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Medical parasitology, as a course bridging basic medical sciences and clinical medicine, has an important disciplinary value in the medical education system. This study investigated the composition of parasitology teachers from multiple medical colleges and universities across China. The results showed that there was a significant difference in the proportion of teachers with clinical medicine background knowledge, and there was common dilemma that there were insufficient clinical medicine knowledge reserves among teachers in some medical colleges and universities, who encountered severe teaching challenges. Based on this issue, this study constructed a basic-clinical medicine collaborative problem-based learning (PBL) teaching model. This model integrated theoretical teaching, case analyses, and experimental operations, and combined transdisciplinary team building and multidimensional teacher training, which significantly improved the clinical teaching capability among parasitology teachers, and effectively compensated the impact of insufficient clinical medicine knowledge reserves on teaching. Following teaching reform, students' scores significantly improved, and their case analysis capability enhanced. This study provides a practical path to address the shortage of clinical medicine background knowledge among parasitology teachers, which facilitates the progress of educational reform of medical parasitology and improvement of teaching quality. ［摘要］ 医学寄生虫学作为基础医学与临床医学之间的桥梁课程, 在医学教育体系中具有重要的学科价值。本研究调 研了我国多所医学院校寄生虫学专业教师的师资构成, 结果显示各院校具有临床医学背景知识的教师比例存在显著差 异, 部分院校师资队伍临床知识储备不足已成为普遍困境, 并面临严峻的教学挑战。基于此, 本研究构建了基础-临床协 同的问题导向学习 (problem-based learning, PBL) 教学模式, 并通过有机整合理论教学、案例分析和实验操作, 同时结合跨 学科团队建设和多维度师资培训, 显著提升了寄生虫学专业教师的临床教学能力, 有效弥补了临床知识储备不足对教学 的影响。教学模式改革后学生成绩显著提高, 病例分析能力增强。本研究为破解寄生虫学专业教师临床医学背景知识 短缺的困境提供了实践路径, 有助于推进医学寄生虫学教学改革与教学质量提升。.

Medical education aims to prepare future physicians for high-quality patient care. This prospective study examines the perceptions of medical students and clinical teachers with regard to teaching in otorhinolaryngology (ENT) clinical rotations. The objective is to identify discrepancies between the perceptions of students and clinical teachers and their potential impact on overall satisfaction with the learning and teaching process. During a two-week ENT rotation, medical students were obliged to attend seven different seminars. At the end of each seminar, both the students and their teachers were asked to evaluate the seminar using a standardized questionnaire. A total of 1139 questionnaires (n = 1089 students and n = 50 teachers) were collected. Data analysis included a descriptive evaluation and a comparison between the two groups using the Mann-Whitney U test and Cliff’s delta. The evaluation revealed a positive perception of teaching as measured by high overall scores, with students averaging 13.2 (± 1.7) and teachers 13.4 (± 1.1) out of a maximum grade of 15. Our analysis revealed no statistically significant disparities in the majority of the question items relating to perceptions between students and clinical teachers. Statistically, highly significant differences with relevant effect sizes were only applicable for the question items: Preparation, Participation by Schedule and Understandable Explanations. Our analysis suggests that there is a high level of agreement between students and teachers in terms of perception and satisfaction. The discrepancies in the areas of Preparation, Participation by Schedule, and Understandable Explanations relate to the nature of student-teacher interactions. This indicates that even when overall perceptions are positive, the interactions between students and clinical teachers may still be viewed differently, highlighting an opportunity for improvement. Our study shows that medical students and clinical teachers largely share similar perceptions of teaching and learning in practical ENT seminars. Differences were limited to Preparation, Participation by Schedule, and Understandable Explanations. Addressing these discrepancies through improved communication may help optimize the learning environment. The online version contains supplementary material available at 10.1186/s13104-026-07802-w.

