Objective: Medical education should support the development of a professional identity. However, it is still unclear what exactly is meant by professional identity formation (PIF), how it proceeds, and how it can be specifically supported. Against this background, this workshop report describes an attempt by a group of experts to identify and evaluate learning objectives in NKLM 2.0 that could be relevant to PIF. The aims of this project were, on the one hand, to determine the extent to which PIF has been incorporated into the NKLM and, on the other hand, to analyze how PIF can be understood on the basis of PIF related learning objectives. Methodology: In a multi-stage, iterative process, a subgroup (N=6) of the GMA Committee on Professional Identity Formation identified PIF-relevant learning objectives in the NKLM and derived fundamental topics and distinctions from them. Results: Basically, a categorization into essential and associated learning objectives emerged, although the assessments of the participants regarding the assignment to the categories varied greatly. 130 learning objectives were marked and weighted as essential, 14 of which were classified as particularly relevant. The result was a weighted list of essential and associated learning objectives for the topic of PIF, as well as two fundamental, summarizing learning objectives in the areas of “role understanding” and “self-reflection”. Discussion: The selection and evaluation of learning objectives within the group were often heterogeneous. This illustrates that the topic of PIF has been vaguely defined to date and is obviously understood differently. In order to explicitly map PIF in the NKLM, the underlying learning objectives would have to be formulated more precisely. In addition, a theory-based definition of PIF would be helpful in order to revise the essential learning objectives and specify the boundaries of the topic.

Background Assessment plays an important role in teaching and learning medical communication. Formative assessment is increasingly recognised as a crucial tool for improving learning outcomes and supporting competence development. In this study, we developed and evaluated different versions of automated formative and summative feedback in an online situational judgement test of basic medical communication competence.Methods We developed four versions of task-based (formative) feedback, differing in their enrichment strategies (i.e. reflection prompts or expert explanations) and the timing of the feedback (i.e. immediate feedback or post-test feedback), and one performance-based (summative) version featuring a test-score profile. In a randomised controlled trial with N = 269 medical students, we evaluated the effects of feedback design on participants’ (i) motivation and (ii) cognitive factors (i.e. cognitive load), as well as on their (iii) feedback perception (e.g. fairness and usefulness of the feedback) and (iv) perceived benefits of the feedback, all of which influence learning. We tested the hypotheses that task-based feedback would be more effective than performance-based feedback (H1) and that task-based versions would have differential effects on the outcome variables (H2).Results Planned contrast analysis revealed that task-based feedback was not consistently more effective than performance-based feedback across all outcomes (H1). In line with H2, analyses of variance revealed differential effects of feedback enrichment and timing: expert explanations enhanced cognitive understanding and perceived feedback benefits, whereas post-test feedback improved motivational outcomes such as perceived competence and fairness.Conclusions The results highlight the complexity of determining an optimal feedback approach, as different implementations can have differential effects on the motivational and cognitive factors that further shape learning processes. The findings suggest that an optimal feedback approach depends on specific learning outcomes and student characteristics, highlighting the importance of careful selection of feedback strategies tailored to specific educational goals and contexts.

BACKGROUND:Much discussion currently surrounds the intense occupational stress of the practical year (the final year of medical school in Germany) and the early years of postgraduate medical training, yet the extent of subjectively experienced stress during the transition from medical school to postgraduate training has not been measured to date. METHODS:We conducted a longitudinal survey of medical students in their 9th and 10th semesters and in their practical year, with a 2-year follow-up. Data were acquired with the Maslach Burnout Inventory (MBI), the Trier Abbreviated Scale on Work-Life Balance, and questions about patient care. Trends were analyzed with linear mixed models. RESULTS:321 students participated; 216 (67.3%) were female. The mean values for exhaustion and depersonalization/loss of empathy rose over time, while personal performance remained steadily low. Classification in categories revealed a high level of emotional exhaustion in 10.3% of subjects, rising to 47.4% in the first year of postgraduate training. It also revealed that 43.6% of subjects exhibited a very high level of depersonalization/loss of empathy as early as the 9th semester of medical school, with a further rise at later times. Personal accomplishment was very low at the beginning in 48.7% of subjects, and then dropped even lower. Work-life balance declined from medical school to the practical year and continued to decline from the practical year to postgraduate training. CONCLUSION:The MBI scale scores were unfavorable at the outset and worsened over time, indicating high stress throughout. There is an urgent need to improve the structural framework of undergraduate and postgraduate medical education.

