Medicine is inherently a spiritual profession; patients and health care professionals both seek meaning and connections beyond just themselves, especially in the context of crises. Yet, the spiritual aspects of care have fallen to the wayside, with the commercialization of the business of health care. In this brief perspective, I integrate lessons from theology and pastoral care into a busy clinical and educational setting to help reclaim the moral dimensions of the care giving relationship.

Introduction:Many online tools and innovations exist to support feedback, but their survivability has not been well-studied. This study explores the influence of learning culture on the adoption, utilization and long-term impact of an online written feedback tool among faculty. The study aims to inform strategies for effective implementation of such tools and guide faculty development within the clinical learning environment.Methods:Utilizing constructivist grounded theory, we conducted semi-structured interviews among ten clinical faculty with supervisory roles and experience in giving medical trainees feedback via an online feedback tool. Using an iterative analytic approach, we identified key propositions to derive an in-depth understanding between learning culture (LC) and the “survivability” of the online feedback tool.Results:Several socio-cultural factors within the LC have affected the survivability of the feedback tool beyond its development and implementation. Firstly, the lack of a support system exacerbated the burden of clinical teachers. Next, the misapprehension about written feedback and low psychological safety undermined the tool adoption. Lastly, the lack of appreciation towards the importance of a strong feedback loop further reduced the tool’s survivability.Conclusion:The development and implementation of online tools in health professions education should take into consideration factors influencing the survivability of the tool. The exploration from a socio-cultural perspective has provided insights to ensure that future online feedback tools and interventions actually survive the test of time and the complexities embedded in the clinical learning environment.

Purpose:Entrustment decision-making is shaped by both supervisor and trainee. Existing research has focused largely on supervisor decision-making; however, less is known about how trainees experience and internalize entrustment. This study explores how trainee entrustment develops over a pharmacy internship and examines lived experiences that influence progression toward unsupervised practice.Methods:A convergent mixed-methods design explored the entrustment journey of provisionally registered (intern) pharmacists in Australia. Quantitative data were collected via self-administered questionnaires at three time points (beginning, middle, end of internship), capturing perceptions of entrustable professional activities (EPA) utility and self-perceived readiness for entrustment across ten EPAs. At year-end, focus groups explored pharmacy interns’ perceptions of the EPA framework and how they interpreted and internalized it in relation to their development. Qualitative data were analyzed using reflexive thematic analysis and triangulated with quantitative findings to examine convergence and divergence over time.Results:Seventeen pharmacy interns completed questionnaires; 16 of these participated in focus groups. Self-perceived readiness for entrustment increased significantly across most EPAs, with median entrustment ratings reaching level 3 (independent with reactive supervision) by the end of internship. Pharmacy interns described that being entrusted supported confidence development, particularly when paired with structured feedback and reflective practice. Some noted that an emphasis on meeting numeric benchmarks risked reducing the process to a “numbers game,” overshadowing diverse and complex learning opportunities, and diminishing feedback opportunities once level 3 was achieved. At times, this created asymmetry between being entrusted by a supervisor and the interns’ own sense of readiness for more complex practice.Conclusion:EPAs support trainees’ progression toward autonomy by embedding structure, feedback, and self-reflection that affirms competence and guides development. When entrustment decisions are tied to achieving a predetermined number of EPA observations, there is a risk that entrustment may be conferred prematurely, thereby reducing the depth of feedback and reflection that follows. When framed as assessments for learning, EPAs better support trainees’ transition to confident, autonomous practice.

Introduction:Simulated patients (SPs) play a key role in medical communication training, yet their contribution to feedback dialogues during post-simulation feedback sessions remains underexplored. This study explored how SPs contribute to meaningful feedback dialogues among students during feedback sessions after simulation-based consultations.Methods:Using an interpretivist qualitative approach, video-recorded feedback sessions with first-year technical medical students and SPs were analyzed. Episodes identified as meaningful feedback dialogues were thematically analyzed, focusing on SP contributions.Results:Of the 120 one-minute episodes during feedback sessions, 36 episodes were classified as meaningful feedback dialogue. These were characterized by one or more of the following aspects: SPs’ guidance on task performance, shifting positions of SPs, and SPs supporting the contribution of students by facilitating and creating space.Discussion:SPs’ guidance on task performance appears to respond to students’ need for direction. While such guidance can support learning, it also risks reducing student reflection. Therefore, SPs need awareness of when and how to provide guidance. Although instructed to remain in the patient positions, SPs adopt multiple positions: the patient’s position, the expert’s position, and the meta-position during the feedback dialogue, which can enrich learning if managed consciously. Increasing SPs’ awareness of these different ways of contributing to students’ learning may enhance their educational impact in communication training.

Shared decision-making, in which a patient's values and preferences facilitate the co-construction of a clinical decision, is a key component of patient-centered care and is of pedagogical interest in medical training. Yet, barriers exist to implementation, with limited information about how patients understand and exert agency. To help educators and health professionals facilitate shared decision-making, we examined how patients narrate their agentic experiences and the roles of their physician and a decision aid mobile application (app) in contributing to agency when engaged in contraceptive clinical encounters. We conducted a qualitative study of 21 female patients, aged 17-45, who utilized a decision aid app before an encounter for contraceptive services. We conducted linguistic analysis of semi-structured interviews where patients narrated their decision-making experiences, by coding for linguistic markers of agency. Patients narrated individual agency, identifying agentive tasks required for decision-making, including gaining knowledge, asking questions, voicing needs, and making choices. Patients narrated the app as a source of information, identifying questions, validating previous knowledge/opinions, and as surrogate provider. Patients narrated physicians as supportive agents, cueing patient agency and actions during the visit. Joint agency of patient and physician and agency distributed across the patient, physician, app, and other resources were contributory. Linguistic analysis can offer important perspectives on patient experiences. The patient, physician, and decision aid app each played roles as agents during shared decision-making. Attending to various roles of agency in clinical encounters and in educational interventions may help health professionals more effectively conduct shared decision-making.