The study evaluated the effectiveness of generative artificial intelligence (GAI)-assisted teaching methods on the medical educational outcomes. Following the PRISMA guidelines, a systematic search was conducted for literature on AI-assisted educational interventions in medical education (e.g. clinical, nursing and dentistry medicine). PROSPERO registration number was CRD420251173150. Meta-analyses of the outcomes were performed using the Review Manager 5.4. Heterogeneity was evaluated using the I 2 statistic and Cochran's Q test. A forest plot, Egger's test and the trim-and-fill method were used to evaluate publication bias and robustness. A total of 5,764 publications was initially retrieved, of which 78 studies involving 3,635 medical students in the GAI-assisted teaching group and 3,931 medical students in the control group were included. The pooled results revealed that GAI-assisted teaching significantly improved academic performance in terms of both knowledge (SMD = 0.95, 95% CI: 0.72-1.18, p < 0.05) and practical (SMD = 1.48, 95% CI: 1.20-1.77, p < 0.05) scores, compared to the control group. Additional benefits included improved student satisfaction (SMD = 1.52, 95% CI: 1.01-2.02, p < 0.05), self-efficacy in learning (SMD = 0.75, 95% CI: 0.17-1.32, p < 0.05), learning initiative (SMD = 1.20, 95% CI: 0.10-2.30, p < 0.05), self-directed learning ability (SMD = 1.25, 95% CI: 0.81-1.69, p < 0.05), clinical thinking ability (SMD = 1.18, 95% CI: 0.86-1.50, p < 0.05) and analytical and problem-solving skills (SMD = 1.53, 95% CI: 0.77-2.29, p < 0.05). The results showed that the GAI-assisted teaching could improve efficiently various aspects of education outcomes for medical students, including academic performance, self-efficacy and initiative in learning, and skills development. In future, policymakers should consider integrating artificial intelligence into teacher training and medical curriculum design to improve learning outcomes.

The present study aimed at the early detection of Polish teacher education students vulnerable to burnout and occupational health issues, using the work-related coping behavior and experience patterns (Arbeitsbezogenes Verhaltens- und Erlebensmuster - AVEM) diagnostic inventory to identify risk work-related patterns (the excessively ambitious pattern A and the resigned pattern B). Participants were 431 full-time first-year teacher education students enrolled at various higher education institutions in Poland. They completed a survey including the AVEM inventory, the Motivation for Choosing Teacher Education Questionnaire, the intrinsic religiosity subscale of the Duke University Religion Index, and the revised Life Orientation Test. The predictive values of background variables, attitudes toward teaching and teacher education, career choice motivation, intrinsic religiosity, and dispositional optimism for assignment to the work-related patterns were examined using multinomial logistic regression, with the healthy ambitious pattern G serving as the reference group. A total of 59.63% of participants were assigned to risk patterns indicating increased vulnerability to burnout and occupational health issues. Older students were less likely to be assigned to pattern A (b = -1.28, p < 0.05), whereas those working longer hours alongside their studies were more likely to be assigned to pattern A (b = 1.09, p < 0.05). Students who identified teacher education as their most preferred study choice (b = -6.58, p < 0.05) were less likely to be assigned to pattern B, as were those who chose teacher education based on ability belief (b = -1.61, p < 0.05). Higher levels of optimism protected against both pattern A (b = -3.99, p < 0.001) and pattern B (b = -4.71, p < 0.001). It is necessary to implement preventive measures to reduce long-term health risks in future teachers. However, the results should be interpreted with caution due to study limitations, such as the use of purposive sampling. Med Pr Work Health Saf. 2026;77(2):119-136.