This essay argues that boundary situations-moments when illness compels a person to confront the limits of bodily and existential integrity-form a shared space between patients and caregivers. By foregrounding illness narratives, we show how story-telling repersonalises clinical diagnosis and restores the subjective 'I' often eclipsed by medical classification. Narrative medicine, grounded in the medical humanities, invites learners and practitioners to acknowledge vulnerability as a mutual condition rather than a professional risk. We propose a didactic shift in which educators speak not only of patients but of people with lived illness experience, while recognising physicians as individuals shaped by the experience of caring. Such reciprocity fosters trust, counters the hidden curriculum that could undermine empathy and weaves humanity into professional identity. Ultimately, illness narratives reveal medicine as an encounter between two vulnerable subjects, where empathy emerges from shared authenticity.

Aim: The CanMEDS framework of the Royal college of physicians and surgeons of Canada and its role profile were originally contrived for the training of specialist physicians. But they also deliver an ideal teaching content to engage undergraduate medical students with the examination of their own professional development as well as with the institutional and social expectations of physicians. Integrating the physician’s roles of CanMEDS into teaching can thus be recognized as an element of professional identity formation. As an example, the article presents a lecture series of the TUM Medical Education Center that implements the CanMEDS framework in its current version from 2015 into its teaching. Method: The article showcases the lecture series “Introduction to clinical medicine” that underwent a reconceptualization and gradual redesign starting with the 2022 winter semester. The general structure as well as content-specific outlines of the lecture series are presented in line with the respective roles of the CanMEDS framework. Special attention is payed to the applied teaching methods of the lecture series (impulse-based teaching, panel discussions, photo competition). Results: After currently two iterations assessments deliver a so far very positive résumé. Comprised of direct gradings as well as text comments by the students the evaluation offers first insights into the reception of the contents and methods (interactivity, reflective practice and duration). Conclusion: The positive feedback regarding the redesign so far is an encouragement for further adjustments in the chosen direction. A next step is to establish the used methods on a broader basis in lectures that involve elements of professional identity formation.

According to your guidelines, the personal narratives in the section "Reflective Practice" do not require an abstract.

Aim: The purpose of this review is to better understand the terminology of professional identity formation (PIF). Guided by the question: “How is PIF defined?”, the article aims at delivering an overview and an analysis of so far established ways of understanding PIF focusing on explicit definitions and main conceptual contributions. Method: A systematic literature search was conducted via MEDLINE and CINAHL. The PRISMA framework was used to support a comprehensive search strategy and screening. In a first step of our conceptual analysis texts were analyzed regarding explicit definitions. In a second analytical step the main foci of the articles as well as different elements of PIF definitions were analyzed by comparing the structure and content of the definitions. Results: 25 of 639 articles met the eligibility criteria. We identified three categories for a further conceptual analysis of the definitions according to the questions: (1) On which aspects of “becoming a physician” is PIF focusing? (2) What are further properties of PIF? (3) What is the result of PIF? Additionally, the main foci of the identified articles were taken into account. The main foci of the identified articles showed diverse intentions regarding PIF. Most often “values” and “norms” were focused aspects of definitions. Regarding further properties of PIF a variety of aspects are stated unsystematically. Possible results of PIF mentioned in or in the context of definitions are most frequently to “think, act, and feel like a physician”. Conclusion: The review and analysis offer an overview over ways to define PIF and typical elements. Contextualization of these results within the publication history of PIF will further the understanding of the term’s development as well as its potential for a more comprehensive definition.

