Ellen L. Usher

Background: Hospitalists work in complex clinical environments with rising patient acuity and competing demands. Uncertainty is an inescapable part of this work, yet little is known about how hospitalists experience and manage clinical uncertainty. Objectives: To explore how hospitalists experience and manage uncertainty in clinical practice. Methods: We conducted a single‐center qualitative study using reflexive thematic analysis within a constructivist paradigm. We interviewed hospitalist attending physicians during and/or after their work week and analyzed data inductively, drawing on literature about uncertainty in other clinical contexts. To strengthen rigor and trustworthiness, we held return‐of‐findings feedback sessions with participants. Results: We interviewed 12 hospitalists between April 2023 and September 2024. Across diverse clinical situations, participants framed uncertainty through the lens of hospital discharge, using it as an anchor for decision‐making. Managing uncertainty required cognitive and emotional resources and was influenced by participants’ “bandwidth,” or perceived capacity to manage competing professional and personal demands. Perceived bandwidth shaped participants’ responses to uncertainty. Adequate bandwidth encouraged uncertainty engagement, while limited bandwidth prompted deferral or offloading. Participants described how they attempted to ease the burden of uncertainty for their oncoming colleagues by adjusting their documentation and care plans during handoffs. Conclusions: Hospitalists experience uncertainty as a routine part of clinical practice and manage it pragmatically to advance patients toward discharge. Their approaches are shaped by their perceived bandwidth. The influences of uncertainty should be considered when assessing workload, organizing clinical service, and planning handoffs.

Practice pointsCompetition, time pressure, social dynamics (e.g., social cues, team learning), immediate feedback, and active effort are design features that contribute to the success of serious ga...

Introduction: Professional identity formation in healthcare professions education (HPE) is a complex and often fraught process. Physicians and trainees experience identity struggles as they navigate their personal and professional development, along with the conflicting expectations, cultural norms and systemic pressures within the healthcare environment. Despite growing attention to these challenges, conceptual clarity around identity struggle remains limited. Method: To advance theoretical understanding of identity struggle, we conducted a critical narrative review of identity theories from developmental psychology, social psychology and sociology. We selected three major theoretical traditions—Neo‐Eriksonian, symbolic interactionist and social identity theories—and analysed their conceptualizations of identity, identity development and identity struggle. We examined these diverse perspectives to inform research and educational practice on professional identity formation in HPE. Results: Each theoretical tradition offers distinct insights into identity struggle. Neo‐Eriksonian theories emphasize exploration and commitment as central processes, framing struggle as developmental and potentially productive. Symbolic Interactionist theories highlight the role of socialization and identity dissonance, viewing struggle as emerging from tensions between personal agency and societal norms. Social Identity theories focus on group belonging and intergroup dynamics, conceptualizing struggle at both individual and socio‐contextual levels. We provide common critiques and limitations of each theoretical tradition. These perspectives illuminate varied mechanisms through which identity struggle manifests and evolves. Discussion: This review underscores the multifaceted nature of identity struggle and the value of theoretical pluralism in understanding professional identity formation. Struggle is not inherently negative; rather, it can be a catalyst for growth when appropriately framed and supported. We propose how educators and researchers might use these theoretical lenses to design interventions that foster productive identity development and address systemic contributors to identity struggles. We invite scholars drawing on critical perspectives of power and structure to challenge and deepen the conversation on identity struggle in HPE.

Purpose: Clinicians and scientists often take a different path in developing competence and confidence as educators compared with peers who have received formal pedagogical teaching. This study explores how award-winning health professions educators reflect on the development and fluctuation of their teaching self-efficacy over time. Guided by social cognitive theory, the study investigates how educators notice, make meaning of, and respond to diverse teaching-related experiences across their careers. Method: Between May and August 2023, 31 Mayo Clinic educators in clinical medicine, basic science, and allied health who had been recognized for teaching excellence in the past 10 years were invited to participate in semistructured interviews. Each participant first completed a preinterview survey and created a graph of their teaching confidence over time, which served as an anchor for the interview discussion. Reflexive thematic analysis identified patterns in how participants described sources of fluctuation in teaching self-efficacy. Results: Of the 31 invited educators, 21 (11 women, 10 men) took part in an interview. Educators described varied trajectories of teaching self-efficacy over time shaped by different experiences, interpretations, and instructional experimentation. Four themes were identified: (1) interpreting implicit and explicit feedback, (2) revising beliefs in response to successes and setbacks, (3) adapting to changing contexts, and (4) using social models to gauge effectiveness. Participants reported becoming more responsive to situational demands and learner needs over time. Conclusions: For these award-winning educators, teaching self-efficacy was constructed and reconstructed through an adaptive, socially situated process of interpretation and reflection. The same events may have affected self-efficacy differently, depending on how individuals framed and acted on their experiences. Findings support a model that emphasizes adaptive expertise and offers implications for faculty development.