In recent years, the frequent occurrence of public health emergencies has posed serious threats to human health, leading to a broad international consensus on the necessity of enhancing national health literacy. In response, the Chinese government has integrated health education into the national education system as a key strategic measure aimed at improving population health. The health literacy level of physical education (PE) teachers, who serve as primary agents in implementing school-based health education, is essential for ensuring the delivery of high-quality health education. Functional health literacy, as the foundational component of overall health literacy, plays a critical role in the development and enhancement of individual health competencies. In this study, we developed a structural model of functional health literacy specific to Chinese PE teachers, aiming to evaluate their own literacy levels and their contributions to school-based health education. Qualitative data were primarily collected through semi-structured interviews. A total of 16 PE teachers from 11 provinces across China mainland were purposively selected as study participants. We employed a grounded theory technical approach to analyze the data using NVIVO 20.0 qualitative analysis software. The functional health literacy model for PE teachers comprises four core dimensions: reading and understanding health knowledge, numerating and calculating health data, communicating and appreciating health performance, recognizing and valuing health values. Reading and understanding health knowledge contains four categories: Health and safety emergency method, health concepts and general knowledge, sports-related health knowledge, medical health knowledge. Numerating and calculating health data include two categories: body mass index and indicators, physical fitness test data. Communicating and appreciating health performance contains three categories: health communication, health identification, health performance. Recognizing and valuing health values contains two categories: health responsibility awareness, significance and value of health. The proposed model offers a theoretical framework to support the professional transition of Chinese PE teachers into dual-role educators specializing in both physical education and health instruction. Applying this model with teacher education programs is expected to enhance the quality and effectiveness of health education in Chinese primary and secondary schools.

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Based on the job demands-resources model and conservation of resources theory, this study examines the association between physical activity and teacher burnout among primary and secondary school physical education teachers, focusing on the mediating roles of mindfulness and spiritual wellbeing. A cross-sectional design was employed to conduct a questionnaire survey among 313 primary and secondary school physical education teachers. Physical activity, mindfulness, spiritual wellbeing, and teacher burnout were assessed using validated scales. Hierarchical multiple regression and bootstrap-based serial mediation analysis (PROCESS Model 6) were employed to test the hypothesized serial mediation model. The results showed that physical activity was associated with teacher burnout through three indirect pathways: (1) the mediating role of mindfulness (Effect = -0.046); (2) the mediating role of spiritual wellbeing (Effect = -0.038); and (3) the sequential mediating role of mindfulness and spiritual wellbeing (Effect = -0.039). The total indirect effect was -0.123. The findings suggest that higher physical activity is associated with lower teacher burnout through both independent and sequential associations involving mindfulness and spiritual wellbeing. These findings should be interpreted cautiously, as the cross-sectional design does not permit causal inference. Nevertheless, the results highlight a potentially meaningful psychological resource pattern that may inform future intervention and longitudinal research.

Transferring and scaling school-based physical activity (PA) programs across educational contexts requires systematic adaptation to ensure implementation feasibility and contextual fit. This study examined Danish physical education (PE) teachers' preconceptions for resistance training and a participatory co-adaptation process used to adapt the evidence-based Resistance Training for Teens (RT4T) program for implementation in Danish lower secondary schools. MEGAFiT, a Danish adaptation of RT4T, was developed using a sequential qualitative design. We conducted six online group interviews with 19 PE teachers and analysed data using the COM-B model to identify key implementation determinants related to capability, opportunity, and motivation. These findings informed four participatory co-adaptation workshops with 14 PE teachers, combining practical testing, reflection, and iterative program refinement. The resulting MEGAFiT program was structured as a six-week PE course consisting of modular, equipment-light resistance training sessions designed to integrate with PE content. Adaptations were documented using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME). Teachers' capability and confidence to deliver resistance training varied substantially and were closely linked to prior experience. Key implementation barriers included limited lesson time, large class size, and restricted access to facilities and equipment. During the co-adaptation process, teachers and researchers collaboratively refined the program by shortening its duration, introducing modular lesson structures, developing equipment-light exercise formats, and redesigning instructional materials to improve usability in PE settings. Explicitly addressing implementer preconceptions through structured co-adaptation strengthened the alignment between the RT4T program and the Danish school context. The findings illustrate how participatory adaptation can help tailor evidence-based PA programs to everyday PE practice by aligning program structure, organization, and materials with teachers' capabilities and contextual constraints.