Abstract Background Student mistakes are common in bedside teaching (BST) and can serve as important learning opportunities. However, little is known about how frequently mistakes occur in authentic clinical settings, what types of learning content they involve, and how teacher and patient presence shape teachers’ handling of these mistakes. This study investigated (RQ1) the relevance of learning content during student mistakes, (RQ2) associations between mistake types and teachers’ reactions, and (RQ3) whether patient presence influences clinical teachers’ responses to mistakes. Methods We conducted an observational study based on video recordings of 36 BST sessions across internal medicine, neurology, and orthopaedics (78.4 h). Using a hierarchical coding scheme, we identified mistakes, classified their learning content and mistake types, and coded teacher reactions as well as teacher and patient presence. Interrater reliability ranged from substantial to excellent. Descriptive statistics were used to determine the frequency of mistakes per hour and their distribution across the learning content. Associations between mistake types and teacher reactions were analysed via Spearman’s rank correlations (RQ2). Mann–Whitney U tests (RQ3) were used when examining whether teachers’ mistake-related behaviours differed depending on the presence or absence of the patient. Results Across all BST sessions, the students made an average of 4.9 mistakes per hour. Mistakes occurred most often during theoretical knowledge and clinical reasoning, predominantly as reproduction mistakes, whereas an incorrect application of skills was most frequent during clinical examination and case presentations. Teacher presence was positively associated with the number of observed mistakes, particularly reproduction mistakes. During the physical examination, the students were supervised for only 72% of the active practice time. Teachers’ reactions - including elaboration, directness of feedback, and time provided for correction - did not differ significantly depending on patient presence. Conclusions Student mistakes are common in BST and hold considerable didactic value; however, this value is not fully realised when supervision is inconsistent or when feedback remains limited. Enhancing clinical teachers’ capacity to detect errors, providing structured and supportive feedback, and adapting their approach to the presence of patients may strengthen their ability to learn from mistakes. Interventions that cultivate psychological safety and promote effective error-management practices could further improve the pedagogical quality of BST.

In recent decades, medical education research has increasingly investigated the subjectivity and viewpoints of (pre-service) healthcare professionals. A promising approach for exploring subjectivity is Q-methodology (Q). Q, which combines qualitative and quantitative methods, involves a card-sorting process in which participants are asked to sort statements into a (normal distribution) grid according to their preferences. Similar sorting patterns are then summarized into profiles and described narratively. A central element of this process is the design of the Q-sample - a set of statements representing a wide range of opinions, beliefs, or perspectives on the subject of study. The Q-sample is, therefore, critical for the success of a Q-study and requires precise development steps. Currently, these steps are only preliminarily described in the literature. The present paper addresses this gap by defining a seven-step approach to Q-sample design based on interview data. It offers a systematic and methodological approach that captures the diversity of viewpoints on a particular research topic. Building on a previous qualitative study, it demonstrates how to translate interview data into a Q-sample while ensuring coverage and balance through the use of a mapping technique. The paper also addresses the significance of editing and how to preserve the everyday language of participants when modifying the Q-sample to facilitate self-reference. A comprehensive overview of the criteria for designing a Q-sample is provided. Practical recommendations for selecting a Q-sample and implementing Q-methodology in medical education are offered, and potential challenges are discussed in detail.

Objective: The aim of this study was to qualitatively describe the relationships between the experience of meaningfulness, crises of meaning and the motivation of medical students. Methods: Semi-structured interviews using an interview guide with 20 students in the clinical study phase were analyzed using type-building qualitative content analysis according to Kuckartz. Results: Sources of professional meaning were identified as belonging and teamwork, performance and striving for development, autonomy, coherence and social relevance. Transition phases, pressure to perform, negative practical experiences and professional or system-related challenges were cited as inhibiting factors for a good experience of meaningfulness. The students reported that experiences of meaningfulness and crises of meaning had an impact on their motivation. Four specific student-types were elaborated, regarding the degree of motivation for their studies and later career entry, in professional meaningfulness and crises: Students with a calling had the strongest motivation and the highest experience of meaningfulness with hardly any crises of meaning. Students who are seekers had a high experience of meaningfulness, but their motivation was low due to crises of meaning, in contrast to students who are doubters, who also had a low experience of meaningfulness. Students who are work-to-live persons, despite low levels of experience of meaningfulness or crises of meaning, showed motivation for their studies and later careers. Conclusion: Students’ experiences of meaningfulness and crises of meaning were shown to be related to their motivation to study and later career entry. The proposed typology revealed individual accentuations of the students on how they can cope with experiences of meaningfulness and motivation. Further research is required to confirm the relationships found and to develop targeted interventions based on them.

