approach. Results: Findings indicate that PIF is shaped through the dynamic interplay between clinical environments, societal and systemic structures, role modelling, and learners’ reflective engagement. Narratives framed professional identity not only in terms of technical competence but also through relational, ethical, and humanistic dimensions. Contextual analysis revealed that tensions between service demands and educational engagement, hierarchy and learner agency, and technical efficiency and humanistic care significantly influenced identity development. Reflection and narrative meaning-making emerged as mediating processes through which learners interpreted and internalized these experiences. Discussion: Drawing on a socio-cultural paradigm informed by activity theory, the study proposes a conceptual framework positioning PIF as a relational and contextually mediated construction shaped by both planned and implicit learning processes. The findings underscore the need for medical education programs to intentionally integrate reflective, narrative, and context-sensitive approaches to support sustainable professional identity development.
Introduction: Entrustable Professional Activities (EPAs) represent an integral component of Competency-Based Medical Education (CBME). They provide a practical framework to assess a trainee’s readiness to perform clinical tasks with increasing independence. This study investigates trainees’ perceptions of EPAs, including benefits, obstacles, shifts in feedback culture, and changes in assumed responsibility using the Consolidated Framework for Implementation Research (CFIR) as a theoretical framework. Methods: We conducted a theory-informed qualitative study using semi-structured interviews with cardiology trainees in Switzerland to examine early implementation of Entrustable Professional Activities (EPAs). The study was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed using the Framework Method, drawing on CFIR to inform the deductive analysis while identifying context-specific aspects of participants’ experiences inductively. Results: We identified ten themes, of which the most prominent were ‘Impact of time constraints for EPA assessment’, ‘Incorporating EPAs into workflows’, ‘Satisfaction with EPA App’, and ‘Enhancement of Feedback through EPAs’. Trainees perceived the use of EPAs as increasing feedback opportunities but reported that their educational value depended largely on time availability, workflow integration, and supervisor engagement. Discussion: Our findings suggest that the implementation and educational value of EPAs depend not only on the introduction of EPA-based assessments themselves but also on the interaction between structural conditions and social factors. Based on these findings, we formulated seven recommendations for training sites implementing EPAs. These are: Carry out assessments carefully, assess EPAs at handover, allocate time for assessments, begin assessments early in postgraduate medical education, provide all affected parties with thorough training, improve didactic competencies and share responsibility of assessments.
Introduction: Journal editors-in-chief (EICs) play a central role in shaping scholarly publishing, yet little is known about how they understand and enact their roles. We explored how medical education journal EICs describe their roles in shaping the publication process. Methods: We conducted a qualitative study using thematic analysis of interviews with nine medical education journal EICs. The interviews were part of a broader investigation of publication timelines and explored editorial leadership and practices, including experiences during the COVID-19 pandemic. Participants’ accounts also provided insight into the broader work of leading a journal, which became the focus of the present analysis. Results: Participants described their work not as a set of discrete tasks, but as five interrelated roles: knowledge developer, proactive communicator, steward of time and energy, nurturer, and orchestrator. These roles were enacted simultaneously and often in tension, reflecting the need to balance scholarly rigor, relational commitments, and system constraints. EICs described actively shaping knowledge, orchestrating complex communication networks, safeguarding finite reviewer and editorial resources, supporting authors and editorial teams, and maintaining workflow continuity. Much of this work was characterized as invisible labor occurring behind the scenes and not captured in formal metrics. Participants also highlighted a structural tension between nurturing authors and stewarding limited resources, underscoring the challenges of sustaining both inclusivity and efficiency within a resource-constrained system. Discussion: This study offers a practice-informed framework for understanding EIC work as relational, strategic, and system-oriented. By making visible the often-invisible labor that underpins academic publishing, our findings challenge reductive conceptions of editorial work and highlight the need for training, support, and systemic changes to better align expectations for rigor, inclusivity, and sustainability.
Purpose: Practice variation across physicians is commonly attributed to idiosyncratic tendencies. What factors contribute to physicians’ practice variation in the disposition of children with asthma exacerbation? How do metrics demonstrating variation impact physicians and learners? Methods: In this social constructivist qualitative study, we interviewed 11 Pediatric Emergency Medicine attendings, purposively sampling across a spectrum of acute asthma exacerbation admission rates. Participants reflected on their recent care of patients with asthma, how they assess patients, and how they determine disposition. They were shown a de-identified funnel plot demonstrating disposition rates across the physician group and reflected on the 1) quality of the metric and 2) impact on practice. We used reflexive thematic analysis to describe patterns across the data that addressed the study’s research questions. Results: Participants cited factors at the patient, caregiver, clinical care team, clinical environment, and personal practice levels that might result in variation. Participants framed the ability to weigh these sometimes competing factors as a reflection of patient-centered care. But when presented with a group-level data display, participants were surprised by the variation, valued seeing how they practiced compared to peers, and sometimes expressed a willingness to alter their practices to be “nearer the mean.” Conclusions: Some variation in care may be driven by physician adaptive expertise, which is not fully captured through metric-driven nomothetic data. Though metrics are fundamental to understanding practice patterns, decontextualized aggregations of data may risk minimizing, or even framing as deviant, the expertise exercised by physicians when they weigh multiple factors in decision-making.
