Enabling undergraduate medical trainees to develop professional identities consistent with their consciousness of inequities in healthcare and their obligation to provide just healthcare is a pressing challenge. Except as a duty not to discriminate, the positive obligations of a physician's commitment to social justice in the clinic can be unclear, including for educators seeking to empower learners to incorporate such commitments into their developing identities. This study explored the pedagogical value of allyship-to be in supportive association with a marginalized or mistreated group-seeking to understand the allyship issues students in clinical training reflect on as noteworthy and how they assess allyship-related encounters with respect to their professional identity. We conducted a qualitative content analysis of 110 vignettes and reflections that students doing their clerkships as acting interns submitted as part of a required ethics course at a US allopathic medical school in 2020-21. Independent coders followed an inductive, iterative process to code the submissions. Students reflected on demonstrated acts of allyship in 65.5% of cases, and in 34.5% of cases, students described situations in which allyship was warranted but lacking. Students most frequently reflected on the allyship needs of those who were racially minoritized, identified as LGBTQ+, were perceived as "difficult," and had complex care needs, and they specified issues like disparaging remarks, implicit bias, ignored patient needs, and treatment refusals as calling for allyship. The highlighted issues reflected their salience in contemporary social justice discourses in medicine. All analyzed submissions also featured meaningful reflections on at least one demonstrated act of allyship or failure thereof. Students discussed these acts' significance by connecting them to a constellation of professional values, such as the obligation to treat the whole person, be inclusive, be fair, and advocate. This study's results show allyship can be a pedagogically useful concept with which students can reflect on and raise their consciousness of vulnerable patients and populations, what acts of allyship can look like at the bedside, and how their commitment to allyship connects with and is reinforced by other professional values.

Patient experiences of obesity bias are commonplace in healthcare. The harmful assumptions, beliefs, and discrimination associated with obesity bias contribute to poorer health outcomes and reduced engagement in care. Furthermore, medical students are susceptible to repeating the bias and stigma they observe in medical training. This study explored medical students' observations of obesity bias during their clinical training to inform future medical education curricula development on obesity bias. In June 2022, 173 third-year medical students completing an extensive course on obesity at George Washington University School of Medicine & Health Sciences were asked to write a reflection on the obesity bias they had observed in clinical settings prior to and during their medical school education, to date. We used inductive coding techniques to identify themes from students' observed obesity bias using the software program Dedoose Version 8.3.35. We identified four main themes based on students' observations of obesity bias, including 1) Don't worry, it's because of your weight (undue focus on weight above other health-related issues), 2) Your weight defines your worth (equating patients' worth to their weight and justifying inadequate treatment), 3) Ok, now I can be honest (harsh and transparent stigmatizing language directed towards absent/unconscious patients), and 4) I'm just a medical student (difficulties speaking out about obesity bias as students). Systematic changes for dismantling obesity bias in medical education and healthcare, more broadly, are in their infancy. This research highlights various ways obesity bias permeates healthcare as observed by medical students in addition to concerns about how patients with obesity are treated in clinical settings. In light of our findings, early intervention in medical education is needed to address and reduce obesity bias in healthcare settings, with additional educational support for practicing providers in identification and attenuation of bias towards patients and families.

