Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.
Phenomenon: Compassion fatigue (CF) manifests as profound exhaustion not relieved by sleep, empathy loss leading to depersonalized patient interactions, ineffective coping, inability to function, emotional overwhelm, and reduced self-care. Documentation of the experience of CF among medical students and recent medical graduates is beginning to appear in the literature, yet our understanding of the extent of its occurrence, its personal impact, and impact on patient care is currently rudimentary. The objective of this scoping review is to identify the extent and type of evidence on CF among medical students and recent medical graduates, review definitions, current terminology, associated factors, and knowledge gaps. Approach: This scoping review used the Joanna Briggs Institute (JBI) methodology for scoping reviews. We systematically searched the electronic databases MEDLINE, Embase, PsycINFO, CINAHL, and Scopus for eligible studies published between 1992 and 2025. Our inclusion criteria included the occurrence of burnout and secondary traumatic stress (STS) or equivalent terms in medical trainees. Medical trainees included medical students studying at university and recent medical graduates within two years of graduation, working under supervision at clinical institutions. We excluded more senior doctors, two years post-graduation and above. We searched electronic databases and extracted data from studies using Microsoft Excel. A narrative summary of the results is presented. Findings: Fifteen papers met the inclusion criteria. The data indicated emerging literature on CF among medical trainees. Inconsistencies in terminology confound CF conceptualization. Factors associated with CF include heavy workloads, frustrations with institutional IT systems and administrative processes, and non-supportive work environments. Medical trainees experience stress inherently associated with their professional stage, and our data suggests that recent medical graduates are aware an adverse event could occur due to their high workload. STS, a critical component of CF, was found to be associated with working in critical care, with traumatized individuals, with patients who die in traumatic circumstances, including by suicide, and interacting with distressed families. Knowledge gaps included quantifying CF prevalence among medical trainees and evaluating the efficacy of trauma-informed interventions, particularly those generated by clinical and educational institutional responses. Insights: This review indicates that CF exists among medical trainees, negatively impacts the individual, and has concerning implications for patient care. Further research is needed to determine the prevalence among medical trainees and the efficacy of interventions, in particular institutional responses to mitigate CF. Organizational responses likely may include reducing workloads of medical trainees, simplifying institutional IT systems and processes, screening medical trainees for CF, and providing education on the condition and evidence-based interventions.
PhenomenonResidents traditionally developed decision-making skills through increasingly independent practice, but many now report diminished roles in decision-making leading to concerns about readiness for practice. The clinical learning environment (CLE) shapes residents' experiences through interacting social, personal, and organizational factors that create tensions residents must navigate. Such tensions likely impact if and how residents engage in clinical decision-making, and understanding these tensions may offer insights into how to best support residents in today's CLE. This study aimed to explore how residents perceive navigating tensions in the CLE through their participation in clinical decision-making. ApproachAs part of a larger qualitative study on resident decision-making, we conducted semi-structured interviews with 38 second- and third-year pediatric residents across three academic medical centers in the United States. Using a constructivist paradigm and template analysis, we analyzed narrative excerpts focused on tensions in hospital-based clinical decision-making. We selected three representative narratives and present them in their entirety to illustrate a more complete picture of the complexity of the CLE. FindingsThe narratives described tensions in 1) who makes decisions, 2) when and where decisions are made, and 3) how decisions are made. Sometimes residents successfully addressed these tensions and described learning, but other times they described being marginalized, resulting in disengagement. InsightsWe propose a model for understanding residents' involvement in clinical decision-making in the CLE that combines elements of Lave and Wenger's Communities of Practice and Vygotsky's Zone of Proximal Development (ZPD). In this new model, residents can be in their ZPD as either central or peripheral participants in clinical decision-making or be marginalized participants and disengaged from learning. By highlighting the workplace tensions that different interacting factors in the CLE create, we propose new ways to support residents' development of decision-making skills in increasingly complex clinical contexts. We suggest conscious deliberation for residents, supervisors, and education leaders. By paying close attention to the context of each dynamic, evolving decision-making process, residents can adjust their expectations for participation; supervisors can support residents within their ZPD as central or peripheral participants; and education and clinical leaders can strive to create schedules, team structures, and workflows that support resident involvement in patient care. Successful navigation of CLE complexity is necessary to ensure that residents develop decision-making skills for future independent practice.