Medizinische Kunst(fertigkeit) und Exzellenz können nicht allein in einem einzig auf die Vermittlung von Fachwissen und -können konzentrierten Medizinstudium aufgehen. Es bedarf der Förderung eines besonderen (selbst-)reflexiven und kritischen Verständnisses Studierender sowohl der (eigenen) persönlichen Entwicklung hin zur ärztlichen Profession als auch der Medizin selbst. Das aus einer seit den 2000er-Jahren geführten Professionalitätsdebatte hervorgegangene Konzept der Professional Identity Formation (PIF) setzt genau hier an, um ein entsprechendes Lehrangebot in medizinische Curricula zu implementieren. Der Artikel möchte die Bedeutung von PIF für die medizinische Ausbildung in drei Schritten zur Darstellung bringen: Eine historische Verortung zeichnet die Genese und Entwicklung des Konzepts nach. Anschließend werden die theoretischen Rahmenbedingungen und Kernelementen der PIF vorgestellt. Ein abschließender Blick auf die Umsetzung in der Lehrpraxis zeigt die didaktischen Potenziale und Gestaltungsoptionen auf.

This contribution investigates professional identity formation in medical education through the conceptual framework of transformative learning theory. Based on narrative interviews with clinical-phase medical students, the authors analyse how processes of reflection and meaning-making emerge from experiences of dissonance, uncertainty, and interaction. Employing the narrative-analytic approach of Lucius-Hoene and Deppermann (2002), the study foregrounds the linguistic and performative dimensions of students’ accounts as sites of transformation. In doing so, it demonstrates that the formation of professional identity is not a linear progression but a relational and discursive process continually negotiated in the everyday contexts of medical training.

Background This study evaluates the influence and longevity of a microsurgery course on the future careers of medical students over a period of up to 10 years. The course, which has been well-established for over 15 years, aimed to impart fundamental microsurgical skills through practical exercises using non-biological and biological models. Material and methods This study was conducted as an anonymous online cross-sectional survey. Only students who have completed a microsurgical training course at our department within a ten years period between 2013 and 2023 were eligible for this online survey. This survey aimed to analyze the subjective microsurgical skills at the time of the survey and the influence of the course on further career decisions and development. Results 300 former participants were eligible and 120 answered the survey. Key findings showed that 99.2% of participants rated the course content and the balance of practice to theory as appropriate, with 100% feeling confident in their microsurgical suturing abilities post-course. A significant 87.5% felt competent to perform vascular anastomoses, though only 63.9% felt confident about nerve coaptation. Statistical analysis indicated no significant gender differences in course evaluations, though some differences were noted between semester-accompanying and block course participants. 54.2% of respondents reported using their microsurgical skills in their subsequent medical careers, and 50.4% indicated that the course influenced their medical specialization choices. Conclusions The study concludes that early exposure to microsurgical training can significantly impact students’ skills and career trajectories, supporting the integration of such courses into medical education curricula to enhance surgical training and professional development.

