Question-asking serves as a fundamental tool for active learning, allowing students to articulate uncertainties, link concepts, and refine their understanding. Despite its recognized value, the potential of student-generated questions in medical education remains underexplored, particularly in Asian academic settings where sociocultural norms may discourage students from speaking up in classroom discussions. Research on students' questions has overlooked their application as a resource for understanding cognitive engagement and identifying problem areas in student learning. This study, conducted at the National University of Singapore, addresses this gap by exploring student-generated questions as a lens into cognitive engagement with course content.  A content analysis approach was used to classify questions submitted anonymously by first-year medical students via a shared question-and-answer document embedded in the self-directed learning segment of a cardiovascular physiology course. Questions were categorized by cognitive levels using the revised Bloom's taxonomy, which provides a structured framework for assessing cognitive complexity. A chapter-based analysis examined question distribution across content areas to identify patterns in topic-specific inquiry. Two independent raters performed the classification, reaching an inter-rater agreement of 83.2%.  Two-hundred ninety-eight (298) questions were analyzed, with most categorized at the 'Understand' (56%) and 'Apply' (29%) levels. This distribution closely aligns with the educational objectives of the self-directed learning segment and foundational medical curriculum, which prioritize comprehension and practical application. Slight variations across cognitive levels, particularly in higher-order categories, suggest that the nature of certain topics or instructional activities may promote deeper engagement. Question frequency was not uniformly distributed across topics, with electrocardiogram and clinical examination topics eliciting the most questions, likely due to the foundational relevance and integration with subsequent teaching activities.  Incorporating opportunities for question-asking within the curriculum is a promising strategy for examining students' cognitive engagement in medical education. The prevalence of 'Understand' and 'Apply' questions highlights a strong engagement pattern aligned with early-stage medical education, while chapter-based trends suggest topic complexity or instructional activities may influence question-asking patterns. By systematically analyzing student-generated questions, this study provides a structured means of assessing how students engage with course content at different cognitive levels. These insights can be used to inform instructional strategies that better support student engagement, allowing educators to refine teaching approaches according to learners' needs.

Trainees are adept at locating social harm and injustice in medical education. One of the ways in which they work for change is through ongoing acts of professional resistance. However, knowing how, when, and where to resist requires some institutional knowledge. Previous research shows that trainees garner clandestine support from faculty members who share similar values and interests. These faculty work in the shadows, assisting trainees to meet their goals of destabilizing harmful systems and structures in medical education, yet little is known about the role these faculty play. This study was designed to explore the kinds of support faculty provide, the role they play in supporting resistance efforts, and how faculty ensure their own safety. We used methodological bricolage to guide both data collection and analysis. We recruited 24 faculty from a variety of health professions and interviewed them on when they would/would not support trainees in their resistance efforts. Participants came from 12 different medical education institutions across four geographic regions of the U.S., along with one Canadian medical school. As the data came in, it was transcribed and analyzed using open coding, at which point we noticed that participants framed their roles using constructs found in the literature. Rather than continuing to open code, we refined our analysis using a deductive coding approach in which we drew on the concepts of and Through constant comparison, we identified patterns across participants in the roles they played and the kind of support they offered. As trainees fight a metaphorical war against social harm and injustice in medical education, faculty play several key roles in supporting trainees. They protect the integrity of the institution and ensure trainees' efforts are not disruptive to the institution's function. They contextualize trainees' efforts within institutional goals. They also mediate relationships between students and institutional leadership. While helping to keep themselves, trainees, and institution safe, they reinforce the importance of being a life-long resistor against social harm and injustice to continue this work. Efforts at changing health professions education is not new; each generation gives rise to trainees who cannot bear to experience or witness the harm and injustice present in the profession's educational and training programs and must work to change it. However, what appears to be new is that faculty are deeply engaged in this process of transformation, working alongside trainees. Given their role in the institution, they serve as the in fighting this war, providing big picture opportunities and risk assessments for trainees to consider. Whereas trainees serve as the doing the work on the ground, faculty provide critical support toward the transformation of medical education.

