Self-regulated learning (SRL) has been the focus of medical education, with the belief that mastering effective SRL strategies can significantly contribute to the academic achievements of medical students, thereby establishing a robust foundation for their future clinical practice. Despite the importance of SRL, empirical evidence linking SRL to academic performance has been mixed. This study aims to quantify the association between SRL and the academic performance of medical students. A one-year longitudinal study was conducted consisting of two waves separated by one year, wherein students from China Medical University who were enrolled in the clinical medicine program in 2018 were randomly selected and followed. Participants provided socioeconomic information in the first wave and completed the Self-regulated Learning Perception Scale (SRLPS) in both waves. Participants' academic performance was assessed using Grade-point Average (GPA) scores for the following year. Fixed-effects models were utilized to address potential endogeneity issues when investigating the association between SRL and academic performance based on the longitudinal data collected. The final sampled data consisted of 395 medical students who completed two rounds of questionnaires. The overall score of SRL was positively correlated with academic performance insignificantly (β = 0.007, SE = 0.004). However, the domain, Learning motivation and action, was significantly positively correlated with academic performance (β = 0.052, SE = 0.020), while the other domain, Lack of self-directedness, was significantly negatively correlated with academic performance (β=-0.037, SE = 0.009). Enhancements in certain self-regulated learning behaviors, like cultivating intrinsic motivation for learning, positively correlated with the academic performance of Chinese medical students. However, the negative correlation with self-directedness in learning highlights the multifaceted nature of SRL and the complexity of its relationship with students' educational outcomes.

Human rights training in mental health professions is essential to reduce stigma and facilitate recovery processes. The aim of this study was to understand the relationship between engagement to human rights and stigma towards people with mental disorders, as well as attitudes towards mental illness in medical and social work students of a Latin American context. An analytical, cross-sectional study was carried out with a sample of 243 students in the last two years of study. Community Attitudes Towards the Mentally Ill (CAMI), Mental Illness Clinicians' Attitude Scale (MICA), Human Rights Exposure in Social Work (HRXSW) and Human Rights Engagement in Social Work (HRESW) were used as instruments. To determine how the explanatory variables are related to the engagement to human rights (dependent variable) a binary logistic regression model was used. Correlations were found between the scales and their components. Economic condition, intersectional approach, authoritarianism, benevolence and mental health ideology explained 55.11% of the variance for commitment to the engagement of human rights. Some factors related to the stigma of mental disorders and the focus on human rights in future mental health professionals are highlighted that should be more visible in the training practices of these professions.

Simulation-based learning (SBL) is an important component in health professions education and serves as effective preparation or a substitution for clinical placements. Despite their widely accepted benefits, students from culturally and linguistically diverse (CALD) backgrounds may not experience the same learning outcomes from engaging in SBL as their local peers due to complex factors. Supporting students from CALD backgrounds in SBL is vital, not only to optimise their learning experiences and outcomes, but also ensure inclusive health professions education. While the literature on the participation of students from CALD backgrounds in SBL activities is emerging, this scoping review was conducted to (1) map the evidence on how SBL impacts the learning outcomes of health professions students from CALD backgrounds; and (2) understand how students from CALD backgrounds perceive their SBL experiences. Following Arskey and O'Malley's framework and Joanna Briggs Institute methodology for scoping reviews, a search was conducted in January 2024 using PubMed, Embase, CINAHL, Scopus, PsycINFO, and ERIC. Ten papers met the inclusion criteria. This review highlighted three themes: (1) diverse learning outcomes of SBL; (2) facing linguistic and cultural challenges that are inherent to SBL; and (3) preparation, reflection, and support to actively participate in SBL activities. This review indicates that SBL could enhance clinical skills and confidence in students from CALD backgrounds. However, well-designed SBL activities to meet the learning needs of students from CALD backgrounds are currently lacking and further research across broader health professions fields is needed.

