Issues In Medical Education Research Articles

Effectiveness of Kathmandu University School of Medical Sciences Medical Evaluation Scheme

Background: Evaluation analysis the learning capabilities and check the knowledge with skills that students have gained during study period. Good evaluation scheme is a key issue in medical education. Evaluation scheme currently in use are reviewed with attention to their strength and weaknesses. The purpose of the present study was to determine perception of medical students regarding effectiveness of Kathmandu University School of Medical Sciences (KUSMS) medical evaluation scheme which may enhance the competency of the medical students as well as quality of medical education. Materials and Methods: This study was cross sectional questionnaire based study which consisted of 250 (165 male and 85 female) medical students who have already appeared in university examination. A Google Form Questionnaire was generated and shared to the student in order to acquire their perception regarding KUSMS medical evaluation scheme. Data was collected and statistical analysis was done. Results: Majority of the participants had shown their strongly agreement that KUSMS medical evaluation scheme is one of the best tool which help them to support in improving their learning skills and in obtaining good mark in their examination. Most of them also agreed that formative assessments give them the best opportunity to improve the weakness in their studies. Similarly, they preferred more integrated pattern of examination (current) rather than discipline based (subject wise) examination. Conclusion: The assessment methods should match the competencies being learnt and the teaching methods being used. Several assessment methods are used longitudinally to assess the student’s learning needs and to identify optimal performance by the faculties.

A Mixed Methods Study of Perceptions of Mental Illness and Self-Disclosure of Mental Illness Among Medical Learners

Introduction: Mental illness stigma remains rooted within medical education and healthcare. We sought to measure perceptions toward mental illness and explore perceptions of self-disclosure of mental illness in medical learners. Method: In a mixed-methods, sequential design, authors recruited medical learners from across Canada. Quantitative data included the Opening Minds Scale for Healthcare providers (OMS-HC), the Self Stigma of Mental Illness Scale (SSMIS), and a wellbeing measure. Qualitative data included semi-structured interviews, which were collected and analyzed using a phenomenological approach. Results: N = 125 medical learners (n = 67 medical students, n = 58 resident physicians) responded to our survey, and N = 13 participants who identified as having a mental illness participated in interviews (n = 10 medical students, n = 3 resident physicians). OMS-HC scores showed resident physicians had more negative attitudes towards mental illness and disclosure (47.7 vs. 44.3, P = 0.02). Self-disclosure was modulated by the degree of intersectional vulnerability of the learner’s identity. When looking at self-disclosure, people who identified as men had more negative attitudes than people who identified as women (17.8 vs 16.1, P = 0.01) on the OMS-HC. Racially minoritized learners scored higher on self-stigma on the SSMIS (Geometric mean: 11.0 vs 8.8, P = 0.03). Interview data suggested that disclosure was fraught with tensions but perceived as having a positive outcome. Discussion: Mental illness stigma and the individual process of disclosure are complex issues in medical education. Disclosure appeared to become more challenging over time due to the internalization of negative attitudes about mental illness.

What makes an article a must read in medical education?

BackgroundThe dissemination of published scholarship is intended to bring new evidence and ideas to a wide audience. However, the increasing number of articles makes it challenging to determine where to focus one’s attention. This study describes factors that may influence decisions to read and recommend a medical education article.MethodsAuthors analyzed data collected from March 2021 through September 2022 during a monthly process to identify “Must Read” articles in medical education. An international team of health sciences educators, learners, and researchers voted on titles and abstracts to advance articles to full text review. Full texts were rated using five criteria: relevance, methodology, readability, originality, and whether it addressed a critical issue in medical education. At an end-of-month meeting, 3–4 articles were chosen by consensus as “Must Read” articles. Analyses were used to explore the associations of article characteristics and ratings with Must Read selection.ResultsOver a period of 19 months, 7487 articles from 856 journals were screened, 207 (2.8%) full texts were evaluated, and 62 (0.8%) were chosen as Must Reads. During screening, 3976 articles (53.1%) received no votes. BMC Medical Education had the largest number of articles at screening (n = 1181, 15.8%). Academic Medicine had the largest number as Must Reads (n = 22, 35.5%). In logistic regressions adjusting for the effect of individual reviewers, all rating criteria were independently associated with selection as a Must Read (p < 0.05), with methodology (OR 1.44 (95%CI = 1.23–1.69) and relevance (OR 1.43 (95%CI = 1.20–1.70)) having the highest odds ratios.ConclusionsOver half of the published medical education articles did not appeal to a diverse group of potential readers; this represents a missed opportunity to make an impact and potentially wasted effort. Our findings suggest opportunities to enhance value in the production and dissemination of medical education scholarship.

