Janneke Ma Frambach

Introduction: Obstetrics and Gynaecology (OBGYN) residents are often responsible for medical students fulfilling learning objectives during clerkship, including performing pelvic examinations. Limited research exists on OBGYN residents’ experiences in supervising students performing these intimate examinations. This study explores how OBGYN residents navigate this supervisory role through the lens of the Cognitive Apprenticeship Model (CAM) by investigating their experiences supervising students performing these examinations on patients. Methods: This qualitative study, conducted at a single tertiary hospital in Singapore, purposively sampled ten OBGYN residents, reaching thematic sufficiency. Data were collected via one-on-one semi-structured interviews, informed by CAM and analyzed thematically using the model as a sensitizing framework. Reflexivity meetings were held for transparency of findings and interpretations. Results: Two overarching themes captured residents’ supervisory experiences: (1) challenges and support related to nuances of pelvic examinations, and (2) limited opportunities for students to perform them. Residents helped students, who particularly struggled with speculum examinations, by providing stepwise guidance using CAM components. Students’ exposure to bimanual examinations was restricted, as residents took over to reduce patient discomfort. Supervision was further constrained by consent issues, student factors, and systemic barriers. Residents employed CAM strategies to overcome these challenges. Discussion: Residents’ supervision of pelvic examinations were influenced by patient, student, and system factors. Despite this, residents used CAM strategies when opportunities arose, providing stepwise coaching, role modelling, reflection, and exploring ways to improve supervision. These findings offer valuable insights for healthcare educators designing Resident-as-Teacher curricula for intimate examinations.

Introduction: Research shows that medical students from certain minoritised backgrounds often face discrimination and reduced belonging, harming wellbeing and performance. However, such research rarely justifies its focus on these backgrounds, taking the selected categories of minoritized students for granted, even though categorisation itself is neither neutral nor harmless. To offer an alternative perspective, we used theoretical perspectives of categorisation to examine categories students construct for themselves and others, what meanings they attribute to these constructions, and how this affects their study experiences. Method: Using a constructivist approach, we conducted semi-structured interviews with 11 students from two Dutch medical programmes. Students reflected on experiences from application to clinical rotations. Transcripts were coded using theoretical concepts of categorisation. The analysis focused on how and when students invoked categories, their attached meanings, and impact. Findings were synthesized into three crafted stories illustrating students’ experiences. Results: Students described categorising themselves and others fluidly, shifting across time and context. Categories became salient when students deviated from an implicit norm (e.g., identifying as lesbian in heteronormative environments or Black among white peers). Students and others valued each other positively, yet sometimes overemphasized categories and negatives. Such dynamics shaped feelings of belonging and exclusion and, sometimes, contributed to dropout. Discussion: Improving students’ learning experiences requires acknowledging categorisation’s omnipresent nature and its interconnected dynamics. Focusing on individuals’ experiences and implicit norms – rather than standard categories – in all stages of educational practice and research is essential for fostering diversity and inclusion in the learning and healthcare environment.

Health professions education is increasingly called upon to prepare clinicians to provide equitable, patient-centered care; yet transgender and gender-diverse (TGD) health remains inconsistently integrated into formal curricula. Despite growing clinical literature, including evidence related to cardiovascular outcomes, educational integration of TGD health content remains limited across residency training programs. This disconnect between emerging evidence and curricular uptake raises questions about structural barriers that shape what is considered "core" knowledge. This study explored academic faculty perspectives on barriers to integrating TGD health content into residency curricula, using cardiovascular health as an illustrative case within Internal Medicine (IM) training. Drawing on a descriptive qualitative approach informed by Queer Theory, we conducted semi-structured interviews with 10 IM faculty members involved in curriculum development and teaching at a large Canadian academic institution. We purposively sampled participants to capture diversity in gender identity, academic rank, and clinical interest. We transcribed and analyzed interviews using NVivo. We performed a thematic analysis framed through a Queer Theory lens to identify how educational exclusion might reflect broader patterns of institutional cisnormativity. We constructed six themes from the data. While some participants cited lack of expertise or clinical exposure, others described structural forces-such as hierarchy-driven curriculum design, perceived niche status, and binary medical frameworks-that shape broader patterns of curricular inclusion and exclusion. When viewed through Queer Theory, these findings illustrate how the cisnormative image of the "default patient" renders some bodies and topics invisible to the curriculum, even when evidence and clinical need are well established. This exclusion of TGD health content, illustrated here through cardiovascular care, reflects cisnormative assumptions embedded within medical education. Just as the field has challenged the normative image of the physician, this study argues for a parallel interrogation of the patient. The same worldview that shapes which bodies clinicians are prepared to see also shapes what educators recognize as core content. Queer Theory exposes these exclusions and points toward structural work in curriculum design, faculty development, and institutional leadership required to address them.