Abductive thematic analysis blends empirical observations with theoretical frameworks, fostering a continuous and dynamic exchange between research evidence and theory. It is distinct from other forms of analysis as it is underpinned by pragmatism and is flexible in its adoption of theory to best answer the research question. As a result of an interplay between theory and data, a surprising, puzzling, or anomalous finding may lead to new insights. This flexible approach to inquiry can draw from theories dependent upon what is best able to explain the data. This results in a theoretically informed explanation for empirical phenomena, which may in turn unveil unique insights about theories, making it a valuable tool across diverse research domains in medical science. The guidelines in this paper aim to illuminate abductive thematic analysis, steering the reader through each step toward maximizing novel theoretical contributions and fostering a comprehensive understanding for researchers and educators.

Physician shortages are common in underserved populations globally, and strategic medical school programs have been associated with increased physician retention. Despite Venezuela's physician emigration crisis and its international impact, there is incomplete understanding of variables influencing emigration decisions and potential solutions to increase retention. Between January and June 2023, an anonymous, online questionnaire surveyed recent Venezuelan medical school graduates (2015-2021) living and practicing within and outside of Venezuela. Mixed-methods questions explored perspectives about medical training in Venezuela, desires for alternative medical school programming and professional development opportunities, and factors influencing emigration decisions. Quantitative responses were analyzed with descriptive statistics. Qualitative data were analyzed with a deductive content analysis approach to code for key themes. Among 312 respondents representing all eight national universities and 17 specialties, 40% had emigrated. Most respondents agreed that care for underserved communities was a positive aspect of training (83%), but nearly all agreed that insufficient hospital resources negatively affected training (97%) and limited the practice of evidence-based medicine (91%). Desires for new curriculum centered on topics of Medical Informatics & Technology, Research, and Public Health. Of all drivers of migration, 20% were related to medical training (versus individual- and societal-level drivers), including desires for improved professional development opportunities, higher quality of training, and modified work culture. This diverse sample of Venezuelan physicians expressed a core tension, common to physicians in low-resourced settings globally, between vocation to serve underserved populations and lack of economic and professional development opportunities. Medical education interventions to stimulate physician retention could include targeted curriculum to prepare students for systems-based practice, programs to address moral distress, and engagement with higher-resourced peer institutions to provide desired clinical and research collaborations.

 Physicians from racially and ethnically minoritized (REM) populations are woefully under-represented in the medical profession. The consequences of under-representation are far reaching, with profound impacts on social justice efforts and public health. One solution to remedy this crisis involves the aggressive recruitment of students from REM backgrounds. Though medical education programs have advanced in the recruitment of REM students, their outcomes during medical school are worse than for students from non-REM populations. Previously, literature has focused on causes for this disparity including social determinants, biases, and burden.  In this manuscript, we invoke Critical Whiteness Theory (CWT) to argue how the systems of assessment in medical schools are an under-appreciated contributor to disparities, effectively perpetuating inequities by promoting a white supremacist culture. We begin by examining the origins of assessment in medical education, exploring the historical desire to measure attributes of a , but the tendency to default toward measures of aptitude and rote medical content knowledge that support a white supremacist culture. The Flexner Report and a systemic shift to favor standardized testing are highlighted as major contributors to the foundation of medical school assessment programs. We then describe potential for progress, through a better definition of the articulated by the competency-based medical education movement, and advanced further through a justice-oriented assessment program.  Using an illustrative case example and review of the literature, we suggest that progress in admissions and remediation are commonly coupled, and misaligned, with a historical approach to assessment. Resulting from the misalignment, we argue that medical education programs effectively "gaslight" REM students by admitting them into programs poorly equipped to support their success and convincing REM students that their poor outcomes were earned. We share examples from pre-clinical and clinical assessment programs, including a continued reliance on standardized tests, arbitrary grading thresholds, shadow assessment programs, and focus on episodic remediation that results in stigmatization for failures.  We conclude by providing a model for how issues identified through this perspective may be remedied through a justice-oriented approach to assessment. Through that approach, we propose improved alignment in the recruitment and retention of REM students, thereby resulting in better outcomes for patients, improved physician representation, and realization of a diverse and more complete picture of the .