PROFESSIONAL MOTIVATION OF STUDENTS AS A FACTOR FOR INTEGRATING FUNDAMENTAL AND CLINICAL DISCIPLINES IN HIGHER MEDICAL EDUCATION

This article addresses the pressing issue of medical education: the integration of fundamental and clinical disciplines. Given the rapid pace of scientific and technological advancements, the professionalism of modern doctors largely relies on their natural and scientific training, which begins in the early stages of medical university education. Medical and biological physics play an important role in this training, but integrating them into medical education is challenging due to the complexity of the discipline's content, which students must grasp at the outset of their education, and the lack of understanding among first-year students about the connections between physics, mathematics, and medicine. The article discusses various approaches to teaching medical and biological physics, focusing on creating professional motivation among students to master fundamental sciences. It highlights the example of designing an X-ray computed tomography (CT) scanner as a means of motivating students to excel in their studies. The importance of leveraging students' prior knowledge from school textbooks on physics, biology, and chemistry to solve tasks fundamental to clinical practice is emphasized. Using the practical lesson topic “Physical foundations of X-ray diagnostics and X-ray therapy” as an example, the article demonstrates the need to focus on the properties of X-ray radiation relevant to medical applications, such as rheography, fluorography, and CT scans. Professional motivation is further enhanced through activities like participating in a biophysics scientific circle and visiting university clinics and training centers, where students can witness the practical application of their theoretical knowledge. The article underscores the importance of integrating fundamental and clinical disciplines while adhering to pedagogical principles such as scientific rigor, continuity, and consistency.

Prevalence and correlates of imposter syndrome and self-esteem among medical students at Jazan University, Saudi Arabia: A cross-sectional study.

Imposter syndrome (IS) and low self-esteem (SE) are common issues affecting medical students that can impact their well-being and development. This study aimed to assess the prevalence and factors associated with IS and SE among medical students at Jazan University, Saudi Arabia. In this cross-sectional study, 523 medical students in years 2-6 at Jazan University, Saudi Arabia, completed validated questionnaires on IS (Young Imposter Scale) and SE (Rosenberg Self-Esteem Scale). Sociodemographic factors were also collected. Descriptive statistics and logistic regression analyses were used to analyze IS and SE prevalence and correlates. Five hundred twenty-three students with a mean age of 22.09 ± 1.933 participated. The prevalence of low SE and positive IS was 17.6% and 24.3%, respectively. IS and SE had a significant negative correlation (p<0.001). Several sociodemographic factors were associated with increased IS, including 2nd and 4th-year students, forced study choice, and a grade point average (GPA) of 3.0-3.49 (P<0.05). Paternal education beyond high school was associated with lower IS (P<0.05). Logistic regression analyses confirmed that 2nd-year students had a 3.88 times higher odds ratio (OR) (95% confidence interval (CI); 2.19-6.88), and 4th-year students had a 2.37 times higher OR (95% CI; 1.40-4.02) of IS than other years. For SE, advanced academic years, forced study choice, 7+ hours of sleep, and a GPA above 3.5 were associated with higher levels (P<0.05). Negative self-appraisals were associated with lower SE, while positive attitudes were associated with higher SE (P<0.05). Our study reveals that IS and low SE are prevalent among Jazan University, Saudi Arabia, medical students. Therefore, intervention courses that address these issues in medical education at Jazan University, Saudi Arabia, may be necessary to support medical students' well-being and academic success.

Medical school origins of award-winning psychiatrists; analysis of a complete national dataset