Scholars in higher education have long theorised the relational and political dimensions of social spaces, including their potential impact on students' wellbeing, sense of belongingness and identity, but this is a largely unexplored topic in health professions literature. To address this gap, we explored how student common rooms in a medical school were allocated and managed, and how these processes shaped student experiences. Our specific research question was: how does the design and management of student social space influence students' experience of this space? We adopted a constructivist perspective and drew upon Lefebvre's idea of space as a sensitising lens to guide our analysis. We conducted an institutional ethnography (IE) informed qualitative study using documents and semi-structured interviews for data collection to understand what influenced students' experiences of social spaces ('House rooms'). We purposively sampled 22 participants: 13 students, seven personal tutors, and two administrators to gather diverse perspectives. We also analysed institutional guides and handbooks, and historical meeting minutes. The medical school conceptualised these rooms as dedicated student spaces to foster students' sense of belongingness and identity. Room planning was 'top down' with minimal student involvement. While the school positioned these rooms as public, students gradually reimagined them as private, social, and safe spaces. The students, the users, claimed the rooms as their own through agency and subtle acts of resistance. Our study illuminates that social space involves not just those people who use it, but also those who manage it. In our example, tacit understanding seemed to be struck between the institution and students, where the latter mostly accepted institutional monitoring and surveillance in exchange for a space within the campus that they could call their own. How social spaces are managed and used are reflections of the relationship between providers and users.

Caring for patients in the outpatient setting is a significant part of many physicians’ responsibilities due to healthcare’s shift from inpatient to outpatient settings. Outpatient care is complex and characterized by longitudinal relationships among all who work in this setting, including the patients. There is recognition of the need to enhance graduate medical education specifically situated in the outpatient setting. Considering that good educational practices need to be grounded in theoretical principles, the aim of this conceptual article is to analyze and explain learning in the outpatient care setting through a critical appraisal of selected learning theories. Four theories were selected to explore residents’ learning in relation to characteristics of the outpatient setting: 1) Cultural-Historical Activity Theory, 2) Situated Learning Theory, 3) Cognitive Development Theory and 4) Self-regulated Learning Theory. These theories were selected for their socio-cultural perspective or their focus on the learner. We highlight the implications for medical education and how these learning theories can inform teaching and learning in the outpatient care setting. For example, identification of contradictions and tensions between educational activity systems can promote expansive and transformational learning. By recognizing the unique opportunities for learning in the outpatient setting and applying learning theories, program directors and education specialists can develop better training programs resulting in more competent physicians to care and serve the needs of patients and society.

Introduction: Medical schools have a duty of care to support their students' health and well‐being. Student support studies have tended to focus on outcomes in respect of effectiveness and satisfaction. In contrast, little is known about how student expectations of support may shape their experiences and engagement with support mechanisms, as well as the relationships students have with those offering support (including the institution itself). To address this gap in knowledge, we explore how medical students' expectations of student support systems shape, and are shaped by, institutional rules and processes. Methods: We employed a qualitative case study approach using an institutional ethnography informed methodology. Our context was a medical school that provides a well‐advertised, formal institutional support system where students are assigned a personal tutor. Data collection included interviews with medical students ( n = 13) plus document analysis (public facing artefacts and internal policies/guidelines related to the support system). We applied the lens of psychological contract theory to guide abductive analysis of interview and text data. Results: Students expected a strong support system to be provided by the medical school and the personal tutors. However, their experiences did not always align with their expectations. Some felt excluded by the system while others regarded the relationship with their personal tutor as more transactional than relational. Where their expectations were unmet, students responded by reducing their engagement with the formal support system and creating their own peer‐support network that supplemented existing formal support. Discussion: Student expectations matter in shaping their experiences of support systems. Where expectations are unmet, students may disengage and/or find alternatives. This may be easier for some students compared with others. More understanding of the relationship between expectations and engagement with support can inform the development of institutional support structures that meet the needs of all students across time.