The development of a robust professional identity is a pivotal aspect of every healthcare professional's educational journey. Critical social perspectives are increasingly influencing the examination of professional identity formation within healthcare professions. While understanding how disabled students and practitioners integrate a disability identity into their professional identity is crucial, we have limited knowledge about the actual formation of their professional identity. This study aims to investigate how disabled students and clinicians in healthcare professions actively shape their professional identity during their educational and professional journeys. We conducted in-depth semi-structured interviews with 27 students and 29 clinicians, conducting up to three interviews per participant over a year, resulting in 124 interviews. Participants represented five healthcare professions: medicine, nursing, occupational therapy, physical therapy, and social work. Employing a constructivist grounded theory approach, our data analysis revealed two prominent dimensions: (a) The contextualization of identity formation processes and (b) The identity navigation dimension in which the professional identity and disability identity are explored. This emerging model sheds light on the dynamic processes involved in identity formation, emphasizing the significance of a supportive environment for disabled students and practitioners. Such an environment fosters the negotiation of both professional and disability identities. Moreover, this study recognizes the importance of a re-examination of the concepts of professionalism and professional identity in healthcare professions. In conclusion, this research underscores the importance of understanding and supporting the multifaceted identity formation processes among disabled individuals within healthcare professions.

The interdisciplinary nature of health professions education requires exploration of problems by interdisciplinary research teams. Drawing on the Dynamics of Cross-disciplinary Research Development conceptual framework, this study explores the processes and experiences of an interdisciplinary research team, identifying elements of successful collaboration. Case study data were collected from a team of nine researchers from six universities. Data included meeting minutes and researcher reflections. Researcher reflection and meeting minute themes converged within the framework constructs: Contexts and inputs, social learning processes, social capital outcomes, and knowledge and human capital outcomes. This study provides a blueprint for interdisciplinary researchers indicating that successful collaboration starts with transparent, distributed leadership. The convergence of data illustrates how social learning processes, social capital outcomes, and knowledge and human capital outcomes facilitate research team outcomes.

The effect of social support on academic procrastination among health professions students and its potential mechanism are yet to be fully explored. A serial mediation model informed by self-determination theory (SDT), was here established to explore that effect, as well as the mediating roles of academic self-efficacy and intrinsic learning motivation. This cross-sectional study involved 596 health professions students enrolled in different majors at a university in Shenyang, China. Data were collected through a questionnaire assessing basic demographic information, social support, academic procrastination, intrinsic learning motivation, and academic self-efficacy. Social support was found to be negatively correlated with academic procrastination. Intrinsic learning motivation and academic self-efficacy were both mediators that partially and jointly mediated the relationship between social support and academic procrastination. These results suggest that multifaceted social and educational interventions aimed at improving social support, intrinsic learning motivation and academic self-efficacy can reduce academic procrastination among health professions students.

In this commentary, the authors comment on a recent paper that argued for clear definitions of metacognition, reflection, and metacognitive reflection. Challenging the notion that exclusive definitions are essential to the sciences of health professions education, the authors argue for approaches that define conceptual spaces in which different definitional positions can coexist and scholarship based on similarity rather than identity can be pursued.

There is increasing interest in health professions education (HPE) in applying argument-based validity approaches, such as Kane's, to assessment design. The critical first step in employing Kane's approach is to specify the interpretation-use argument (IUA). However, in the HPE literature, this step is often poorly articulated. This article provides guidance on developing the IUA using a worked example involving a workplace performance assessment tool. In developing the IUA, we have drawn inspiration from approaches used in the discipline of language assessment to situate the inferences, warrants and assumptions in the context of the assessment tool. The worked example makes use of Toulmin's model of informal logic/argumentation as a framework to structure the IUA and presents Toulmin diagrams for each inference such that the reader can connect the argument chain together. We also present several lessons learned so the reader can understand the issues we grappled with in developing the IUA. A well laid out IUA allows the argument to be critiqued by others and provides a framework to guide collection of validity evidence, and therefore is an essential ingredient in the work of assessment design and validation.