Research is never truly neutral; all research is inherently subjective because it is shaped by who conducts it, how they think, and the systems they operate within. Paradoxically, despite reflexivity's critical intent - a practice for recognizing and addressing researcher influence - it too often becomes a superficial checkbox exercise that fails to meaningfully challenge deeper structural and systemic inequities. As a result, Health Professions Education (HPE) research often reinforces global power imbalances, privileging Western perspectives while excluding knowledge from the Global South and marginalized communities. This article advocates for Critical Reflexive Praxis (CRP), an approach grounded in Critical Theory, that combines self-reflection with deliberate action to disrupt power dynamics and promote equity in research. CRP extends beyond traditional reflexivity by interrogating and transforming the underlying structures that shape knowledge production and dominant research practice. By adopting CRP, researchers can challenge entrenched hierarchies, include and amplify marginalized perspectives, and create research that fosters meaningful social transformation. This article offers practical guidelines for enacting CRP across individual, interpersonal, local, and global levels during HPE research planning, paving the way for more equitable and impactful contributions to HPE and beyond.

In organizational studies and management literature, the term aesthetic labor is used to describe how employee appearance is managed to provide particular customer experiences. Health professional education programs also manage the appearance of students, particularly by formulating dress codes. Previous literature has shown that dress codes can reflect racist, sexist and class biases and reinforce hierarchies of privilege within and between health professions.

Self-regulated learning (SRL) can significantly improve academic achievement and clinical performance. The clinical clerkship is a crucial setting for reinforcing and extending SRL skills and behaviors into clinical practice. However, learning in clinical settings is often opportunistic and contextual, requiring diverse instructional strategies and tailored learning opportunities. Studies from the past two decades have indicated challenges in implementing SRL strategies particularly in Asian countries. While many of the pedagogical approaches used in medical education include aspects of SRL theory, a comprehensive overview of effective SRL instructional strategies in clinical clerkships is lacking. We reviewed all studies (published between January 2012 and May 2024, identified systematic search of EBSCOhost, PubMed, ScienceDirect, Scopus, and Web of Science) that discuss instructional strategies influencing SRL among clinical clerkship students, in general, and with special reference to the Asian context. Twenty seven articles were included in the final analysis. We conducted convergent integrated synthesis on the data extracted from all included studies to generate categories and themes. SRL instructional strategies reported included implementing learning plans and goal setting, operationalizing formal mentoring and feedback processes, utilizing technology-enhanced learning, facilitating collaborative group learning, providing simulation-based learning experiences, and applying experiential learning strategies. When implemented effectively, such strategies were shown to promote self-regulated learning, motivational beliefs, self-monitoring, and self-reflection. Faculty support, mentoring and timely feedback were crucial in successfully implementing SRL strategies. Incorporating SRL into existing curricula was ideal for ensuring feasibility and long-term sustainability. Limited research from the Asian region indicates that SRL has not been used to its full potential in Asian medical education. Asian medical students' SRL potential could be maximized with shared roles of students and teachers in a student-driven approach. Medical educators should take responsibility for providing opportunities and a conducive environment to foster SRL among clinical clerkship students. Future research should prioritize longitudinal, experimental studies with comparison groups and objective SRL outcome measures to rigorously evaluate the impact of instructional strategies in the clinical clerkship context.

Traditional student evaluations of teaching and educator portfolios do not adequately assess the breadth and depth of medical educators' efforts. Current processes use limited perspectives, focus on a small portion of educators' work, and emphasize subjective opinions, which introduce bias. Use of these data for high-stakes decisions such as academic promotion contributes to inequitable career advancement. We propose a holistic, growth-focused, behaviorally anchored system of evaluation which incorporates perspectives of the learner, peers, and self, and which examines the full scale of educator activities from a single session, to course design, to development of educator skills over years.

The healthcare workforce in the United States does not provide the same standard of care for people with disabilities as for nondisabled people. Many academic medical institutions do not routinely offer disability-conscious medical training, and many clinicians and medical educators feel ill-equipped to incorporate anti-ableist learning goals into their curricula. Drawing on a critical review of the literature and interviews with medical educators, representatives of professional organizations, and disability advocates, this article presents promising practices for disability-conscious undergraduate medical education. Disability-conscious education, which is grounded in the insights of disability studies and disability rights and justice frameworks, is distinguished from disability-specific education, which may not extend beyond biomedical models of disability. First, we define current approaches to teaching about disability, highlighting limitations and opportunities for further development. We then identify and analyze approaches to teaching about disability that support the development of disability consciousness among learners. With attention to both curricular format and theoretical frameworks, we offer concrete approaches that medical schools can take to equip students with the knowledge, attitudes, skills, and practices they need to provide equitable care for patients with disabilities.