Academic abuse remains a concerning and under-recognized factor affecting medical students' well-being and academic achievement. Empowerment, on the other hand, may mitigate negative experiences and enhance performance. This study aimed to examine the relationship between academic abuse, empowerment, and academic performance among medical students in a Latin American setting. A cross-sectional study was conducted among 255 medical students at a private university in Lima, Peru. Participants were selected using stratified sampling by year of study. Academic performance was assessed using the RAU Scale, academic abuse through the Teacher Abuse Questionnaire, and empowerment using the Instrument of Perception of Empowerment (IPE). A Poisson regression model with robust variance was used to directly estimate prevalence ratios (PR) and their corresponding 95% confidence intervals (95% CI). The model included academic abuse and its dimensions as the main explanatory variables and was subsequently adjusted for sociodemographic and academic covariates (sex, age, nationality, and having failed a subject). Of the participants, 72.2% exhibited adequate academic performance, while 76.5% reported low levels of abuse and over 90% demonstrated high empowerment. Multivariate analysis after adjustment showed that high academic abuse (PR&#x2009;=&#x2009;0.84; 95% CI: 0.74-0.96; p&#x2009;=&#x2009;0.011) and female sex (PR&#x2009;=&#x2009;0.81; 95% CI: 0.69-0.94; p&#x2009;=&#x2009;0.005) were associated with a lower probability of adequate academic performance, whereas older age (PR&#x2009;=&#x2009;1.02; 95% CI: 1.00-1.03; p&#x2009;=&#x2009;0.013), Peruvian nationality (PR&#x2009;=&#x2009;1.16; 95% CI: 1.02-1.33; p&#x2009;=&#x2009;0.028), and having failed at least one subject (PR&#x2009;=&#x2009;1.21; 95% CI: 1.05-1.39; p&#x2009;=&#x2009;0.008), were associated with a higher probability of adequate academic performance. Academic empowerment did not show a statistically significant association with academic performance after adjustment for covariates. Academic abuse negatively impacts student performance, while empowerment appears to be widespread yet insufficient to fully buffer these effects. Addressing academic mistreatment and fostering a supportive and empowering educational environment should be priorities in medical education reform.

Shame is an unpleasant, activating emotion that has been shown to undermine learners' motivation and achievement and identity development in mathematics education. Recent studies have implemented positive psychology interventions (PPIs) to reduce preservice teachers' shame in mathematics, with promising quantitative outcomes. However, little is known about how such interventions operate within learners' emotional and social contexts. This study aimed to replicate a PPI with preservice primary teachers, explicitly examining the social dynamics and individual experiences involved in reducing shame. Ninety-nine students participated and were randomly assigned to an experimental group (nEG&#x2009;=&#x2009;51) or a control group (nCG&#x2009;=&#x2009;48). Using a mixed-methods design (including an RCT in the quantitative part), we assessed changes in mathematics-related shame and qualitatively explored preservice teachers' emotional and relational experiences throughout the intervention. Findings show a significant reduction in shame in the experimental group compared to the control group, with a medium effect size (Cohen's d&#x2009;=&#x2009;.54). Self-efficacy or social integration did not moderate this effect. Qualitative analyses reveal that changes in shame were closely tied to students' experiences of pleasant emotions, social relations and shifts in self-perception as mathematics learners. Our findings underscore the importance of social-emotional processes in understanding the impact of interventions. We argue that targeting shame in teacher education requires emotional and social support as well as cognitive support to foster sustainable competence and self-development in mathematics.