The influence of hierarchical structures in maternity wards on supervision, learner autonomy, and professional development has been recognized, yet its impact on medical trainees in low-resource teaching hospitals remains poorly understood. This study explored how medical interns and residents perceive and navigate power relations in the maternity ward of Zewditu Memorial Hospital, a tertiary teaching hospital in Addis Ababa, Ethiopia. Using an interpretive phenomenological approach, we conducted in-depth interviews with 20 participants between November 2022 and February 2023, including medical interns, residents, and general practitioners involved in maternity care. We analyzed the data thematically to capture participants' lived experiences of hierarchy, supervision, and clinical responsibility. Findings revealed three interrelated subthemes-status-role interactions, activity-transferring, and blame shifting-which together illuminate how hierarchical relations structure clinical learning, professional identity, and emotional well-being. Participants described a supervisory environment dominated by OB/GYN specialists whose authority was enacted through evaluative control and largely non-negotiable decision-making. This hierarchical arrangement constrained trainees' autonomy, limited opportunities for critical engagement, and positioned interns and residents as responsible for patient care without corresponding decision-making power. Activity-transferring frequently placed trainees in situations that exceeded their experience and formal roles, generating fear of errors and ethical tension. Blame-shifting further intensified trainees' vulnerability, undermining confidence, psychological safety, and their willingness to speak up. The findings reveal that hierarchy in the maternity ward functioned as a double-edged structure for clinical education. While it supported supervision and accountability, it also constrained learning, ethical agency, and open communication. Rather than reflecting a negotiated learning environment, clinical training was largely obedience-based, with authority concentrated among senior physicians and risk distributed to trainees. Educational strategies that promote guided autonomy, respectful supervision, and psychological safety are essential to enhance learning and support professional development in maternity care training contexts.
Pharmacology learning plays a key role in medical education as the basis for prescribing and therapeutics, with direct implications for patients' health. Studies have found deficiencies in medical students' prescribing skills and a scarcity of pharmacology learning in the clinical context. The development of good prescribing skills requires innovative educational approaches. This quasi-experimental study aimed to determine the effects of simulated clinical interviews on the improvement of drug prescribing skills among medical students in Peru. In 2020, we led a research team from three local medical schools with competency-based curricula and an initial stage of simulation development. Using an expert-validated instrument constructed from the World Health Organization (WHO) Guide to Good Prescribing, we assessed students' prescribing skills during three simulated interviews: baseline, pre-, and post-intervention. The educational intervention took place between Interviews 2 and 3, consisting of simulated interview (Interview 2), plus debriefing (after Interview 2), and pre-briefing (before Interview 3) simulation strategies focused on prescribing skills. We assessed its effects on students' performance during Interview 3. Eligible participants were students from each institution who had taken pharmacology in the previous semester (pharmacokinetics, pharmacodynamics, and case studies). We sought their voluntary participation through social media, considering their availability of four hours over two days. Participants received the WHO Guide to Good Prescribing and information about the drugs to be used the following week in the simulated clinical interviews. We had to conduct the three interviews, to which participants were randomly assigned, in two groups-in-person in the first batch and remotely in the second batch-due to mandatory social distancing during the COVID-19 pandemic. Participants' prescribing skills and knowledge significantly improved over the three interviews only when participants experienced all phases of the intervention: pre-briefing, debriefing, and feedback. Pharmacology learning may benefit from the implementation of remote and in-person simulated clinical interviews aimed at developing good prescribing skills. The logical sequence of the WHO Guide for Good Prescribing may facilitate skill assessment and acquisition.
Background: Radiology readouts, which involve student-teacher (mentored) and student-student (peer) interactions, are a cornerstone of medical education; however, communication dynamics in these settings, and students' perceptions of them, are underexplored. This qualitative study examined medical students' perceptions of peer and mentored learning during radiology readouts and analyzed associated verbal communication patterns. Methods: This qualitative observational study was conducted at Maastricht University in the Netherlands between April and May 2023. We conducted the study in three stages: (1) observation of student-student interactions, (2) observation of student-teacher interactions, and (3) semi-structured interviews with students about their perceptions of these interactions. We categorized verbal communication data using an adapted Verbal Response Modes (VRM) taxonomy, grouping intents into cognitive structuring, instructing, and questioning. We analyzed the interview data thematically. Results: Verbal communication analysis revealed that cognitive structuring during student-student interactions primarily involved disclosure and confirmation, while student-teacher interactions also included interpretation. Questioning was consistent across both interaction types, but instructing, such as advisement, was more prevalent in student-teacher interactions. We identified two key themes in the interview data. Theme 1: Peer interactions fostered uncertainty, while teacher interactions provided certainty through accurate information. Theme 2: Peer interactions facilitated verbalization of thoughts, whereas teacher interactions enhanced thought processes through meaningful prompts and insights. Conclusion: These findings indicate that student-teacher interactions are more responsive (interpretation) and directive (advisement), promoting certainty and deeper discussion, whereas student-student interactions, though more egocentric (disclosure), support thorough articulation despite perceived uncertainty. This study informs the design of radiology education by highlighting the complementary roles of peer and teacher interactions in fostering diagnostic reasoning and managing uncertainty.