There is a crucial need to more deeply understand the impact and etiology of bias toward persons with developmental disabilities (PWDD). A largely unstudied area of concern and possible intervention is the portrayal of PWDD in medical education. Often, medical photographs portray PWDD with obscured faces, emotionless, and posed in an undignified way. This exploratory, qualitative study aimed to explore how photo representations of PWDD influences medical students' attitudes and beliefs toward disability. We recruited 10 medical students from a single medical school in the northeastern United States to participate in in-depth, individual semi-structured interviews via Zoom. During the interviews, we asked students to reflect on and respond to two image sets of PWDD: a standard image set, which were photos from medical textbooks, and a positive image set, which were photos from the U.S.-based disability nonprofit, Positive Exposure. Using thematic analysis underpinned by the Health Stigma and Discrimination Framework, we coded and organized the transcripts into four themes that characterized participants' attitudes and beliefs about PWDD. The four themes we identified were as follows. : Standard imagery characteristics (e.g., black bars, unnatural posing, lack of clothing) were perceived as dehumanizing and raised concerns about consent and autonomy, whereas positive imagery characteristics (e.g., clothing, natural poses, nonclinical settings) were seen as humanizing and enhanced perceptions of agency. : Standard imagery often led to assumptions of compromised quality of life, while positive imagery suggested a good quality of life. Dehumanizing portrayals increased perceived difficulty in establishing rapport, while humanizing imagery mitigated these perceived barriers. Image sets showcasing a diverse spectrum of presentations for a given diagnosis were valued for medical education. We conclude that photographic representation of disability in medical education can influence medical students' attitudes and beliefs about PWDD. Photographic elements can either humanize or dehumanize, with humanizing representation leading to more positive attitudes and therefore also an educational benefit. Thoughtful and inclusive visual content is needed in medical education to encourage positive attitudes and foster a more empathetic healthcare environment. Our results support future plans to further investigate how photo representation affects attitudes in a larger sample. Additionally, our study's insights contribute to the ongoing initiative Textbook Beauty, providing guidance for the selection of photography to improve attitudes toward disabilities.

The involvement of people with lived experience (patients) in medical education offers a unique opportunity for students and residents to access personal and collective knowledge about the lived experience of health, ill health, and medical care. Involvement also has the potential to elevate the role of people with lived experience and their knowledge within medicine by providing a model for meaningful collaboration and partnership. However, involvement has been critiqued by critical disability scholars for its potential to harm without leading to meaningful change in professional knowledge or practice. In this article, we (two educators with lived experience and an academic psychiatrist) describe the development and delivery of an annual lived-experience presentation about psychosis for the second-year class of a large, urban medical school in Canada. We describe our reflexive process attempting to enact meaningful involvement and disrupt the uneven power relations that shape and constrain this work, in a setting where the risks of exploitation, tokenism, and co-optation are significant. Our goal has been to re-imagine the "patient panel," which puts significant limits on the position of patients as knowers. By re-defining roles and shifting power from faculty to lived experience educators, we have aimed to present important non-medical ideas about psychosis and how to effectively support people who experience it, while disrupting interpersonal and structural bias.

Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalizing SGM presence within healthcare spaces. Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to participants' relationship with their bespoke experiences, respecting differing narratives within the broad 'SGM' umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modeling was often experienced more positively than vertical faculty-to-student role modeling. However, as expected, heteronormativity exerted an inhibitory effect on this process. We built upon existing social cognitive paradigms to develop a 'double-funnel' model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of student-led SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining 'normativity' in medical schools.

Ensuring equitable access to professional education programs for learners who need accommodations is distinctly challenging when education moves beyond the classroom into clinical or fieldwork sites. Fieldwork educators and university academic coordinators who arrange fieldwork placements work with university accessibility services and students to arrange required accommodations, while preserving confidentiality, maintaining high learning standards, and ensuring attainment of professional competencies. This work is complicated by time pressures and heavy caseloads in fieldwork settings. Here we report on a subset of data from a cross-Canada online survey of fieldwork educators ( = 233) and academic coordinators ( = 54) in 10 health and social service professions. Using descriptive statistics, we analyze responses to two question series concerning perceptions of the capacity of disabled students to attain professional competencies, and overall perceptions of students who need accommodations. Respondents showed most concern about competency attainment for learners with cognitive or learning disabilities, followed by neurological and mental health issues. Thematic analysis of open-ended comments suggests doubt regarding the ability of institutional fieldwork sites to adequately implement accommodations. In their perception of learners who need accommodations, academic coordinators were somewhat more negative than fieldwork educators, in particular seeing students who need accommodations as a potential burden that could harm placement relationships with fieldwork sites. They tended to indicate that fieldwork success depended on student insight and self-advocacy. Struggles faced by disabled students in health and social service professions appear to be occasioned not only by disabling systems and institutions, but also by perceptions that they may have diminished competence.