BackgroundBritain attracts doctors from all over the world to work in the National Health Service. Elucidating the educational backgrounds of award-winning doctors working in the country is potentially an important medical education issue and a merit award audit. Using the British clinical merit award schemes as outcome measures, we identify medical school origins of award-winning doctors who have been identified as having achieved national or international prominence.MethodsThe Clinical Excellence Awards/Distinction Awards schemes select doctors in Britain who are classified as high achievers, with categories for national prominence and above. We used this outcome measure in a quantitative observational analysis of the 2019–20 dataset of all 901 award-winning doctors. Pearson's Chi-Square test was used where appropriate.ResultsFive university medical schools (London university medical schools, Glasgow, Edinburgh, Aberdeen and Cambridge) accounted for 59.1% of the psychiatrist award-winning doctors in the 2019 round, despite the dataset representing 85 medical schools. 84.1% of the psychiatrist award-winners were from European medical schools, compared to 92.1% of the non-psychiatrist award-winners. International medical graduates accounted for 22.7% of the award-winning psychiatrists. Psychiatrists with the lower grade national awards came from a more diverse educational background of 17 medical schools. IMGs represented diverse medical schools from five continents and were most represented in the lowest grade of national merit awards at 24.2%.ConclusionsThe majority of the award-winning psychiatrists originated from only five medical schools. A greater diversity of medical school origin existed for the lowest grade national psychiatrist award-winners. International medical graduates contributed substantially to these award-winners; psychiatrist award-winners were more likely to be international medical graduates (22.7%) than non-psychiatrist award-winners (10.8%). This study not only indicates educational centres associated with the production of award-winners but also provides students with a roadmap for rational decision making when selecting medical schools.

Church and Liberal Healthcare: Need of Spiritual and Moral Education for Healthcare Workers

The increased attention of the Orthodox Church to issues of medical education in our country was the result of the fact that in the 1990s it once again became one of the most active forces in our society. The connection between the church and the medical community, which goes back to a time when the doctoring of the mind and bodily health was in fact the work of the same people, cannot leave the church indifferent to the professional formation of healthcare workers. The Soviet era saw the forced de-Christianization of the medical profession and measures taken to abolish medical ethics rooted in the Hippocratic Oath and the Gospel commandments. The restoration of dialogue between church and medicine began after the collapse of the Soviet state, but it is still insufficiently regular. Currently, factors complicating this dialogue are liberal medical legislation and capitalist economies in health care. The former, by legalizing abortion, artificial insemination, and sterilization, absolves the doctor of moral responsibility in matters concerning the management of human life; the latter encourages him to view his profession not as a service, but as a means of making money from other people’s suffering. If the dialogue between church and medicine were to be carried on permanently within the walls of medical schools, it would strengthen the spiritual and moral foundations of the medical profession, upon which it has always existed. One of the most significant forms of this dialogue should undoubtedly be the teaching of biomedical ethics, which should be grounded in modern theology and the values of traditional spiritual cultures of Russia.

Трансплантационный туризм как актуальная гуманитарная проблема в современном медицинском образовании

Важным компонентом современного медицинского образования является биоэтика, которая позволяет дискутировать об актуальных гуманитарных проблемах. Одной из них, несомненно, является трансплантационный туризм. Имеющиеся сведения о попытках некоторых россиян решать свои проблемы со здоровьем посредством выезда заграницу, получения там донорского органа и проведения операций позволяют судить о растущей значимости данного явления. Его объективными предпосылками являются дефицит донорских органов и неспособность системы здравоохранения единовременно удовлетворить потребности всех нуждающихся пациентов. Основным направлением для трансплантационного туризма в последнее время являются страны Азии: Индия и Китай, но ситуация там меняется, поскольку власти предпринимают усилия, направленные на устранение данного неприглядного явления. Риски, сопровождающие выезд российских граждан в качестве трансплантационных туристов, разнообразны. Они включают в себя как медицинские, так и этические аспекты.

CREATING A LEVEL PLAYING FIELD: ADDRESSING GENDER BIAS IN UNDERGRADUATE MEDICAL STUDENT ASSESSMENTS

Objectives: To identify the mechanisms to reduce gender bias during assessments in undergraduate medical education. Material and Methods: A qualitative study with a phenomenological study design was conducted at a Public and Private Med- ical College in Peshawar, Pakistan, from July 2020 to October 2020. In this qualitative study, four gender-specific focal group interviews with undergraduate medical students and 10 individual interviews with senior faculty members were conducted by using a pre-tested &amp; validated semi-structured interview guide. The interviews were recorded and transcribed verbatim. The thematic analysis of the data was done where codes were developed and organized into distinct categories giving rise to discrete themes. Data triangulation was done to increase the credibility and authenticity of the study. Results: Out of 24 students and 10 faculty members, half of the participants were females who shared their perceptions about mechanisms to counteract gender bias in medical education. The analysis revealed 24 codes that were labeled and organized into 10 categories. The 4 themes deducted from these categories were Anti-Bias Training, Surveillance of Exam- ination, Psychological Evaluation of Students &amp; Faculty, and Transparency &amp; Accountability. Conclusion: Gender bias can substantially affect medical students’ capacity to learn and succeed in their careers, is a well-es- tablished fact. Thus, to reduce gender bias in medical education, medical schools must take more excellent initiatives and promote anti-bias awareness sessions &amp; workshops, post-examination feedback &amp; reporting systems, and strict surveillance &amp; accountability. Similarly, psychological evaluation of teachers &amp; students, structured examination patterns, and promoting a panel of assessors for high stake exams are other strategies to counteract this issue in undergraduate medical education. Keywords: Assessment, Gender bias, Reduce, Undergraduate Medical Education