Medical students increasingly rely on third-party resources, or study tools developed outside of formal medical education institutions, to study for the US Medical Licensing Exams (USMLE). One such third-party resource is Anki, an online flashcard platform, and the AnKing, a premade deck created by a group of medical students. While prior scholarship has begun to analyze the content and benefits of such third-party resources, few have considered how not only the content but also the design and usage patterns of such resources may perpetuate medical knowledge that is harmful to patients. Trained in both medicine and history as an MD/PhD student, the author considers how expertise from the social sciences can inform our analysis of the process by which historical medical knowledge on race, health, and disease is developed, maintained through historical change, and passed down to current medical students. Sociological methods in Science and Technology Studies informed the analysis of Anki as a political technology, where social values are embedded in its design, typical use by students, and repair mechanisms, or how the technology is maintained and updated. The author accompanies her experience studying with AnKing from 2020 to 2022 with a systematic content analysis of AnKing's training videos and social media posts (March 2025-February 2026) and of the race-based medical content in the AnKing deck (Update #14, March 2025). Historical literature on race-based medicine informed analysis of emerging themes in the deck. Anki's design with a distinct question-and-answer format and its embedded values of speed and volume in usage patterns help form implicit associations, including between race and disease risk. Its repair mechanism via mass collaboration and self-reference to other third-party resources contribute to the perpetuation of historical concepts of race-based medicine. In AnKing, 0.5% of flashcards (202/42,629) contained references to differing diagnosis and treatment patterns among racial groups. Three major definitions of race appeared: racial groups as defined by differing prevalence of disease, race as a shortcut for genetic heritability, and race as a risk factor for disease. AnKing defines clearly demarcated biological racial categories as an individual patient characteristic that increases risk of disease, lacking the historical and social context which reveal the structural role of racism in health. By considering one popular third-party resource through the lens of the history and sociology of medicine, the author demonstrates how insights from the social sciences inform how medical knowledge develops, transforms over time, and continues to perpetuate within the contemporary educational environment.
Phenomenon: Continuing professional development (CPD) providers innovate and adopt alternate delivery models to better meet the needs of contemporary healthcare professionals (HCPs). This study aims to investigate HCPs' CPD preferences and needs. Approach: In April 2024, we conducted a cross-sectional, Q-methodology study to investigate the preferences and needs of healthcare professionals (physicians, nurses, allied health professionals, etc.). We recruited 47 participants for three main study phases: concourse generation, Q-sort, and by-person factor analysis and interpretation. We also recorded demographic characteristics, including age, geographic location, healthcare discipline, and years of practice. Findings: We derived a Q-sample containing 40 statements related to HCPs' CPD preferences and needs following a review of CPD program evaluation data and a comprehensive literature review. The study participants' age and occupation were evenly distributed but a large majority practiced in Ontario, Canada. We identified four factors, representing different types of CPD participants and their training needs. Value and productivity-focused clinicians preferred convenient and time-efficient CPD activities due to heavy clinical workloads and perceived consequences of work absence. Application and competency-based learners consisted of senior HCPs who prioritized learning activities that were relevant and applicable to clinical practice. Respite seekers and growth-oriented professionals were younger and more interested in training involving nontechnical topics (e.g., leadership, equity, diversity and inclusion). Respite seekers viewed CPD as a retreat while remaining in-practice, but growth-oriented professionals sought to develop skillsets that were transferrable and facilitated role transition. We also identified a single consensus statement that highlighted neutral viewpoints toward the need for CPD activities to have "appropriate difficulty and volume of content." Insights: Q-methodology facilitated deeper understanding of regional CPD preferences and needs, uncovering viewpoints masked by social desirability and professional expectations. These preferences and needs were also potentially influenced by structural issues and demographic factors (age, levels of experience). Greater needs-matching and alignment with government policies and profession-specific regulatory standards can improve meaningful learning and CPD uptake. Future research should conduct more in-depth analysis of the identified factors through comprehensive demographic data collection and longitudinal designs.