Written from the author's multiple perspectives as a medical educator, physician, and cancer survivor, this reflective piece explores professional identity formation as a process that extends beyond the acquisition of communication skills, drawing attention to the distinction between language and communication. By weaving together educational practice and lived experience, the text invites readers to pause and consider how becoming a doctor is a deeply personal process that requires space for reflection, uncertainty, and the search for one's own language and meaning, in teaching as well as in our personal and professional lives.

Narrative competence in medicine enabled physicians to listen to patients' illness experiences, construct their narratives, and enhance reflective practice, empathy, humanistic literacy, and person-centered care. However, systematic research and clear definitions for measurable indicators of narrative competence assessment were lacking. This study aimed to develop and validate a narrative competence scale for medical students. A 57-item draft scale was developed, and categorized into four dimensions and eleven sub-dimensions after interdisciplinary literature review. Three rounds of the Delphi method were conducted with eleven experts specializing in narrative medicine. Pilot testing involved 200 fifth- and sixth-year medical students in Taiwan (136 males, 64 females). Confirmatory factor analysis CFA) and Cronbach's α were used to evaluate the NCS-MS's reliability and validity. The NCS-MS was refined through three rounds of the Delphi method, focusing on item revisions and sub-dimension definitions. The results of CFA indicated a good fit for the four-factor model (RMSEA = 0.055, SRMR = 0.045, GFI = 0.911, NFI = 0.926, IFI = 0.971, CFI = 0.970). The Cronbach's α coefficients for the four dimensions ranged from 0.797 to 0.942, with an overall α of 0.972, demonstrating excellent internal consistency reliability. The NCS-MS effectively evaluated the narrative competence of medical students. From the perspective of narrative medicine, the NCS-MS served as a research or teaching assessment tool for assessing medical students' narrative competence in narrative medicine research, instructional design, and implementation.

Engagement and burnout symptoms among medical students are key factors influencing their academic performance, risk of dropout, and overall well-being. While research has primarily focused on negative constructs such as burnout symptoms, less attention has been given to how positive constructs, such as engagement, evolve over time. This study examines the temporal changes in medical students' engagement and exhaustion while exploring two distinct pathways: the 'bright path', which investigates engagement as a mediator between self-compassion and academic achievement, and the 'dark path', which examines exhaustion as a mediator between self-criticism and academic achievement. Self-report measures were used to assess self-compassion, self-criticism, engagement, and exhaustion, while academic achievement was measured objectively. The data were drawn from a longitudinal research project that followed 117 medical students throughout their entire Bachelor's program. Analyses included linear growth models and parallel process latent growth curve models to examine changes over time and potential mediation effects. The findings show a decline in engagement and exhaustion throughout the Bachelor's program. Furthermore, neither engagement nor exhaustion mediated the relationships within the bright and dark pathways. Findings underscore the importance of fostering environments that promote well-being and engagement while addressing negative factors like exhaustion that can hinder student success. They also highlight the potential influence of contextual factors in shaping medical students' experiences, suggesting that interactions between personal resources and environmental demands may play a key role in shaping students' engagement, exhaustion and academic achievement.

Introduction:The COVID-19 pandemic prompted significant changes in the administration of the Dutch Interuniversity Progress Test of Medicine, offering a unique opportunity to investigate the effects of various test formats. This study explores the impact of transitioning from paper-based to computer-based testing, the shift from summative to formative testing, and the effectiveness of remote proctoring compared to live supervision.Methods:Data from over 10,000 participants across five medical schools were analyzed.Results:Results showed no significant difference in student performance between paper-based and computer-based tests. Additionally, remote proctoring proved to be as effective as live supervision in preventing dishonest behavior. Formative testing yielded slightly better results than summative testing in most schools, although the effect varied between institutions.Discussion:Overall, our study concludes that computer-based testing is a viable alternative to paper-based formats, and remote proctoring can effectively replace live invigilation, at least in our setting and under COVID-19–related circumstances.

Professionalism is a core competency on which learners should, ideally, receive feedback to improve their performance. Feedback literacy conceptualizes how learners make sense of and use feedback. The contextual and subjective nature of professionalism, along with concerns about professionalism's potential to encode majority culture norms, add unique complexity to receiving and responding to professionalism feedback. This study used feedback literacy as a framework to explore how diverse learners experience and respond to professionalism feedback. The authors conducted a multi-center qualitative study with a critical constructivist orientation. Fourth-year medical students and senior residents were interviewed about their experiences with professionalism feedback. Interviews were analyzed using reflexive thematic analysis. Feedback literacy provided an analytic lens for theme development. Thirty-one medical students and 18 residents were interviewed between 2021 and 2022. Learners saw little value in professionalism feedback when viewing professionalism as a character trait rather than a skill to be improved. Learners who received constructive professionalism feedback critically reflected on the quality of their own professionalism and of the feedback, specifically evaluating the feedback for racial or other bias. Constructive professionalism feedback generated protracted emotional responses, and learners often lacked agency to respond to professionalism feedback due to the method of feedback delivery. Learners engage with professionalism feedback by spending significant time examining the context of the feedback and searching for evidence of racial or other bias. Understanding how learners experience professionalism feedback is important for fostering strong professionalism feedback literacy for learners and educators.