Medical school origins of award-winning surgeons; analysis of a complete national dataset

BackgroundBritain attracts doctors from all over the world to work in the National Health Service. Elucidating the educational backgrounds of award-winning doctors working in the country is potentially an important medical education issue and merit award audit. Using the British clinical merit award schemes as outcome measures, we identify medical school origins of award-winning doctors who have been identified as having achieved national or international prominence.MethodsThe Clinical Excellence Awards/Distinction Awards schemes select doctors in Britain who are classified as high achievers, with categories for national prominence and above. We used this outcome measure in a quantitative observational analysis of the 2019 dataset of all 901 award-winning doctors. Pearson's Chi-Square test was used where appropriate.ResultsSeven medical schools (London university medical schools, Glasgow, Edinburgh, Aberdeen, Oxford, Cambridge and Manchester) accounted for 52.7% of the surgical award-winning doctors in the 2019 round, despite the dataset representing 85 medical schools. Surgeons with the lower grade national awards came from a more diverse educational background of 43 medical schools. International medical graduates accounted for 16.1% of the award-winning surgeons and 9.8% of the award-winning non-surgeons. 87.1% of the surgical award-winners were from European medical schools, whereas 93.2% of the non-surgical award-winners were from European medical schools.ConclusionsThe majority of the award-winning surgeons originated from only seven, overrepresented, medical schools. A greater diversity of medical school origin existed for the lowest grade national merit awards. These comprised 43 medical schools and indicated greater globalization effects in this category. International medical graduates contributed substantially to these award holders; surgical award-winners were more likely to be international medical graduates (16.1%) than non-surgical award-winners (9.8%). This study not only indicates educational centres associated with the production of award-winners but also provides students with a roadmap for rational decision making when selecting medical schools.

Gender bias and 'doctor brides'. A social dilemma of medical students in Pakistan.

To assess gender bias, discrimination and bullying at medical schools, and to explore the phenomenon of 'doctor brides'. The multicentre survey was conducted at 14 medical education institutions across Pakistan from September 2020 to April 2021, and comprised medical students of either gender at both public-sector and private-sector institutions. The survey questions explored beliefs, experiences and knowledge related to common stereotypes and social issues in medical education, including female role models, work-life balance, gender roles, lack of support from family and faculty, and bullying. Association between gender with survey variables was explored. Data was analysed using SPSS 26. Thematic analysis was used to exploring knowledge around 'doctor-brides'. Of the 377 subjects, 245(65%) were females. The overall mean age was 21.4±1.8 years. There were 211(53.8%) subjects aged 21-23 years, and 368(97.6%) were Muslims. Significantly more women than men were of the opinion that men are encouraged and are more likely to assume leadership roles (p=0.002). More women than males agreed that household chores and work had an impact on speciality choice (p<0.001). Most sexual assault victims were women (p<0.0001), but men generally faced more bullying and hostile behaviour (p=0.014). With regard to women being forced to quit medicine after marriage/childbirth by their in-laws/husbands or change their careers from clinical medicine to preclinical teaching, 99(26.25%) subjects knew first-hand of such cases, while 238(63.12%) had no such experience to share. Gender bias, discriminatory behaviour and bullying were found to be widely prevalent in medical schools across Pakistan. The general perception of 'doctor brides' needs to be revisited.