Phenomenon: Clinicians employed by hospitals affiliated with medical schools play vital roles in undergraduate medical education. Clinical affiliate faculty (CAF) have opportunities for academic advancement to reward activities aligned with the school's mission, yet many do not pursue promotion. While the challenges underlying these outcomes are well-described, the motivations, expectations, and experiences of those who do pursue and attain promotion remain underexplored. Inquiry into these experiences may reveal actionable facilitators and institutional practices that make promotion more effective in recognizing and sustaining CAF engagement. Approach: In our roles as faculty affairs deans, we conducted a qualitative study to explore what motivates CAF to pursue promotion and their expectations and experiences of successful promotion. We conducted semi-structured interviews between 2023 and 2024 with 24 CAF from one US medical school who were promoted in rank between 2018 and 2023. We used reflexive thematic analysis to analyze the interview transcripts, and our interpretation was informed by social cognitive career theory and the social cognitive model of career self-management. Findings: Three overarching themes captured CAF experiences of promotion: (1) intrinsic and extrinsic motivation, (2) symbolic capital, and (3) professional affirmation. CAF motivation to pursue promotion was rooted in their belief that it was an attainable goal,-a belief supported by reflection, empowering social influences, and intrinsic traits. The expectation that successful promotion would position them to advance their own careers and support the careers of others further fueled their motivation. In addition to these anticipated outcomes, successful promotion provided CAF personal fulfillment, validated their contributions to undergraduate medical education, legitimized their identities as clinical educators, fostered a sense of belonging to the medical school, and inspired greater engagement with the school. Importantly, some CAF achieved promotion despite challenges related to their socioeconomic background and their identities as individuals underrepresented in medicine. Insights: This study expands our understanding of what motivates CAF to pursue promotion and their expectations and experiences of successful advancement. The findings offer insights into how promotion reinforces CAF legitimacy as clinical educators and strengthens their sense of belonging to the medical school, thereby empowering them to contribute meaningfully to the institution. The findings also illuminate practical strategies to improve promotion processes and mitigate the contextual influences of socioeconomic status, gender, and race/ethnicity to ensure all CAF can achieve these outcomes.
Phenomenon: Increasingly, peer feedback and assessment exercises are being introduced into health professional degree programs with many proposed benefits including the unique feedback received from peers and development of clinical education skills. However, studies investigating the bidirectional significance of peer feedback in workplace-based assessments (WBAs) are limited. The peer assessed mini-clinical evaluation exercise (peer mini-CEX) is a WBA conducted as part of The University of Melbourne Doctor of Medicine course, which involves peers assessing one another in a clinical setting. Approach: This research investigated students' perceptions of the bidirectional effects of peer feedback on medical students undertaking peer mini-CEXs. Between August and October 2023, we conducted semi-structured interviews of penultimate and final year medical students. We undertook an exploratory qualitative study based on social constructivist theory. We transcribed the interviews and analyzed them via inductive thematic analysis, which led to the development of themes and the thematic map. Findings: Fourteen students, including eight third-year and six fourth-year students, participated in the study. Students appeared to engage in two general approaches to the peer mini-CEX: a mastery approach or a compliance approach. These themes encapsulated a tension between the desire to achieve deeper learning versus a strategic approach to assessment. When students took a mastery approach, perceived bidirectional benefits clustered around improvements in feedback provision and reception, more intentional observation and reflection leading to enhanced clinical skills, and development of professional communication skills. If students took a compliance approach, the reported outcomes were limited or undesirable with students viewing the assessment as a tick box exercise and identifying the limitations of peer feedback. A third theme, the social milieu, illustrated the influence of the social context on peer interactions and whether a mastery or compliance approach was undertaken. Insights: This study is the first to explore students' perceptions of the nuanced bidirectional effects of peer feedback in a WBA. Participants report benefits of the peer mini-CEX in domains such as clinical skills, professionalism, communication, and feedback provision and reception. However, even engaged students often described adopting a superficial approach to the peer mini-CEX, resulting in minimal learning. Our findings indicate the influence of the social milieu on peer assessment and feedback processes. With contemporaneous feedback training and priming, peer assessment and feedback can be a valuable exercise for medical students. Further research into peer feedback in WBAs is required.