For over half of a century, there have been calls for greater patient and community involvement in U.S. medical education. Accrediting agencies, as the regulatory authorities for medical education, develop policies that impact every program in the U.S.; they have the ability to support patient involvement across the medical education system. In this article, we first review the requirements of U.S. accrediting agencies for undergraduate and graduate medical education to involve patients in educational programs. While agencies have patient members on their committees, they do little to encourage patient involvement through their standards or procedures. We then describe opportunities for accreditation to support patient involvement across teaching and learning activities, curriculum design and evaluation, policymaking and governance, and scholarly endeavors. We link these opportunities to specific standards that could be revised or have their data reporting requirements adjusted. U.S. agencies could also follow the examples of their counterparts outside the U.S., which have created new standards to encourage patient involvement. Ensuring patient representation on educational programs' governing and policymaking bodies is one among many immediate actions that could be taken by accrediting authorities to encourage system-level reforms. As medical school and residency training represent the beginnings of decades of practice for physicians, properly involving patients would maximize benefits for learners, educators, and society.

Autism manifests in various progressive, fluctuating, or static differences that may be disabling. This requires healthcare staff to provide individualized, culturally competent care for autistic people (AP). However, staff are underprepared since disability curricula are not universally implemented, which may exacerbate health disparities for AP. The Alliance for Disability in Health Care Education (ADHCE) delineated staff competencies to address disparities. The purpose of this review was to describe what is known about disability education initiatives and health-related outcomes for AP. The review included published literature on disability education for any health personnel providing services to AP in any setting where healthcare services are delivered. In June 2023, six databases were queried. Of 3,396 screened reports, 42 were extracted. Most articles originated in the United States and reported various instructional strategies on child-focused educational content for small interprofessional groups in various settings. The biomedical and biopsychosocial disability models were prominent. The training covered few, if any, ADHCE competencies and rarely involved collaboration with AP. Positive outcomes included improved functional health, behavior, and communication. Patient-reported outcomes and physical and psychosocial health were underreported. Future initiatives should involve scaled-up global efforts, address core competencies for care across the lifespan, and establish community partnerships to ensure meaningful outcomes.

: The Ethiopian Ministry of Health introduced medical licensure examinations to maintain high standards in medical practice and build public trust in healthcare professionals. Studies also suggested significant issues in clinical competence among Ethiopian junior doctors as well concerns regarding unlicensed practice. Given the need to ensure safe health care, we investigated the psychometric properties of the multiple-choice items comprising the Ethiopian national licensing exam (NLE). These analyses help to provide an argument for the validity and reliability of the test scores. : We used a cross-sectional study design to analyze data from three cohorts of undergraduate medicine licensing examinations in Ethiopia (2020-2022,  = 2,213). Using Classical Test Theory, we assessed the psychometric properties of 600 MCQ items with 2400 single best answer choices, specifically item difficulty, item discrimination, and the number of nonfunctional distractors, and scale reliability. We provide results regarding the overall test and its sub-domains. : Ethiopia's undergraduate medical licensure examination demonstrated acceptable reliability (Alpha > 0.80), with significant variability in item difficulty and examinee performance. Although these results indicate a sufficiently defensible exam, our results point to issues regarding item statistics, especially a high number of nonfunctional distractors. : This study provides first evidence regarding the psychometric soundness of the Ethiopian NLE. However, a significant number of items should be carefully reviewed and possibly revised. As the examination is relatively new, ongoing refinement to item-development and review processes is essential to improve and ensure its quality.

Government, organizational, and professional society policies are part of the complex system that underpins and influences the education of health professionals. Despite their significant influence, these policies rarely receive attention in scholarship examining the processes and outcomes of current health profession education systems. Policy analysis is a field of research that examines how and why policies are developed, the assumptions underpinning policies, and policies' effects. Given the potential value policy analysis can offer health professions education research, our manuscript aims to 1) describe policy analysis as a field of research that draws on multiple disciplines and methodologies, and 2) demonstrate and discuss what policy analysis research can contribute to health professions education by sharing examples of two studies and discussing their value. To explain how policy analysis can be applied in health professions education research, we describe four key steps and considerations for using policy analysis- (i) assemble your research team; (ii) develop the research questions; (iii) select the methodology for the policy analysis; and (iv) select methods for data collection and analysis.