Developing and maintaining connections with others, or what we refer to as the formation of social ties, may strengthen medical students' sense of belonging in medical school. Social ties play a particularly important role for women medical students as the medical field remains largely dominated by masculine norms. However, forming social ties remains challenging for women in medicine. This study used the COVID-19 pandemic to examine how women medical students navigated the spatial contexts of medical school to form social ties. Using longitudinal qualitative research and narrative inquiry, it describes how 17 women medical students formed social ties during the early stages of COVID-19. Beginning in fall 2020, during the initial two-years of medical school, the participants (1) described how personal ties were deterred from forming in early experiences of medical school; (2) shared experiences that promoted a sense of community bonding during middle and later periods; and (3) expressed limitations of access to the formation of professional ties throughout their initial 2-years. This study has important implications for understanding ways spatial contexts, access to physical connections, and the mental and emotional barriers or pathways play roles in social tie formation for women medical students and how longitudinal qualitative research can narrate these changes through time.

The COVID-19 pandemic highlighted how racially minoritized patients and clinicians have suffered racial discrimination. It also made visible the ways in which Asians across the globe experience racial hate and illuminated that the experiences of Asians in medicine are not often spotlighted. In the United States specifically, Asian Americans are not viewed as minoritized in medicine, yet their professional experiences are rarely highlighted. Informed by the discourses of the model minority, the forever foreigner, and ethnic lumping, we used Asian critical theory to explore how Asian American medical providers in Utah understand racial and ethnic identity and how these identities and experiences of racialization inform their professional identities. Using a case study approach, we identified and interviewed 23 physicians, physician assistants, and nurse practitioners (during spring 2022) who live in and practice medicine in Utah. Transcribed interviews were coded using reflective thematic analysis. Findings were organized into three themes: (1) feeling different, (2) experiences with discrimination, and (3) wrestling with the model minority myth. While Asian American medical providers experience not belonging, they also have the agency to disrupt discrimination and stereotypes. Asian American medical providers' racial and ethnic identities influence their professional interactions. Understanding the intersections of their social and professional identities are important to providing support for Asian medical providers, within the United States and beyond.

In this editorial the editor considers the twin issues of replicability and reproducibility in health professions education research, and notes challenges and opportunities that scholars in the field face in attending to the replicability and reproducibility of the work they produce.

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, we address the dilemma of engaging with foundational works versus depending on summary articles. We argue that an over-dependence on secondary sources can lead to prejudices and unquestioned assumptions, and limit the constructive development of our field. We urge health professions education scholars to honour the original literature not just for their own learning and understanding, but so that the field can move forward in developing theory and methodology.

Despite demonstrating the required competencies to graduate, many newly qualified doctors find the transition to internship difficult. There is a concern over whether their preparation is aligned with the expectations of the role. This study aimed to gain a better understanding of the competencies needed for legitimate practice as junior doctors and explores their perceived preparedness for practice. A qualitative, descriptive study using focus groups was undertaken with first year internship doctors. Thirty-two junior doctors in their first year of internship took part in five focus groups. The data were analysed using a reflective thematic analysis approach with a subsequent analysis using the Legitimation Code Theory (LCT) specialisation dimension coding framework to aid interpretation. Personal attributes including adaptability, organisation and proactivity form the basis of achievement in internship. While graduates felt ready in some ways, it was not in the ways that counted. Participants felt well prepared in terms of their clinical knowledge and skills, but legitimacy came from being able to take responsibility, communicate effectively and apply knowledge confidently and efficiently to all aspects of patient care, something that they did not feel ready to do. Using LCT has revealed a shift in the basis of achievement between medical school, where individual academic performance is rewarded, and internship, where personal and social competencies are legitimised. There is a clash between what graduates feel well prepared for and the expectations and demands of the internship role, resulting in a difficult and stressful transition from student to doctor.