The complex skill of prescribing often fails to translate effectively from basic medical training into clinical practice, leading to poor patient management and medication errors. Previous research has demonstrated that learners face substantial challenges in achieving the threshold of integrated understanding and decision-making required for rational prescribing in different contexts. These challenges stem from the fact that learning to prescribe remains an implicit experience. Students tend to imitate physicians' prescribing patterns without understanding how the expert's cognitive schema operates, making it difficult to transfer this skill to new or diverse situations. While several interventions have been introduced, the challenge in transferring this skill may lie in the educational strategies for prescribing, further compounded by the complex web of underlying concepts inherent to the task. To address this, we explore the Four Component Instructional Design (4 C/ID) model, integrated with cognitive load theory. The 4 C/ID model posits that complex skills training requires a combination of learning tasks, supportive information, procedural information, and part-task practice. This integration aims to develop the knowledge, skills, and attitudes necessary for complex tasks and enhance knowledge transfer without overloading cognitive abilities. To illustrate this integration, we present a blueprint for an antimicrobial module spanning pre-clinical to clinical years, focusing on identified threshold concepts of pharmacology and fostering the practice of both routine and non-routine prescribing skills. Students engage in whole-task activities, supported by mental models, procedural knowledge, and repetitive practice. We recommend a blended learning approach for this module, using successful strategies from other domains. In traditional curricula, our module can be introduced during clinical rotations and culminate as a capstone course. This module offers a promising solution to current challenges in teaching and practicing prescribing.
Prosocial behavior, a cornerstone of effective healthcare, is crucial for positive doctor-patient relationships and ethical medical practice. However, cultivating prosociality in medical students, particularly within diverse cultural contexts, presents a significant challenge. While mindfulness interventions show promise, the underlying mechanisms, especially the role of self-construal, remain underexplored. This study addresses this gap by investigating the effects of a seven-day online mindfulness program on prosocial behavior among Chinese medical students and the mediating role of self-construal, a culturally contingent framework. Divergent from Western research suggesting mindfulness promotes prosociality via interdependent self-construal, we explored a potentially distinct dynamic in a collectivist setting. In 2023, we randomly assigned 64 medical students without prior mindfulness experience to a mindfulness practice group (n = 33) or a control group (n = 31). Pre- and post-intervention assessments included trait mindfulness, self-construal, and prosocial behavior, using validated Chinese instruments. The mindfulness intervention significantly increased prosocial behavior and both independent and interdependent self-construal. However, mediation analysis revealed that only independent self-construal significantly mediated the mindfulness-prosociality link; interdependent self-construal showed no significant mediating effect. This unexpected finding highlights the cultural plasticity of self-construal theory, suggesting mindfulness in collectivist contexts may facilitate prosociality by activating individual agency and autonomy-a pathway diverging from Western observations. These findings have substantial implications for adapting mindfulness interventions in global medical education, advocating for culturally informed designs that leverage the dynamic interplay between mindfulness, self-construal, and prosocial development. This research refines the theoretical understanding of self-construal and offers a novel perspective on cultivating essential prosocial attributes in future healthcare professionals. Furthermore, this work suggests practical strategies for integrating mindfulness training into medical curricula, potentially enhancing student well-being, ethical decision-making, and patient-centered care.
Medical education plays a crucial role in shaping how future physicians understand and approach the prescribing of teratogenic medications to individuals with the capacity for pregnancy. The teaching that we, as medical students, experienced on this topic relied on blanket cautions derived from current guidelines that either warn students to never prescribe teratogenic medications for "women of childbearing age" or to adhere to rigid contraceptive mandates that lack guidance on contraceptive counseling, reproductive goals, or individual risk. This educational approach erases patient diversity and undermines the principles of reproductive justice. As students who are invested in reproductive health both from an educational and personal standpoint, and with our clinical education taking place in an institution and geographic and political context supportive of comprehensive reproductive health, we felt a better approach was possible. We have witnessed thoughtful, nuanced conversations between patients and providers surrounding the friction between patients' fertility goals and treatment options for other medical conditions. We outline three anecdotes that exemplify the discordance between the limited preclinical instruction most of our classmates receive and the clinical practices we have observed that foreground reproductive justice, inclusivity, and patient-provider trust. Moreover, there is a lack of empiric evidence regarding medical students' knowledge and capacity to conduct teratogenic medication counseling. Existing literature reveals a fragmented and simplified approach taken by many clinicians in prescribing these drugs. These shortcomings are related to those that exist in the context of our personal education, and it is likely that medical education on the topic of teratogenicity, contraception, and fertility is institution dependent. Given that best practices and instructions for approaching these counseling situations are not yet formalized, it is reasonable to assume that students are likely graduating from medical school with varied levels of confidence, skill, and training in this area. We find it necessary that reproductive counseling and contraceptive care for patients on teratogenic medications is taught comprehensively to students to reflect our responsibility as physicians to respect individual reproductive goals, provide inclusive and affirming care, and build trust. The individual tension we have identified within our educational experience sheds light on an area of instruction that may hold significant potential in shaping a generation of thoughtful, effective physicians.