Medical image segmentation is challenging due to the diversity of medical images and the lack of labeled data, which motivates recent developments in federated semi-supervised learning (FSSL) to leverage a large amount of unlabeled data from multiple centers for model training without sharing raw data. However, what remains under-explored in FSSL is the domain shift problem which may cause suboptimal model aggregation and low effectiveness of the utilization of unlabeled data, eventually leading to unsatisfactory performance in unseen domains. In this paper, we explore this previously ignored scenario, namely domain generalized federated semi-supervised learning (FedSemiDG), which aims to learn a model in a distributed manner from multiple domains with limited labeled data and abundant unlabeled data such that the model can generalize well to unseen domains. We present a novel framework, Federated Generalization-Aware Semi-Supervised Learning (FGASL), to address the challenges in FedSemiDG by effectively tackling critical issues at both global and local levels. In our proposed framework, globally, we introduce Generalization-Aware Aggregation (GAA), assigning adaptive weights to local models based on their generalization performance. Locally, we use a Dual-Teacher Adaptive Pseudo Label Refinement (DR) strategy to combine global and domain-specific knowledge, generating more reliable pseudo labels. Additionally, Perturbation-Invariant Alignment (PIA) enforces feature consistency under perturbations, promoting domain-invariant learning. Extensive experiments on four medical segmentation tasks (cardiac MRI, spine MRI, bladder cancer MRI and colorectal polyp) demonstrate that our method significantly outperforms state-of-the-art FSSL and domain generalization approaches, achieving robust generalization on unseen domains. This work provides a practical solution for addressing domain shifts in federated semi-supervised learning, advancing multi-center collaboration in privacy-sensitive healthcare applications. The code will be made public upon acceptance.

To address the limitations of traditional linear tools in predicting teacher occupational stress, this study aimed to develop and validate machine learning models using easily obtainable, self-reported data. A cross-sectional study of 2,832 in-service teachers in Lanzhou, China, was conducted. The presence of occupational stress, defined by the Core Occupational Stress Scale, was modeled using sociodemographic, work-related, and lifestyle factors. The dataset was partitioned into training (80%) and validation (20%) sets to compare six machine learning models: Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), a Backpropagation Neural Network, Elastic Net, Logistic Regression, and a Support Vector Machine. Model performance was evaluated using the Area Under the Receiver Operating Characteristic Curve, accuracy, F1-score, and Decision Curve Analysis. The optimal model was interpreted using the SHapley Additive exPlanations method. The prevalence of occupational stress was 33.3%. On the validation set, the Extreme Gradient Boosting model demonstrated the best performance, with an Area Under the Curve of 0.620, an accuracy of 0.603, and an F1-score of 0.682. Decision Curve Analysis confirmed this model provided the highest net benefit. The LightGBM and Neural Network models exhibited significant overfitting. SHapley Additive exPlanations analysis identified weekly exercise time, sex, and age as the most influential predictors. A user-friendly, web-based tool was developed from the final model. Machine learning, particularly the Extreme Gradient Boosting algorithm, can effectively predict occupational stress in teachers. This approach offers a promising tool for early identification, enabling targeted interventions.

Medical trainees need guidance from more experienced individuals to help them engage in and learn from clinical practice. While supervising physicians often serve as guides, many additional health professionals (HPs) routinely interact with trainees. These HPs can offer guidance, contributing to trainees' development of physician competence and collaborative skills. However, trainees may overlook HPs as an educational resource and HPs may not be fully aware of their educational influence or empowered to contribute to workplace learning. As a result, interprofessional workplace guidance and the accompanying learning opportunities can be easily missed without intentional support. This article presents twelve practical tips informed by theory and empirical work to promote interprofessional workplace learning by engaging medical trainees, supervising physicians, HPs, and medical education programs. Tips for trainees call for expanded learning goals and sources for workplace guidance. Tips for supervising physicians provide strategies to model, broker, and legitimize interprofessional learning. Tips for HPs highlight how to augment their current influence on trainees in the workplace. Finally, tips for educational program leaders outline structural actions to empower HPs as part of the workplace educational team.