The stigma of underperformance is widely acknowledged but seldom explored. 'Failure to fail' is a perennial problem in health professions education, and learner remediation continues to tax supervisors. In this study, we draw on Goffman's seminal work on stigma to explore supervisors' accounts of judging performance and managing remediation in specialty anesthesia training in Australia and New Zealand. In doing so, we focus on what Goffman calls a "stigma theory" to explain the supervisors' reported practices. We performed a secondary analysis of nineteen interviews originally gathered using purposive sampling to explore how assessment decisions were made. We conducted a theory-informed thematic analysis of the supervisors' accounts to identify signifiers of stigma and underlying structures and beliefs. From both deductive and inductive analysis, we developed themes that demonstrate how the stigma of underperformance influences and is induced by supervisors' reticence to discuss underperformance, their desire to conceal remediation, and their differential treatment of trainees. We also found that accounts of trainees 'lacking insight' resembled stigma-induced stereotyping. We argue from our data that our cultural expectations of perfectionism propagate a stigma that undermines our efforts to remediate underperformance and that our remediation practices inadvertently induce stigma. We suggest that a multifaceted approach using both individual and collective action is necessary to change both culture and practice and encourage the normalisation of remediation.

Health professional organisations are increasingly promoting the use of self-directed learning. Furthermore, the rapidly evolving field of healthcare has meant that there is greater emphasis within tertiary education for students to become self-directed learners and possess the skills to engage in life-long learning. The aim of this scoping review was to explore the drivers that improve the student learning experience, in undergraduate clinical science programs that utilise self-directed learning. The Joanna Briggs Institute Scoping Review Methodology guided this study. The electronic databases MEDLINE, Embase, Emcare, Scopus and ERIC were comprehensively searched in April 2022 and re-run August 2023, for peer-reviewed research articles published in English. The original search was developed in MEDLINE and then adapted to each database. Following the Joanna Briggs Scoping Review methodology, articles were screened first by title and abstract and then by full text. Included articles were assessment for methodological quality. The search strategy yielded 2209 articles for screening. 19 met the inclusion criteria. Five key factors were identified which improve the student learning experience in self-directed learning: (i) curricular elements; (ii) educator influence; (iii) impact of peers, (iv) environment; and (v) clinical placement experiences. There are many curricular, environmental, and external factors which can improve the student learning experience in programs that utilise self-directed learning. Greater understanding of these factors will allow educators within clinical science programs to implement self-directed learning strategies more effectively within curriculum.

To support a complex health system, students are expected to be competent leaders as well as competent clinicians. Intentional student leadership development is needed in health professional education programs. Student-led experiences such as student-run clinics and interprofessional training wards, are practice-based learning opportunities where learners provide leadership to clinical services and/or address a gap in the system. Given the absence of leadership definitions and concepts, this scoping review explored how student leadership is conceptualized and developed in student-led experiences. The review was conducted in accordance with best practices in scoping review methodology within the scope of relevant practice-based student-led experiences for health professional students. The research team screened 4659 abstracts, identified 315 articles for full-text review and selected 75 articles for data extraction and analysis. A thematic analysis produced themes related to leadership concepts/theories/models, objectives, facilitation/supervision, assessment and evaluation of curriculum. While responding to system gaps within health professional care, student-led experiences need to align explicit leadership theory/concepts/models with curricular objectives, pedagogy, and assessments to support health professional education. To support future student-led experiences, authors mapped five leadership student role profiles that were associated with student-led models and could be constructively aligned with theory and concepts. In addition to leveraging a student workforce to address system needs, student-led experiences must also be a force for learning through a reciprocal model of leadership and service to develop future health professionals and leaders.