Introduction: Interprofessional Training Units (ITUs) on hospital wards offer a way to prepare healthcare students for collaborative care in the Landscape of Practice (LoP), where professional communities and patients intersect. While learning in ITUs aims to enhance teamwork and patient outcomes, little is known about patient perspectives on care and interprofessional education (IPE) in fast-paced ITU settings. This prompted our research question: What are patients' and their partners' perceptions of the care they received and of the educational dynamics in an ITU on a maternity ward? Methods: Using semi-structured interviews, we collected qualitative data from 14 pairs of patients and their partners in the ITU of a maternity ward in a Dutch teaching hospital between February and May 2025. We adopted an inductive constructivist thematic analysis, using sensitizing concepts from LoP and Core Competencies for Interprofessional Collaborative Practice to guide coding and interpretation. Results: We identified three interrelated themes concerning patients' and their partners' perceptions about care and education in the ITU: 1) Patients' need for trust in the student-team was the key condition for patients' acceptance of interprofessional care on the ITU. For patients to feel they could trust the student team, students needed to convey confidence while being transparent about their limitations and show genuine care for patients and their partners; 2) Patients' and partners' recognition of the value of IPE at multiple levels: for themselves, for the students, and for future patients; 3) Patients' and partners' view of their role in the ITU: when patients felt they were able to trust the student-team, and even more when they recognized the value of IPE, they expressed willingness to facilitate students' learning. However, they described this contribution as limited in scope: they were open to supporting IPE in practice as 'boundary spanners' but did not wish to take on a formal teaching role as 'boundary brokers.' Conclusion: Our study shows that learning with and from patients in an ITU requires shifting beyond a focus on students understanding each other's roles and responsibilities. Instead, it calls for an approach that also acknowledges the needs as well as desired roles of patients and their partners within the LoP. As 'boundary spanners,' patients and their partners can help bridge the gap between their lived experiences of care and students' different professional perspectives. We also offer some practical implications for ITU tutors.
Background: Clinical education and healthcare work occur within their own complex sociocultural contexts, where interactions can be emotionally intense. Scholars have begun to conceptualize emotional experiences using a socio-cultural lens, examining emotions within their own complexity and contextuality. To better understand and help providers process the intense emotional experiences inherent to clinical education and work, it is important to analyze them from a socio-cultural perspective. Objective: This study aimed to identify the emotional experiences of clinical providers engaged in healthcare work and to determine the value of adopting a reflective approach to processing intense emotions. Our research questions were (1) What clinical activities prompt emotional response among providers, and how does context (system, socio-cultural, political, etc.) shape these experiences? (2) How does providers' reflectivity about their emotional experiences in context affect their understanding and outcomes? Method: The study was conducted between 12 July 2021 and 07 January 2022 at a university hospital's general surgery clinic in the Eastern Anatolia Region of Türkiye. This narrative, ethnographic study analyzed the emotional narratives embedded in clinical work. The participant group consisted of 31 volunteers from a single clinical team: five faculty members, five residents, six nurses, 15 sixth-year medical students (interns). We analyzed narratives generated from participant observation and narrative interviewing using the "Three Stage Contextual Theme Analysis Framework" model. Findings: We created a tripartite conceptual framework to convey (a) the multi-level context in which emotional experiences occur, (b) providers' reflection on emotional experiences in context, and (c) the consequences of contextual, reflective emotional experiences. Our analysis revealed two main contexts in which emotional experiences take place: "institutional and clinical context" and "national and local context." The institutional and clinical context consists of "social, emotional," "physical," and "institutional and clinical system" subcontexts, while the national and local context consists of "health system" and "socio-cultural life" subcontexts. Conclusion: Given the consequences of intense emotional experiences in clinical education and healthcare work, it is important to understand them in context, using a reflective narrative approach. This approach allows educators to reframe both clinical education and healthcare work in a more humane and socioculturally sensitive manner.