Objective: The development of didactic skills plays a relatively subordinate role in medical training. However, teaching makes a central contribution to the training of young physicians and is an important part of the profession. In the present study, we therefore examine the question of how physicians’ teaching-related self-efficacy is related to aspects of their general job-related well-being. This construct is measured via the three components job satisfaction, job motivation and emotional exhaustion. From the results, we derive starting points for measures to increase the teaching-related self-efficacy of lecturers and the quality of teaching in clinical settings in the future. Method: Between 10/2016 and 09/2018, participants in university didactics training courses for medical lecturers at the Technical University of Munich (TUM) University Hospital were surveyed in writing. On this basis, we were able to analyze data from 293 participating physicians. We examined the assumed connections between teaching-related self-efficacy and emotional exhaustion, job satisfaction, and job motivation using Pearson correlations. For the relation to teaching experience, we calculated a Spearman correlation. We examined by t-test a possible difference in teaching-related self-efficacy between physicians who had received didactic training prior to our training vs. those who had not. Results: The study showed a statistically significant correlation between teaching-related self-efficacy and job satisfaction (r=0.138; p=0.020) as well as with job motivation (r=0.278; p<0.001). There was no statistically significant correlation with emotional exhaustion (r=-0.087; p=0.147) at work. Furthermore, teaching experience correlated positively with teaching-related self-efficacy (ρ=0.186; p=0.002) and physicians rated themselves significantly more self-efficacious in teaching if they had previously completed didactics training (t(282)=2.684, p=0.008). Conclusion: The teaching-related self-efficacy of physicians teaching at university correlated closely with the aspects of job satisfaction and job motivation, but not with emotional exhaustion. These findings offer starting points for interventional studies to investigate causal relationships that foster approaches to promote physicians’ teaching-related self-efficacy.

Self-reflection and e-learning represent two recent shifts in medical education, offering benefits for teaching clinical communication, a core component of medical training. Integrating reflection exercises into e-learning environments can encourage students to engage deeply with course content and their own experiences, fostering self-awareness, novel insights, and professional growth. However, few studies have explored how online learning environments might support students in reflecting on their learning experiences. In particular, research is lacking on how medical students perceive their learning experiences in online environments, including reflection, especially in the context of clinical communication training. This study examines how students approached structured reflective writing within an e-learning course on physician-patient communication to explore (I) the learning content addressed in students’ reflections and (II) the insights students gained through the course. First-year clinical medical students (n = 55) participated in an e-learning course, which consisted of three modules: communication basics, consultation structuring, and empathy and emotions. Each module included three guided prompts to encourage reflection. All participants composed nine written reflections. Qualitative thematic analysis of all 495 reflective texts was conducted to identify themes and insights. The students engaged with core communication topics and developed greater self-awareness regarding their communicative practice. The reflections revealed challenges, perceived skill gaps, and new understanding. Five core themes were identified: 1. patient-centred communication, 2. conversation structure, 3. emotions, 4. learning experiences, and 5. attitudes. Themes 1–3 primarily described specific learning content and were closely related to the first research question, while themes 4 and 5 encompassed broader reflections on personal and professional development as well as intentions to apply lessons learnt in future practice, predominantly addressing the second research question. Our findings demonstrate that reflective writing within our e-learning fostered students’ metacognitive engagement, enhanced their awareness of communication nuances, and supported transformative learning processes. Students not only recalled central course content but additionally explored topics such as dealing with their own uncertainty by examining their beliefs, attitudes, and challenges, recognising the role of communication in professional development. These findings align with previous research and highlight the potential of reflective writing to bridge theory and practice, contributing to students’ growth as empathetic and resilient healthcare professionals.

BEYOND THE ROLE:WHO WE CAN TRULY BE AS DOCTORS. WHY PROFESSIONAL IDENTITY FORMATION IS MORE THAN KNOWLEDGE AND SKILLS: How do we become - and remain - the kind of doctors we truly aspire to be? This article explores how self-reflection and teaching methods from narrative medicine can open up space for developing a professional identity within medical training. From clinical, educational, and lived illness perspectives, the authors argue that vulnerability, subjectivity, and humanity are fundamental to the medical profession.

BACKGROUND:Medical communication is a core task of physicians, and its quality affects both patients and physicians. Hence, the teaching and measurement of medical communication competence (MCC) are crucial during medical studies. This study aims to explore the factorial and construct validity of the Video-Based Assessment of Medical Communication Competence (VA-MeCo), an online-situational judgement test (SJT) designed to measure three aspects of medical students' communication competence in patient encounters: advancing content, providing structure, and building relationship. METHODS:We conducted an online survey with N = 395 medical students. Factorial validity was tested by confirmatory factor analysis (CFA). To investigate convergent and discriminant aspects of construct validity, we tested correlations of participants' VA-MeCo sub-test scores with scores in relevant cognitive variables, patient-interaction, and general personality traits. RESULTS:The CFA confirmed the expected three-dimensional factorial structure showing good model fit and highly correlated dimensions. A McDonald's Ω of.94 for the complete test and >.81 for the sub-scales indicated high reliability. Regarding construct validity, the directions of the correlations were in line with the theoretically assumed associations; correlation sizes partly deviated from our expectations. CONCLUSIONS:The results support that MCC can be validly measured using the VA-MeCo. The CFA results align with theory and previous studies that proposed three distinguishable dimensions of MCC. The findings on convergent and discriminant validity demonstrate that the test measures MCC as a specific construct that is positively related to patient-interaction; moreover, it can be distinguished from related but more generic constructs (e.g., social competence) and is not overly confounded with construct-irrelevant traits (e.g., intelligence). Notwithstanding the need for further validation, the results indicate that the VA-MeCo is a useful test for assessing MCC in medical education.