To adapt to medical school, students need to change their approaches to learning and study. Transformative learning through critical reflection on disorienting learning experiences supports perspective change to direct new activity. We explored how portfolio meetings support changes in students' perspectives towards learning and study during the transition to studying medicine. This qualitative mixed methods study explored changes in medical students' perspectives before and after two portfolio meetings with a mentor during the first year of medicine. Adopting a constructionist approach, we analyzed interview transcripts and written reflections from a diverse sample of students using reflexive thematic analysis. The findings were integrated during analysis. Transformative learning theory was our interpretive lens. Our analysis revealed five themes. Two themes represented students' initial apprehension about portfolio meetings: The Disclosure Dilemma and A Question of Priorities. The theme "Seeing the Big Picture" described new perspectives from reflection on learning while preparing for meetings. Clarity from Dialogue described changed perspectives to learning and study after meetings. In the theme Dialogue Disappointment, meetings perceived as unhelpful led to persisting doubts about the value of portfolio meetings. Transformative learning was evident when students described new insights into their learning leading to goal-setting and new study strategies. When initial meetings were helpful, doubts about portfolio meetings were dispelled, enhancing student engagement in future meetings. Not all meetings were transformative, highlighting the importance of student and mentor preparation and training. Further research is needed to determine whether early portfolio experiences shape later engagement in clinical contexts.

When considering health professionals' requirements and responsibilities, competence is a complex concept that extends beyond knowledge to encompass understanding, application, technical skills, problem-solving, and clinical judgment. Rural clinical placements provide a rich learning environment for students to improve their competencies, self-esteem, and preparedness for practice (PFP). This scoping review aimed to identify pre-registration health students' perspectives on rural placement regarding competency and skill development, and enablers and barriers to learning. The methodology outlined by the Joanna Briggs Institute was followed. Out of 1186 records (366 duplicates), 821 were screened by title and abstract, 59 underwent full-text screening and 18 studies were included. Over half the studies included medicine students (n = 11). Reported competencies predominantly focused on self-assessed confidence regarding clinical skills. The reported barriers and enablers to learning highlighted the complexity of the placement experience and the importance of interpersonal factors, learner engagement and the supervisor's role. The review identified a gap in the literature pertaining to student perspectives of competencies and skills not assessed or experienced as well as a lack of standardised measures for PFP. The identified enablers and barriers provide suggestions for rural placement design and emphasise the importance of the student learning experience. Future research could include multiple health disciplines and specific methodologies to identify health students' perspectives regarding the development of competency, relatedness and autonomy, that is how to support health students to think, feel and act like health professionals.

Situational Judgement Tests (SJTs) are popular to screen for social skills during undergraduate medical admission as they have been shown to predict relevant study outcomes. Two different types of SJTs can be distinguished: Traditional SJTs, which measure general effective behavior, and construct-driven SJTs which are designed to measure specific constructs. To date, there has been no comparison of the predictive validity of these two types of SJTs in medical admission. With the present research, we examine whether the HAM-SJT, a traditional SJT, and the CD-SJT, a construct-driven SJT with an agentic and a communal scale, administered during undergraduate medical admission can predict OSCE (i.e., objective structured clinical examination) performance in a low-stakes (n = 159) and a high-stakes (n = 160) sample of medical students. Results showed a moderate positive relation between the communal scale of the CD-SJT and performance in OSCE stations with trained patients in the high-stakes sample (r =.20, p =.009). This SJT had also an incremental value in predicting the OSCE performance above and beyond GPA (i.e., grade point average), a science test (i.e., HAM-Nat), and gender (ß = 0.18, 95% CI [0.03; 0.33], p =.020). That is, individuals who chose more communal behavioral responses in the SJT were rated more favorably in interactions with trained patients in the OSCE. A comparable correlation coefficient was observed for the HAM-SJT when controlling for range restriction due to admission (r = 0.14 vs. r = 0.20). Our research provides a first indication for the predictive validity of construct-driven SJTs in high-stakes undergraduate medical admission.