CLUSTERING OF MEDICAL IMAGES USING MULTIWAVELET TRANSFORM AND K-MEANS ALGORITHMS

Imaging data and biological records are both included in the field of medical informatics. Medical image clustering is an important area of research that is getting increased interest in both academia and the health professions. It addresses the issues of medical diagnosis, analysis, and education. Several medical imaging methods and applications based on data mining have been made and tested to deal with these problems. This paper looks at how image classification techniques diagnose diseases in the human body. It concerns the imaging modalities, dataset, and the pros and cons of each method. An optimal clustering technique of medical images using multiwavelet transforms proposed that combines the multiwavelet transform filterbanks with the k-means clustering algorithm to improve the performance and get a clinically meaningful clustering shape. In comparison with other methods of clustering, it was shown that this method has a much higher cluster classification than those published before. A user-friendly Matlab program has been constructed to test and get the results of the proposed algorithms

Diffusion of Technology in the Teaching of Neuroanatomy in Times of Pandemic: A Medical and Academic Perspective on Learning.

The Covid-19 pandemic has caused major changes in many sectors of society worldwide. The issue of medical education stands out since it had to adapt to the rules of social isolation, ensuing discussions about the computerization of teaching methodology, particularly in neuroanatomy. In particular, the latter showed satisfactory adaptability to new technologies and highly promising learning results. During this review, we aim to evaluate the current state of neuroanatomy teaching and evaluate the possibilities of incorporating technology into teaching–learning of human anatomy in a post-pandemic world.

Investigating the Effects of Premedical Experiences on Medical Student Neuroanatomy Self‐Efficacy

One key issue in medical education is medical student fear of learning and applying neuroanatomy called neurophobia. In a previous study, we found a negative correlation between neurophobia and neuroanatomy self‐efficacy (one’s confidence in their ability to complete neuroanatomy tasks). Our findings suggest increasing neuroanatomy self‐efficacy may reduce one’s neurophobia. Additionally, the literature shows self‐efficacy improves academic achievement and clinical performance in medical school. It is unknown whether experiences before medical school may later influence medical student neuroanatomy self‐efficacy. This study aims to fill this literature gap by isolating which premedical experiences most significantly influence neuroanatomy self‐efficacy. We hypothesize medical students with premedical neuroanatomy‐specific experience will exhibit greater neuroanatomy self‐efficacy than students without this experience.Instrumentation to measure neuroanatomy self‐efficacy and categorize premedical experiences was developed and administered to medical students (n=233). Premedical experiences were categorized as: neuroscience (NSC), neuroanatomy (NAC), neuroscience and neuroanatomy (NSAC), cadaveric gross anatomy (GR), or anatomy and physiology (AP). An analysis of variance with a Tukey’s post‐hoc test was performed to isolate which premedical experience(s) showed significant differences in neuroanatomy self‐efficacy compared to students with no previous experience. All statistical tests were performed at the p=0.05 level. IRB approval was obtained.Data analysis showed indirect premedical neuroanatomy exposure as part of a premedical gross anatomy course (GR) resulted in greater neuroanatomy self‐efficacy (p=0.01, Cohen’s d= 0.50) compared to students with no previous experience. Interestingly, enrollment in a premedical molecular neuroscience (NSC) or neuroanatomy (NAC) course individually did not show an increase in neuroanatomy self‐efficacy. Only medical students with both premedical NSC and NAC experiences (NSAC) demonstrated higher neuroanatomy self‐efficacy than students with no premedical experience (p= 0.001, Cohen’s d= 0.52).Premedical exposure to neuroanatomy as part of a gross anatomy course (GR) or enrollment in both premedical neuroanatomy andneuroscience courses (NSAC) appears to be associated with higher neuroanatomy self‐efficacy in medical students. Considering the decline in neurologists, and fewer medical students choosing neurology, these findings support youth STEM initiatives to provide increased access to both neuroscience and neuroanatomy experiences along with cadaveric gross anatomy.

A discourse analysis of General Medical Council (GMC) guidelines for the inclusion of cultural diversity issues in medical education and practice

Background Several studies have highlighted the insufficient inclusion of cultural diversity in medical schools’ curricula and the extent of health inequalities highlighted by the COVID-19 pandemic. This study aimed to critically review a range of GMC publications to identify the inclusion of cultural diversity topics in their guidelines, as according to recent studies, doctors are inadequately prepared to serve a diverse population. Methods Twenty-four relevant GMC publications were analysed. An inductive thematic analysis was conducted to review the content of the guidelines; and discourse analysis was used to critically understand the linguistics used whilst also considering the cultural and social context. Results The GMC publications primarily focused on discouraging discrimination and promoting equality. Themes around diversity in medical practice were less commonly covered. There was considerable internal inconsistency across the guidelines. Guidelines aimed at medical schools and medical students were more likely to consider cultural diversity issues compared to those intended for doctors. Conclusions Cultural diversity teaching can only be as effective as the policy that drives it. Despite the inclusion of cultural diversity issues in GMC guidelines, this study suggests considerable ambiguity in how these issues are represented and understood. The guidelines require careful revision and should be written to reduce the likelihood of variable interpretation, thereby promoting better cultural diversity inclusion in medical schools’ curricula, and consequently better patient care.