The language of medicine (i.e., biomedical discourse) represents queerness as pathological, yet it is this same discourse medical education researchers use to that narrative. To be truly inclusive, we must examine and disrupt the biomedical discourse we use. The purpose of this study is to disrupt oppressive biomedical discourses by examining the language and structures medical educators use in their publications about queerness in relation to physicians and physician trainees. We searched PubMed, Web of Science, CINAHL, PsycINFO, and ERIC in October 2021 and again in June 2023 using a combination of controlled vocabulary (select terms designated by a database to enhance and reduce ambiguity in search) and keywords to identify articles related to sexuality, gender, identity, diversity and medical professionals. Searches were limited to articles published from 2013 to the present to align with the passage of The Respect for Marriage Act. Articles were included if they focused on the experiences and paths of physicians and physician trainees identifying with or embodying queerness, were authored by individuals based in the United States, and presented empirical studies. We excluded articles only discussing attitudes of cisgender heterosexual individuals about queerness. Two authors independently screened all articles for inclusion. We then used narrative techniques to "re-story" included articles into summaries, which we analyzed with four guiding questions, using queer theory as a sensitizing concept. Finally, we sought recurrent patterns in these summaries. We identified 2206 articles of which 23 were included. We found that biomedical discourse often: characterized individuals associated with queerness as a single homogenous group rather than as individuals with a breadth of identities and experiences; implied queer vulnerability without naming-and making responsible-the causes or agents of this vulnerability; and relied minimally on actual intervention, instead speculating on potential changes without attempting to enact them. Authors each reflect on these findings from their positionalities, discussing: disrupting essentializing categories like "LGBT"; addressing harm through allyship around queerness; editorial responsibility to disrupt structures supporting oppressive biomedical discourse; the importance of program evaluation and interventions; and shifting the focus of medical education research toward queerness using QuantCrit theory.

Women medical students experience unique stressors and challenges during medical school related to inherent structural androcentric norms. Through a longitudinal qualitative study of 17 women medical students in their first two years of medical school, we sought to investigate how they navigated their medical school experience. We used a critical lens and narrative inquiry to understand their experiences within the powerful and marginalizing culture of medical school. Our participants identified two essential support groups: those relationships made within, and those sustained outside, medical school. These findings invoked a kinship framework-one where women medical students have a network of chosen kin who provide essential support for them during their first 2 years. The participants' chosen kin medical school provided support through recognition of one another, belonging by not belonging, being encouraged to reach out, and creating long-term relationships. The chosen kin medical school provided support by reminding the student who they are and creating stability. Integrating models of kinship into medical school as practiced by women medical students may have immense value in providing essential supports for medical students, preventing burnout, and changing the culture of care for future physicians that would align recognition and practice of self-care with patient care.

Abuse and oppression in medical education persists. Particularly when transitioning to practice, students and residents face dissonance between what they perceive as the ideals of patient care and reality. They witness, and eventually take part in, joking about fellow students and patients, discriminating against minorities, and imposing unbearable workload to subordinates, to mention some practices that have been normalized as the reality of medical training, beyond any possibility of change. We suggest that Critical Pedagogy, an educational movement rooted in Brazil that aims to empower learners and educators as full citizens, can help medical education reinstitute hope for a more humanistic culture by testing new realistic transformative actions, i.e., untested feasibilities, to promote change. We use vignettes based on real situations of oppression to present three concepts of Critical Pedagogy contextualized to medical education: (a) critical consciousness as ; (b) pedagogy with learners; and (c) education as a democratic relationship between individuals. The vignettes explore how each one of these concepts can support educators and learners to break chains of injustice and oppression. Perceiving disagreements as opportunities for change, legitimizing the perspectives and values of all engaged in analyzing reality, is needed to nurture critical consciousness. Critical Pedagogy understands education as a partnership of trust between learners and educators and seeks a pedagogy that is built with learners, not on them. Finally, we present suggestions for individual- and systems-level actions that can translate these principles of Critical Pedagogy into a of untested feasibilities for medical education.