Purpose: Clinician educators are essential to the academic medicine workforce, yet understanding how they assess their own teaching competencies is limited. The Clinical Educator Milestones (CEMs) guide growth across key educator domains, but their use and perceived relevance remain underexplored. This study aims to (1) evaluate clinician educators’ self-reported performance on the CEMs; (2) examine differences by career level, specialty, and experience; and (3) inform faculty development efforts through a clearer understanding of educators’ perceived strengths and gaps. Method: Clinician educators from 9 US academic institutions completed a self-assessment rating their performance across 4 universal pillars and 11 educational theory and practice competencies on a 1- (novice) to 5- (expert) point scale in 0.5-point increments from August to November 2024. Descriptive statistics and mean difference tests were used to analyze variation across demographic and professional characteristics. Results: A total of 484 responses to at least 1 CEM were received. Respondents rated themselves highest in commitment to professional responsibilities (mean [SD], 4.30 [0.68]), teaching and facilitating learning (mean [SD], 3.96 [0.74]), and professionalism (mean [SD], 3.93 [0.73]) and lowest in medical education scholarship (mean [SD], 3.11 [1.15]), program evaluation (mean [SD], 3.33 [1.03]), and the science of learning (mean [SD], 3.43 [1.10]). Statistically significant group differences were found by years of posttraining clinical experience (F2,413 = 16.87, P < .001, η2 = .076), years of teaching experience (F2,433 = 20.87, P < .001, η2 = .088), and academic rank (F2,403 = 13.96, P < .001, η2 = .065). Conclusions: This study identifies key trends in self-perceived strengths and needs among clinician educators and highlights the limited awareness of the CEM framework. As institutions aim to build effective educator development systems, the CEMs can serve as a useful structure for tailoring support to individuals and identifying institutional needs.

Purpose: Sense of belonging (belongingness) is a psychological inference about the quality of fit or potential fit between a person and a social context. Although inconsistencies in its measurement have been documented in other fields, how belongingness is defined and operationalized in medicine remains unclear. This review synthesizes how researchers have conceptualized and quantitatively assessed belongingness and related constructs among physicians. Method: This systematic review included original, English-language, peer-reviewed studies published through February 14, 2023, that measured sense of belonging (or a related, positively valenced construct) among medical students, residents, and/or practicing physicians using the keywords belongingness , social connectedness , social integration , relatedness , sense of community , and fitting in . The authors examined data at the study (e.g., participants, setting, location, methodological and reporting quality), instrument (e.g., origin, use, rating scale attributes, validity evidence), and item (via thematic analysis of content) levels. Results: Fifty-two studies met eligibility criteria, encompassing 16,956 participants, 54 instruments (23 author created, 17 reproduced, 12 adapted, and 2 indeterminate), and 350 items. Instrument lengths ranged from 1 to 30 items (median, 4); 47 of 54 instruments (87%) used Likert-type rating scales (3–7 response options; median, 5). Sources of validity evidence for resulting scores included content (39 of 54 [72%]), relations to other variables (36 of 54 [67%]), internal structure (26 of 54 [48%]), and response process (4 of 54 [7%]). Of 198 items provided verbatim, 69 (35%) measured belongingness or a related, positively valenced construct. Items targeted perceptions of interpersonal connection and broader belonging to organizations or professional groups. Conclusions: Belongingness measures among physicians demonstrate substantial heterogeneity. Opportunities for improvement include addressing methodological and reporting gaps, strengthening validity evidence, and enhancing conceptual clarity. These findings highlight areas for further development in how belongingness is measured across medical training contexts and health care organizations.