Existing approaches to cultural diversity in medical education may be implicitly based on different conceptualisations of culture. Research has demonstrated that such interpretations matter to practices and people concerned. We therefore sought to identify the different conceptualisations espoused by these approaches and investigated their implications for education. We critically reviewed 52 articles from eight top medical education journals and subjected these to a conceptual analysis. Via open coding, we looked for references to approaches, their objectives, implicit notions of culture, and to implementation practices. We iteratively developed themes from the collected findings. We identified several approaches to cultural diversity teaching that used four different ways to conceptualise cultural diversity: culture as ‘fixed patient characteristic’, as ‘multiple fixed characteristics’, as ‘dynamic outcome impacting social interactions’, and as ‘power dynamics’. We discussed the assumptions underlying these different notions, and reflected upon limitations and implications for educational practice. The notion of ‘cultural diversity’ challenges learners’ communication skills, touches upon inherent inequalities and impacts how the field constructs knowledge. This study adds insights into how inherent inequalities in biomedical knowledge construction are rooted in methodological, ontological, and epistemological principles. Although these insights carry laborious implications for educational implementation, educators can learn from first initiatives, such as: standardly include information on patients’ multiple identities and lived experiences in case descriptions, stimulate more reflection on teachers’ and students’ own values and hierarchical position, acknowledge Western epistemological hegemony, explicitly include literature from diverse sources, and monitor diversity-integrated topics in the curriculum.

International Medical Programmes (IMPs) form a distinctive modality in medical education, with diverse student populations, English as a language of instruction and 'globalized' curricula. A lack of common understanding of IMPs' purposes and role in the medical education landscape triggers critiques. This study aims to document the effects of different discourses used to justify the purpose of IMPs. We use a discourse analysis approach to explore the different ways in which the purposes of IMPs are constructed at the regulatory, institutional, and individual level, and how these discourses interact. The research situates in two IMPs, in the Netherlands and in Hungary. Key-informant interviews, policy documents, and scholarly literature form the archive. The purpose of IMPs is constructed discursively around three distinct narratives and associated practices: around serving the institutions that host them, around serving the (global) public interest, and around serving individual students. Co-existence and misalignments of these three discourses cause conflicting practices and confusion among stakeholders. This study illustrates how diverging perspectives on internationalization in medical education create tensions for learners and staff. Articulating a clear and explicit meaning to internationalization may reduce uncertainties, and may reinforce realistic expectations of what constitutes a good outcome.

Background: There is growing global awareness of the importance of matters of equity and social justice. In health professions education (HPE), research has focused at undergraduate level and on health sciences curricula. Increasingly, health care professionals engage in HPE Master's and doctoral studies, where they are educated as curriculum designers and ‘producers’ of knowledge through their research. Considering their role in shaping what (and how it) is taught in health sciences curricula, questions can be asked about the extent to which postgraduate pedagogies are mindful of matters of social justice. As supervisors of postgraduate HPE students and as directors of such programmes, we interrogated and juxtaposed our perspectives on social justice and how these perspectives influence our postgraduate HPE supervisory and directing practices in our respective contexts. Methodology: Utilising a duo‐ethnographic approach, in which we each represented a site of enquiry, we generated data through written reflections and dialogic engagement framed around research questions about (1) our understanding of social justice, (2) how this influenced our practices as postgraduate supervisors and (3) how this influenced our practices and policies as directors of postgraduate studies. We recorded and transcribed our data generation meetings. Based on open coding of the transcriptions and written reflections, we constructed a conversation around our research questions. We integrated our reflexive journals in the conversation. Findings and Discussion: Our conversations were characterised by three sets of ideas involving the terminology around social justice, the complex nature of social justice, and the individual and social justice. These played out differently in our contexts, but they caution both of us against assumptions and encourage us to create time for conversations with our students, to consider what we ‘teach’ them, how we guide them and how we avoid gatekeeping their entry into the disciplinary space.

Introduction: School-level student support programmes provide students with pastoral care and support for academic, wellbeing and other issues often via a personal tutor (PT). PT work is a balancing act between respecting the confidential information divulged by students and doing what is expected in terms of accountability and duty of care. We aimed to explore how tutors manage this tension, with the aim of advancing understanding of student support programmes. Methods: This qualitative study was informed by an Institutional Ethnography approach. We conducted 11 semi-structured interviews with PTs from one medical school in Singapore. We considered how they worked in relation to relevant national and institutional-level policy documents and reporting guidelines. Data collection and analysis were iterative. Results: We crafted two composite accounts to illustrate the dilemmas faced by PTs. The first depicts a PT who supports student confidentiality in the same way as doctor-patient confidentiality. The second account is a PT who adopted a more mentoring approach. Both tutors faced confidentiality challenges, using different strategies to “work around” and balance tensions between accountability and maintaining trust. PTs were torn between school and student expectations. Discussion: Fostering trust in the tutor-student relationship is a priority for tutors but tensions between confidentiality, accountability and governance sometimes make it difficult for tutors to reconcile with doing what they think is best for the student. A more nuanced understanding of the concept of confidentiality may help support PTs and ultimately students.