Martin Gartmeier

Clinical ward rounds are complex, high‑stakes encounters in which physicians must integrate clinical reasoning, team coordination, and patient‑centred communication. While ward rounds are routinely described as occasions on which physicians “see” their patients, ironically, the visual dimension of ward round communication has rarely been examined conceptually. In this paper, we argue that communication during ward rounds and other complex clinical encounters crucially relies on physicians’ professional vision: learned, task-specific ways of noticing, interpreting, and using visual information in socially and institutionally structured contexts. Drawing on research from medical education, cognitive psychology, and interaction research, we conceptualize professional vision enacted during ward rounds as encompassing two interrelated aspects: a cognitive aspect (noticing and knowledge‑based reasoning) and an embodied and interactional aspect (the coordination of gaze, body, and talk). We show how these aspects unfold across different phases of ward rounds and enable physicians to align information retrieval, decision‑making, teamwork, and patient engagement. By explicating professional vision as a central yet previously under-theorized resource in clinical practice, exemplified here through ward-round communication, this paper offers a conceptual foundation for future empirical research and suggests new directions for simulation‑based and professional vision‑focused instructional approaches in medical education.

Background: Student mistakes are common in bedside teaching (BST) and can serve as important learning opportunities. However, little is known about how frequently mistakes occur in authentic clinical settings, what types of learning content they involve, and how teacher and patient presence shape teachers’ handling of these mistakes. This study investigated (RQ1) the relevance of learning content during student mistakes, (RQ2) associations between mistake types and teachers’ reactions, and (RQ3) whether patient presence influences clinical teachers’ responses to mistakes. Methods: We conducted an observational study based on video recordings of 36 BST sessions across internal medicine, neurology, and orthopaedics (78.4 h). Using a hierarchical coding scheme, we identified mistakes, classified their learning content and mistake types, and coded teacher reactions as well as teacher and patient presence. Interrater reliability ranged from substantial to excellent. Descriptive statistics were used to determine the frequency of mistakes per hour and their distribution across the learning content. Associations between mistake types and teacher reactions were analysed via Spearman’s rank correlations (RQ2). Mann–Whitney U tests (RQ3) were used when examining whether teachers’ mistake-related behaviours differed depending on the presence or absence of the patient. Results: Across all BST sessions, the students made an average of 4.9 mistakes per hour. Mistakes occurred most often during theoretical knowledge and clinical reasoning, predominantly as reproduction mistakes, whereas an incorrect application of skills was most frequent during clinical examination and case presentations. Teacher presence was positively associated with the number of observed mistakes, particularly reproduction mistakes. During the physical examination, the students were supervised for only 72% of the active practice time. Teachers’ reactions - including elaboration, directness of feedback, and time provided for correction - did not differ significantly depending on patient presence. Conclusions: Student mistakes are common in BST and hold considerable didactic value; however, this value is not fully realised when supervision is inconsistent or when feedback remains limited. Enhancing clinical teachers’ capacity to detect errors, providing structured and supportive feedback, and adapting their approach to the presence of patients may strengthen their ability to learn from mistakes. Interventions that cultivate psychological safety and promote effective error-management practices could further improve the pedagogical quality of BST.

Physicians routinely operate in environments that require the rapid processing of complex and dynamic visual information to diagnose patient conditions, communicate effectively, and make informed decisions. Despite the central role of visual attention in clinical practice, these processes are rarely conceptualized or systematically measured in medical education research. In other professional domains, such abilities are described as professional vision (PV)—the situated capacity to selectively attend to relevant cues and interpret them considering domain-specific knowledge. Although the term professional vision foregrounds visual attention, we use it here to cover the multimodal clinical perception in which visual cues are typically embedded—predominantly visual, but in many tasks also auditory and verbal—with visual attention as the analytic anchor. This paper introduces a cognitive process model of professional vision for medical education (PV-CP) that specifies the perceptual and cognitive subprocesses underlying how physicians perceive and interpret clinically relevant information. Building on this model, we propose a theory-driven framework for the measurement of professional vision using multimodal indicators. Central to our argument is the assumption that professional vision represents a latent, temporally unfolding construct that cannot be validly captured through single behavioral metrics or outcome measures. Instead, robust measurement requires the coordinated analysis of gaze-based indicators of visual attention and cognitive indicators of reasoning, each reflecting distinct subprocesses of professional vision. By systematically linking families of indicators to specific subprocesses and clarifying their respective inferential strengths and limitations, the PV-CP model advances a process-oriented approach to studying professional vision in medical education. The framework provides a conceptual basis for integrating multimodal data sources and supports more precise interpretations of gaze and reasoning data in expertise research. In doing so, the model contributes to the theoretical refinement of professional vision and offers a structured foundation for future empirical research and the design of learning environments aimed at fostering clinically relevant perceptual–cognitive skills.