: This study investigated the views and experiences of students, teachers, and administrators regarding educational ethics to gain a deeper understanding of the role educational ethics can play in medical education. This research contributes to a deeper understanding of ethical issues related to increasingly complex medical education and may encourage all stakeholders in the field of medical education to reflect on these issues. : In this qualitative study, we conducted 29 individual interviews with medical teachers and medical school administrators and seven focus group interviews with 45 medical students. Interviews took place in 2020 at seven medical schools with different qualifications in Türkiye. We examined the interview data using thematic content analysis. : We developed six themes: 1) fundamental ethical values in medical education, 2) responsibilities of medical students, 3) responsibilities of medical teachers, 4) responsibilities of medical school administrators, 5) ethical problems experienced in learning-teaching processes, and 6) suggestions for solutions to ethical problems in teaching processes. : Our findings provide a basic rationale for considering educational ethics in medical education. Educational ethics appear to be important in creating an academic climate in which human values are protected, thus promoting professional identity formation and internalization of the medical profession's ethical values. Medical schools should be encouraged to prepare position statements as a sign of ethical sensitivity to maintain and enhance the value of trust in medicine among both the public and members of the medical community.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the disorders that persists in adulthood and poses unique challenges in high-demand professions like medicine. While existing literature often frames ADHD through a deficit-based lens, the lived experiences of medical students and professionals with ADHD remain underexplored. This study employed transcendental phenomenology to investigate the lived experiences of 13 medical students and professionals diagnosed with ADHD in Türkiye. I conducted semi-structured interviews between February and April 2025 via Zoom. I transcribed and analyzed the interviews using Moustakas's five-step phenomenological framework. Researcher reflexivity and external auditing ensured analytical rigor. Participants described a cyclical experience of chronic procrastination, time management difficulties, impulsivity, memory lapses, and emotional distress-frequently exacerbated by institutional stigma and lack of accommodations. Despite these barriers, many reported adaptive strengths such as hyperfocus, rapid decision-making in emergencies, and creativity in problem-solving in a cyclical pattern. Coping strategies included structured planning, therapy, mentorship, and personalized productivity tools. Participants consistently emphasized the need for formal institutional support, including flexible scheduling, neurodiversity awareness, and tailored mentorship. ADHD among medical students and professionals entails a duality of cognitive-emotional challenges and situationally advantageous traits. Without adequate support, these medical students and professions risk experiencing burn out, self-doubt, and underperformance. Yet, with proper accommodation and cultural shifts in medical institutions, individuals with ADHD can thrive and contribute uniquely to clinical care.

Medical education's ongoing expansion in Brazil presents new challenges, including the growing demand for qualified educators to support effective interprofessional training. In this essay, we examine the role and contributions of non-physician educators in medical programs, highlighting the need to recognize their value. Beyond their andragogical and scientific contributions, non-physician educators often play a central role in educational innovation and scientific advancement. We also underscore the need for greater financial and institutional recognition to ensure a more comprehensive and robust medical education, better preparing future physicians to work in multidisciplinary teams. In this context, we encourage institutions to review their curricula and implement policies that integrate and adequately acknowledge the significance of these professionals in medical training.

The complex skill of prescribing often fails to translate effectively from basic medical training into clinical practice, leading to poor patient management and medication errors. Previous research has demonstrated that learners face substantial challenges in achieving the threshold of integrated understanding and decision-making required for rational prescribing in different contexts. These challenges stem from the fact that learning to prescribe remains an implicit experience. Students tend to imitate physicians' prescribing patterns without understanding how the expert's cognitive schema operates, making it difficult to transfer this skill to new or diverse situations. While several interventions have been introduced, the challenge in transferring this skill may lie in the educational strategies for prescribing, further compounded by the complex web of underlying concepts inherent to the task. To address this, we explore the Four Component Instructional Design (4 C/ID) model, integrated with cognitive load theory. The 4 C/ID model posits that complex skills training requires a combination of learning tasks, supportive information, procedural information, and part-task practice. This integration aims to develop the knowledge, skills, and attitudes necessary for complex tasks and enhance knowledge transfer without overloading cognitive abilities. To illustrate this integration, we present a blueprint for an antimicrobial module spanning pre-clinical to clinical years, focusing on identified threshold concepts of pharmacology and fostering the practice of both routine and non-routine prescribing skills. Students engage in whole-task activities, supported by mental models, procedural knowledge, and repetitive practice. We recommend a blended learning approach for this module, using successful strategies from other domains. In traditional curricula, our module can be introduced during clinical rotations and culminate as a capstone course. This module offers a promising solution to current challenges in teaching and practicing prescribing.