Engagement with interprofessional education (IPE) is essential to prepare health professions students for collaborative practice, yet the behavioral determinants shaping students' active participation remain insufficiently understood. This review conceptualizes engagement as a proximal behavioral construct reflecting students' cognitive, affective, and behavioral involvement in IPE activities. We employed the Theoretical Domains Framework (TDF) as it synthesizes behavior-change constructs into modifiable domains, enabling systematic identification of determinants and theory-informed targets for intervention. We searched six databases (PubMed®, Medline®, EMBASE®, CINAHL®, ProQuest®, and ERIC) for articles published between January 2010 and October 2024, with updates conducted to January 2026. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Crowe Critical Appraisal Tool. We synthesized reported enablers and barriers influencing student engagement using deductive content analysis and mapped them to TDF domains. We included 30 studies. We identified determinants of student engagement with IPE across 12 of the 14 TDF domains. The most commonly identified enabler was Social/Professional Role and Identity, particularly through role clarification, understanding of professional responsibilities, and recognition of complementary contributions within teams. Other frequently represented enablers included Environmental Context and Resources (e.g., structured clinical exposure, immersive placements, simulation, and repeated opportunities for interaction), Social Influences (e.g., facilitator support, peer relatedness, mentoring, and encouragement), Knowledge, Skills, Beliefs about Consequences, and Beliefs about Capabilities. We mapped barriers to nine TDF domains, with Social Influences emerging as the most common barrier, particularly through hierarchy, dominance of some professional groups, isolation, and lack of authority to speak up. Other common barriers included Environmental Context and Resources (e.g., limited time, scheduling conflicts, short placement duration, and workload pressures), Emotions (e.g., anxiety, defensiveness, and embarrassment), Knowledge (e.g., unclear expectations and limited understanding of other professional roles), and Beliefs about Capabilities (e.g., low self-confidence in contributing to interprofessional discussions). Student engagement with IPE is shaped by modifiable cognitive, affective, and contextual determinants. Mapping these influences through the TDF clarifies the behavioral mechanisms underpinning engagement and identifies theory-informed targets for the design and delivery of IPE interventions.
Purpose: International medical graduates (IMGs) have long sustained the US healthcare system. In the US, 25% of practicing physicians are IMGs, who are pivotal for delivering primary and preventive care and for tending to first-generation immigrants. Despite their contributions, studies primarily have focused on individual challenges and difficulties of IMGs. In contrast, structural barriers-and their impact on IMGs' private lives and emotional wellbeing-are rarely discussed. Using the example of Asian IMGs in the US, we explored structural barriers that complicate everyday thriving, including family wellbeing, work conditions, and emotional life. Method: We conducted a constructivist, qualitative interview study with 20 IMG physicians (60% female) in 2023. We purposefully sampled across multiple specialties, clinical settings, and geographic areas. The average time serving as an attending was 11.8 years. We recorded and transcribed semi-structured interviews, which lasted 45-60 minutes. With attention to IMGs' positionality, we applied reflexive thematic analysis and Burgess-Proctor's strategies for engaging with and empowering participants. We also drew on Ahmed's theory of the politics of emotions to inform our interpretation. Results: IMGs described interconnected structural barriers rooted in the US visa system, including financial hardship, prolonged family separation, and sponsorship-dependent career precarity. Beyond these constraints, participants also encountered institutional selection bias and professional gatekeeping, including an invisible ceiling, tokenization, and limited recognition of IMG status within broader diversity discourse. While expressing gratitude for US career opportunities, participants reported a significant emotional toll characterized by guilt and shame tied to outsider positioning and pressures to justify their legitimacy in US training. Discussion: Structural barriers have a profound impact on IMGs' relational and emotional lives. What might appear as a personal hardship-such as family separation-is in fact a consequence of structurally imposed constraints. Participants pointed to concrete areas where institutional practices could change, including formalized mentorship structures, stronger institutional accountability, more explicit inclusion practices, and policy advocacy. Addressing these inequities will require institutional engagement, with implications for sustaining the US physician workforce.