Student-centred learning (SCL) enhances the skills of critical and creative thinking, clinical reasoning, and decision making with long term knowledge retention and deeper understanding. The Faculty of Medicine, Sabaragamuwa University of Sri Lanka (FOM/SUSL) is a recently established medical school transforming from the traditional discipline-based curriculum to integrated approach. This study was aimed to explore the perception of academics on SCL and obtain feedback to revisit teaching-learning strategies. A qualitative study was conducted at the FOM/SUSL among the 25 academics across all phases at FOM/SUSL. Semi-structured focus group discussions were conducted using a predefined guide consisting of open-ended questions designed to explore academic perceptions of student-centred learning to promote the conversation on semi structured format. Data were analysed using inductive thematic analysis. Several themes emerged, including a shift from passive to active learning, structural constraints related to time, assessment and resources, student resistance shaped by prior educational experiences, and the use of hybrid teaching strategies to facilitate transition. Teacher perceptions were reflected in active student participation. There was a yearning for a transition from traditional teacher-centred approaches. Significant challenges such as student adaptation difficulties, language barriers and limitations such as lack of human and physical resources were identified. Integrating online lectures and practical sessions were also posed challenges in implementation. Student-centred learning is strongly endorsed by academic staff; however, its implementation is shaped by structural, cultural, and institutional constraints. A phased hybrid approach appears to be a pragmatic strategy for sustainable transition. Not applicable.

Followership refers to the active, relational behaviors individuals enact when supporting, shaping, or influencing leadership from positions without formal authority. Although leadership dominates health professions curricula and scholarship, followership remains comparatively underexamined. This qualitative study explores how fourth-year medical students conceptualized and practiced followership during a high-fidelity, military medical simulation. Seventeen medical students participated in semi-structured interviews within three weeks of completing the exercise. Interviews focused on students' experiences with leadership and followership during the exercise. Transcripts were analyzed using thematic analysis informed by a constructivist orientation to understand how students made meaning of their experiences. Three interrelated themes were constructed describing how students perceived and enacted followership during the simulation: (1) anticipating and providing proactive support for leaders; (2) knowing when to step up, step back, and speak up; and (3) maintaining calm and promoting team morale during stress. Students emphasized that followership was not passive obedience but a practice that influenced team performance, leader effectiveness, and psychological safety. Many also recognized how their followership behaviors shaped their leadership development, reinforcing the interdependence of these roles. Findings offer insight into how learners conceptualize and enact followership in high-fidelity simulation environments. Recognizing followership as distinct from leadership and teamwork, this study contributes to a more precise understanding of how trainees develop within team-based healthcare settings.

Impression management is the projection of attitudes, beliefs, or actions which are not wholly authentic, to influence perceptions of oneself. This paper describes an autoethnography, conducted in a medical education conference, detailing the process of impression management. The researcher is a PhD student and early-career clinician who wears multiple hats as a student, teacher, and researcher, allowing multiple viewpoints to play into the process of impression management. The autoethnography walks through a process of preparation, impression management, and authenticity which emerged during the observation period, ending with several takeaways to guide further research in this space. La gestion des impressions consiste &#xe0; projeter des attitudes, des croyances ou des actions qui ne sont pas enti&#xe8;rement authentiques afin d&#x2019;influencer la perception que les autres ont de soi. Cet article pr&#xe9;sente une autoethnographie r&#xe9;alis&#xe9;e lors d&#x2019;un congr&#xe8;s en &#xe9;ducation m&#xe9;dicale, d&#xe9;crivant le processus de gestion des impressions. La chercheuse, doctorante et clinicienne en d&#xe9;but de carri&#xe8;re, porte plusieurs &#xab; chapeaux &#xbb; &#x2014; &#xe9;tudiante, enseignante et chercheuse &#x2014;, ce qui permet &#xe0; diff&#xe9;rentes perspectives d&#x2019;influencer ce processus. L&#x2019;autoethnographie retrace un cheminement fait de pr&#xe9;paration, de gestion des impressions et d&#x2019;authenticit&#xe9;, tel qu&#x2019;il s&#x2019;est manifest&#xe9; durant la p&#xe9;riode d&#x2019;observation, et se conclut par plusieurs pistes de r&#xe9;flexion pour orienter de futures recherches dans ce domaine.