Assessment plays an important role in teaching and learning medical communication. Formative assessment is increasingly recognised as a crucial tool for improving learning outcomes and supporting competence development. In this study, we developed and evaluated different versions of automated formative and summative feedback in an online situational judgement test of basic medical communication competence. We developed four versions of task-based (formative) feedback, differing in their enrichment strategies (i.e. reflection prompts or expert explanations) and the timing of the feedback (i.e. immediate feedback or post-test feedback), and one performance-based (summative) version featuring a test-score profile. In a randomised controlled trial with N = 269 medical students, we evaluated the effects of feedback design on participants' (i) motivation and (ii) cognitive factors (i.e. cognitive load), as well as on their (iii) feedback perception (e.g. fairness and usefulness of the feedback) and (iv) perceived benefits of the feedback, all of which influence learning. We tested the hypotheses that task-based feedback would be more effective than performance-based feedback (H₁) and that task-based versions would have differential effects on the outcome variables (H₂). Planned contrast analysis revealed that task-based feedback was not consistently more effective than performance-based feedback across all outcomes (H₁). In line with H₂, analyses of variance revealed differential effects of feedback enrichment and timing: expert explanations enhanced cognitive understanding and perceived feedback benefits, whereas post-test feedback improved motivational outcomes such as perceived competence and fairness. The results highlight the complexity of determining an optimal feedback approach, as different implementations can have differential effects on the motivational and cognitive factors that further shape learning processes. The findings suggest that an optimal feedback approach depends on specific learning outcomes and student characteristics, highlighting the importance of careful selection of feedback strategies tailored to specific educational goals and contexts.

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Background: We define teacher wait time (TWT) as a pause between a teacher question and the following response given by a student. TWT is valuable because it gives students time to activate prior knowledge and reflect on possible answers to teacher questions. We seek to gain initial insights into the phenomenon of TWT in medical education and give commensurate recommendations to clinical teachers. Methods: We observed n = 719 teacher questions followed by wait time. These were video-recorded in 29 case-based seminars in undergraduate medical education in the areas of surgery and internal medicine. The seminars were taught by 19 different clinical teachers. The videos were coded with satisfactory reliability. Time-to-event data analysis was used to explore TWT overall and independently of question types. Results: In our sample of case-based seminars, about 10% of all teacher questions were followed by TWT. While the median duration of TWT was 4.41 s, we observed large variation between different teachers (median between 2.88 and 10.96 s). Based on our results, we recommend that clinical teachers wait for at least five, but not longer than 10–12 s after initial questions. For follow-up and reproduction questions, we recommend shorter wait times of 5–8 s. Conclusions: The present study provides insights into the frequency and duration of TWT and its dependence on prior questions in case-based seminars. Our results provide clinical teachers with guidance on how to use TWT as an easily accessible tool that gives students time to reflect on and respond to teacher questions.

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience.

We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers’ reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.

Background: Professional identity formation (PIF) is a life-long process, starting even before professional education. High levels of motivation for medical school are essential for effective learning and academic success. Both are key factors in future physicians’ professional and personal development, and according to self-determination theory, professional identity (PI) and students’ levels of motivation could be closely linked. Therefore, we sought to investigate whether PI and strength of motivation for medical school are associated in new medical students. Methods: In a cross-sectional survey, all new medical students in Munich, Germany, were asked to complete the Macleod Clark Professional Identity Scale (MCPIS-9) and the Strength of Motivation for Medical School-Revised questionnaire (SMMS-R) as well as to provide information about age, gender, and waiting time before starting medical school. Results: Eight hundred eleven out of 918 new medical students participated in the survey. A positive correlation between the MCPIS-9 and the SMMS-R (p < 0.001) was found. Female students showed higher scores in the SMMS-R (p < 0.05) and the SMMS-R-subscale Readiness to Start (p < 0.001). The amount of waiting semesters showed a positive correlation with the total SMMS-R score (p < 0.01) as well as with the subscales Readiness to Start and Persistence (both p < 0.001). Discussion: We found an association between PI and strength of motivation for medical school in a large cohort of new medical students. Female gender and more waiting semesters were associated with higher levels of self-perceived motivation and higher scores on the SMMS-R-subscale Readiness to Start. More research is needed to better understand this topic to further improve medical education.

Case-based group discussions (CBGD) are a specific, interaction-focused format dedicated to fostering medical students’ skills in applying basic biomedical knowledge to patient cases. Existing conceptions of CBGD suggest that a gradient towards increased opportunities for students to make elaborative verbal contributions is an important element of such seminars. To verify this assumption, we investigate empirically if clinical teachers progress from more basic, knowledge-oriented questions towards more advanced, elaboration-oriented questions in such seminars. We videotaped 21 different clinical teachers and 398 medical students in 32 CBGD-seminars on surgery and internal medicine. We coded closed-reproductive and open-elaborative teacher questions as well as reproductive and elaborative student responses to these questions. Inter-rater reliability was satisfactory. To determine trends regarding the teacher questions / student responses, we compared eight time-segments of equal duration per seminar. Overall, clinical teachers asked more closed-reproductive than open-elaborative questions. Students gave more reproductive than elaborative responses. Regarding the frequencies of these forms of teacher questions / student responses, we found no significant differences over time. Clinical teachers did not deliberately modify the types of questions over time to push students towards more elaborative responses. We conclude that the critical question to which degree promising teaching approaches are actually put into clinical teaching practice should be raised more purposefully in medical education research.