Promoting climate change issues in medical education: Lessons from a student-driven advocacy project in a Canadian Medical school

Health advocacy is an essential competency prescribed by many professional medical bodies tasked with fostering the development of medical trainees into well-rounded physicians. With increasing recognition of the ramifications of the negative impacts of climate change on population health, mitigation intervention is gaining traction as an important area in public health and physician's advocacy work. However, several lines of evidence show that Canadian medical training provides limited curricular activities to understand the impacts of climate change on health. This report highlights an advocacy effort by a group of medical students at McMaster University, Canada to promote better awareness and formal educational activities on climate change and health among medical learners. The project involves educational activities, didactic lectures, and an engagement with the medical school administration to promote curricular activities and resources on climate change and health. The lessons from this advocacy work include the need for better integration of climate change issues and health education into medical training, celebrating climate advocacy work, and creating a formalized portfolio within medical school administration to support climate change and health issues.

Technologic optimization of a virtual disease focused panel during the COVID pandemic and beyond.

Since the beginning of the COVID-19 pandemic, several service fields have opted for virtual work as much as possible, in order to decrease the spread of the virus. Although several articles have now addressed the key issues in telecommunications and medical education, none have described the digital or virtual functionality of a professional society disease focused panel (DFP) or inter-institutional collaborations. This is extremely important as we believe that the virtual functioning of the DFP will be the new norm for years to come. In this article, we highlight the limitations in the functioning of DFP brought forth due to the ongoing pandemic, while also providing the digital technologic solutions to adapt and also maintain or increase its productivity.

An Internal Perspective: the Psychological Impact of Mistreatment.

Student mistreatment remains a prominent issue in medical education. Mistreatment has been linked to negative mental health outcomes, including depression, anxiety, and burnout. Continued challenges in this arena include difficulties in identifying mistreatment and underreporting. The objective of this study was to better understand the nuances of individual students' reactions to mistreatment. Medical students, who had experienced mistreatment, were invited to participate in this study. Individual, semi-structured, peer-to-peer interviews were conducted with 21 students. Interview transcriptions were coded using grounded theory and inductive analysis, and themes were extracted. The interviews generated 34 unique mistreatment incidents. Four major themes arose in students' reactions to mistreatment. (1) Descriptions-the student described the incident as inappropriate, unusual, or unnecessary. (2) Recognition-most students did not immediately recognize the incident as mistreatment. (3) Emotions-the student described negative emotions (negative self-views, anger, powerlessness, shock, discomfort) associated with the mistreatment incident. (4) Coping mechanisms-the student utilized avoidance and rationalization to process their mistreatment. Mistreatment generates complex emotions and coping mechanisms that impair the learning process. These complex emotions and coping mechanisms also make it difficult for trainees to identify mistreatment and to feel safe to report. Increasing understanding of the psychological impact of mistreatment can help peers and educators better screen for mistreatment in trainees and guide them in reporting decisions.

Peer learning for students and supervisors: Complexity in the clinical setting

Learning to translate theory into practice in the healthcare setting is a key capability for students to develop as they work towards becoming professionals in their chosen field. As students learn to provide care for patients in authentic settings, the role of supervisors is crucial to ensure patient and student safety, and to extend learning opportunities. In this issue of Medical Education, Dyar et al1 carefully explore the role of supervisors working with students engaged in workplace peer learning. In this context student pairs work in a dedicated ward, learning together and supporting each other. Using a phenomenographic approach Dyer et al unravel the potential ambiguity in relationships and roles for students and supervisors in a student-led clinical environment.

Can the arts and humanities bring the patient's voice centre stage in medical education?

'Where is the patient's voice in medical education?' ask Gabrielle Brand and colleagues in their paper published in this issue of Medical Education (1). The answer to this question depends on the type of patient voice that you are referring to. On the one hand, there is the voice of the patient receiving health care, subject to the hierarchies of power in the patient-clinician context (2), often unwell and unlikely to be strategically focussed on the educational needs of students.