Identifying heart failure (HF) from electrocardiograms (ECG) is challenging due to the lack of definitive features. This study aims to develop a deep learning-based clinical decision support system, CTTSnet, for accurate and automated HF screening using ECGs. We propose a novel teacher-student framework, CTTSnet, which synergistically integrates a Transformer as the teacher and a Convolutional Neural Network (CNN) as the student. This architecture combines global context-awareness with efficient local feature extraction. The model was trained and evaluated on a large-scale, real-world dataset of 27,018 ECGs and further validated on two external public datasets to assess generalizability. CTTSnet achieved an AUROC of 0.941 on the primary clinical dataset, surpassing strong baselines. The model attained an accuracy of 87.3%, with a recall of 88.6% and specificity of 85.8%. External validation on two additional public datasets further confirmed the model's generalizability. CTTSnet provides a scalable, high-accuracy tool for HF triage from routine ECG recordings. Its potential clinical value lies in assisting early identification of patients at risk of HF, thereby helping reduce missed diagnoses and facilitating timely referral for further evaluation.

Rural medicine is often viewed as a professional compromise, yet it offers some of the most formative clinical training available. It teaches physicians to thrive in discomfort-whether the discomfort is limited medical resources, broad responsibility, geographic isolation, or patients' economic barriers. That discomfort is what shapes physicians into more resilient, resourceful, and empathetic clinicians. Experiences across rural and remote regions demonstrate how limited access to technology and subspecialists sharpens diagnostic reasoning, strengthens reliance on physical examination, and demands confident judgment, while delayed transfers and scarce support systems heighten responsibility and interdisciplinary collaboration. Rural physicians also confront the daily impact of social determinants of health, serving not only as clinicians but as public health advocates within vulnerable communities. These challenges reveal discomfort as a powerful teacher, fostering adaptability, leadership, and perspective. Intentionally seeking rural training is therefore not a detour but a formative pathway that equips physicians with the skills necessary to practice effectively in any setting.

Dissonance is common in clinical learning, especially when experiencing conflict with prior beliefs, expectations, or developing identities. Yet, an understanding of how teachers and learners move from dissonance to growth in emotionally charged, hierarchical clinical environments remains underexplored. In this study, the authors sought to explore how teachers and learners experience and navigate dissonance in the context of equity-related pedagogy. This qualitative study employed Constructivist Grounded Theory (CGT). Fifteen participants including medical students, residents, and faculty were recruited through purposive, theoretical, and snowball sampling. Data were collected through semi-structured interviews, which were analysed using constant comparative analysis to develop a theoretical framework. Participants described dissonance as a dynamic experience ranging from manageable discomfort to panic. Dissonant moments were especially intense when they involved hierarchy, surveillance, identity threat, ethical conflict, or perceived harm. In these conditions, learners often shifted toward self-protection and cognitive shutdown. Growth was more likely when educators normalised struggle, modelled vulnerability, and created structured opportunities for reflection. Participants also described trust and safety as reciprocally co-created: when teachers signalled curiosity and care, learners were more willing to disclose uncertainty and remain engaged, which in turn prompted further teacher investment. Findings reinforce that learners need supportive conditions to grow through dissonance. Such conditions include spaces where they can face challenges without fear of judgement or punishment. Findings suggest that creating such conditions remains difficult in medical education, where rigid hierarchies and institutional norms often erode psychological safety. This work extends prior research by showing how trust and safety are co-created in real time, with both learners and educators influencing and reinforcing each other's openness and vulnerability.