BACKGROUND: Medical students, often high-achieving and motivated, face unique challenges as they transition to clinical practice. This professional identity formation process requires adapting to patient contact, clinical reasoning, and high-stakes assessments such as OSCEs. Alongside these demands, students struggle with perfectionist expectations, heavy workloads, and patient responsibilities, leading to fears of failure, inadequacy, or professional unpreparedness. International research shows recurring concerns, including breaking bad news, managing patients, and feelings of exclusion among international students. However, existing studies are limited by their cross-sectional focus and site-specific scope, lacking longitudinal data or cross-country comparisons. Addressing this gap is crucial for understanding how concerns evolve over time and for shaping unified, high-quality medical education. This study aims to explore medical students’ fears across different countries. METHODS: In this study, we assessed the answers of medical students to the question, “What are you not looking forward to in your future job as a doctor?” This question was part of four questions of a longitudinal international survey aiming at students at the beginning and again towards the end of their studies. We analyzed responses given by medical students at the start of their studies at Ludwig-Maximilians University in Germany (LMU), Utrecht University in the Netherlands (UU), Karolinska Institutet in Sweden (KI) and the University of Nicosia in Cyprus (UNIC). A combination of qualitative analysis and hierarchical cluster analysis was used to identify recurring concerns, assess their importance, and examine differences based on university, gender, and societal context. RESULTS: A total of 2048 responses were collected between 2017 and 2021. The analysis identified two predominant categories: “stress” and “working conditions”. The category “failure” ranked third overall, though it did not appear among the top four response categories at LMU. Ranks 3 and 4 consisted of the categories “healthcare system”, “hierarchy”, “bad news” and “work-life balance”. The distribution of these categories varied between countries. CONCLUSIONS: Quantifying students’ concerns and their prevalence enables international comparisons and highlights critical factors to address through systemic reforms targeted interventions. These findings provide valuable insights for improving students’ preparedness for medical practice.

Abstract Background Rural areas are increasingly moving back into the focus of social research, especially in the context of health care. As the shortage of general practitioners (GP) in rural areas is a significant challenge in Germany, there are several programs to counteract underuse effectively, acutely, and sustainably. One of those programs is ’Beste Landpartie Allgemeinmedizin’ (BeLA), which was developed to strengthen primary care in rural areas and to sustainably promote young doctors to work as general practitioners in rural regions through didactical and financial support. The program includes an accompanying qualitative study exploring the motivational structures of medical students from a sociological perspective. For this study, the nexus of working in rural areas from the perspective of medical students with different forms of rural experiences was of interest. Methods Qualitative interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed using the sociological conceptual framework of spatial methods. Results The images and experiences of working in rural areas condition medical education in various ways. In addition to general images of living and working in rural areas in a biographical dimension, the idea of working as a GP in rural areas includes images of specific medical competencies and is conditioned by different medical tasks. From such a perspective, the images and attributions of working in primary care in a rural region demonstrate particularities, challenges, and the potential attractiveness of working in rural regions. Discussion The images and experiences of rural areas condition medical education in various ways and shape the expectations and the decision-making of possibly working in rural areas. The particularities, opportunities, and challenges of working in rural areas, which relate to both professional aspects and social life, are a major factor in the attractiveness of a potential rural practice. Didactical and educational curricula need to adapt the various attributions of working in rural areas.