Introduction: Neurodivergent individuals are increasingly recognised as playing a critical role in the health professions workforce. However, many face significant barriers during their education due to stigma, ableism, and institutional inflexibility. We have approached this work through the lens of the neurodiversity paradigm, reframing disadvantage as arising not from individual traits but from the social, structural, and cultural contexts that shape experiences within healthcare and education. Methods: We conducted an online survey (during May to July 2024) of neurodivergent graduates from a range of Australian health professions programs, exploring their diagnoses, use of accommodations, and experiences navigating their education. We also invited participants to share advice for future neurodivergent students entering health professions education. Thematic analysis of qualitative data was guided by Jain's framework of legibility, which describes how disability, or neurodivergence in this context, is recognised and understood by both individuals and institutions and how recognition shapes accommodations, inclusion, and learner experiences. Results: The 183 respondents had completed a range of health professions qualifications and, strikingly, often identified with multiple forms of neurodivergence. This allowed us to identify patterns of experience that spanned professional groups and rigid diagnostic boundaries. Many reported experiencing stigma and inadequate or inaccessible accommodations, where neurodivergence was framed within a deficit-focussed model. Even when formally granted, supports were inconsistently implemented. Participants described complex processes of self-recognition, often occurring during study or after graduation. Despite these barriers, self-recognition and peer connection were sources of empowerment and agency. The advice participants shared emphasized self-advocacy, self-compassion, connection with community, and the distinct value neurodivergent learners bring to healthcare. Conclusion: Our findings show that the way neurodivergence is recognised and understood by individuals and institutions profoundly shapes neurodivergent learners' educational experiences. When recognition is founded in deficit-based assumptions, it reinforces exclusion, stigma, and structural inequity. To support student agency, self-determination, and belonging, recognition of neurodiversity through a neuro-affirming lens is required. These insights highlight the urgent need for systematic reform to embed neuro-affirming principles within health professions education. Truly inclusive education must prioritise universal design, reduce reliance on diagnostic disclosure, and provide environments where all learners can thrive.
Simulation-based healthcare education presents complex sensory, social, and cognitive demands that may systematically disadvantage autistic learners. Although contemporary research acknowledges autistic professionals' presence in healthcare practice, the literature remains conspicuously silent on how autistic learners actually experience simulation-based environments. Without understanding these lived experiences, we risk perpetuating educational practices that exclude neurodivergent talent and missing insights that could improve simulation design for all learners. This study aimed to explore the lived experiences of autistic healthcare learners in simulation-based education and understand how they make sense of these experiences. This interpretative phenomenological analysis explored the lived experiences of seven autistic healthcare learners from the UK and Europe. Participants included medical students and qualified doctors with simulation experiences spanning undergraduate curriculum-based training, postgraduate education, and professional development activities. We conducted semi-structured online interviews lasting approximately 60 minutes between February and May 2025, with interviews progressing from descriptive accounts to reflective consideration of ideal simulation experiences. Data analysis followed established interpretive phenomenological analysis (IPA) procedures, developing emergent themes and identifying patterns across participants whilst preserving individual voices. We developed four interconnected themes from participants' accounts. First, "Navigating Artificial Realities" captured how participants developed strategic, performance-based approaches to simulation's predictable structure, often prioritising technical success over genuine skill development. Second, "The Social Minefield of Group Learning" revealed how group composition and social dynamics served as gatekeepers to meaningful engagement. Third, "The Cognitive Burden of Dual Processing" described participants' exhausting experience of simultaneously managing clinical learning and social monitoring, with educational engagement competing against social performance demands. Fourth, "Communication as a Structural Barrier" highlighted participants' need for clear, direct instruction and feedback across all simulation phases. Our findings suggest that autistic learners may experience well-documented challenges in simulation-based healthcare education with particular intensity, revealing how simulation learning environments that appear inclusive may present challenges for autistic learners through design failures rather than learners' individual limitations.
Accumulating evidence points to the benefits of narrative medicine for healthcare workers (HCWs), but how positive outcomes from narrative medicine workshops emerge is not entirely clear. Experimental psychological research suggests potential mechanisms through which narrative medicine may achieve its outcomes. However, in experimental research, the mechanisms of reading and writing usually are studied separately and with a focus on group-level effects, leaving participants' singular experiences unexamined. To address this gap, we investigated clinicians' experiences of combined close reading, guided creative/reflective writing, and group discussion in a seven-week narrative medicine training course for healthcare and social-work professionals in Finland. After the course, we conducted individual semi-structured interviews (n = 14). We analyzed all data using inductive reflexive thematic analysis. We generated five themes: Experiences of group reading and writing involved (1) a sense of wondrous transcendence of the everyday; (2) feelings of unexpected mercy towards oneself and others; (3) the strengthening of listening, self-reflection, and self-disclosure skills; (4) transformation of relationships and a novel sense of relatedness; and (5) ethical reflections of patient-centered ideals in daily practice. These themes extend prior findings in healthcare education and psychology by illustrating how potential benefits of narrative medicine workshops can emerge in multifaceted ways. We suggest future avenues for exploring the topic in other cultural and care settings.