Traditional clinical teaching involves physician teachers asking questions to gauge students' knowledge-controversially referred to as "pimping." Previous studies have explored students' perceptions of pimping; however, research from a motivational science perspective is limited. This study used Self-Determination Theory (SDT) as a lens to explore medical students' perspectives of pimping. In this qualitative study, we purposively sampled and interviewed undergraduate medical students from the class cohorts of 2019-2022 from the University of Saskatchewan, Canada, who shared their experiences and perspectives of pimping and how it affected motivation and well-being. We used thematic analysis guided by SDT to code the data and develop themes. We conducted interviews until no new themes were identified. Thirteen medical students participated-nine from Year 1 (five female, four male), one from Year 2 (female), one from Year 3 (male), and two from Year 4 (both male). Learners expressed mixed perspectives about pimping, some noting increased motivation for studying and engagement, while others experienced the opposite. We identified themes related to thwarting of autonomy, competence, and relatedness; more controlled forms of motivational behaviors (feeling forced, guilt, embarrassment, desire to prove); and negative well-being consequences. Learners described autonomy-supportive approaches to questioning. This study supports SDT's continuum of motivation emphasizing quality of motivation beyond just presence or absence of motivation, which helps understand how pimping can motivate students but through less optimal controlled forms of motivation, accompanied by negative well-being. Effects of pimping may also differ between junior and senior learners. We present practical implications for questioning approaches that support learner autonomy and shift away from exerting control and pressure.

: Clinicians employed by hospitals affiliated with medical schools play vital roles in undergraduate medical education. Clinical affiliate faculty (CAF) have opportunities for academic advancement to reward activities aligned with the school's mission, yet many do not pursue promotion. While the challenges underlying these outcomes are well-described, the motivations, expectations, and experiences of those who do pursue and attain promotion remain underexplored. Inquiry into these experiences may reveal actionable facilitators and institutional practices that make promotion more effective in recognizing and sustaining CAF engagement. : In our roles as faculty affairs deans, we conducted a qualitative study to explore what motivates CAF to pursue promotion and their expectations and experiences of successful promotion. We conducted semi-structured interviews between 2023 and 2024 with 24 CAF from one US medical school who were promoted in rank between 2018 and 2023. We used reflexive thematic analysis to analyze the interview transcripts, and our interpretation was informed by social cognitive career theory and the social cognitive model of career self-management. : Three overarching themes captured CAF experiences of promotion: (1) intrinsic and extrinsic motivation, (2) symbolic capital, and (3) professional affirmation. CAF motivation to pursue promotion was rooted in their belief that it was an attainable goal,-a belief supported by reflection, empowering social influences, and intrinsic traits. The expectation that successful promotion would position them to advance their own careers and support the careers of others further fueled their motivation. In addition to these anticipated outcomes, successful promotion provided CAF personal fulfillment, validated their contributions to undergraduate medical education, legitimized their identities as clinical educators, fostered a sense of belonging to the medical school, and inspired greater engagement with the school. Importantly, some CAF achieved promotion despite challenges related to their socioeconomic background and their identities as individuals underrepresented in medicine. : This study expands our understanding of what motivates CAF to pursue promotion and their expectations and experiences of successful advancement. The findings offer insights into how promotion reinforces CAF legitimacy as clinical educators and strengthens their sense of belonging to the medical school, thereby empowering them to contribute meaningfully to the institution. The findings also illuminate practical strategies to improve promotion processes and mitigate the contextual influences of socioeconomic status, gender, and race/ethnicity to ensure all CAF can achieve these outcomes.

Clinical education and healthcare work occur within their own complex sociocultural contexts, where interactions can be emotionally intense. Scholars have begun to conceptualize emotional experiences using a socio-cultural lens, examining emotions within their own complexity and contextuality. To better understand and help providers process the intense emotional experiences inherent to clinical education and work, it is important to analyze them from a socio-cultural perspective. This study aimed to identify the emotional experiences of clinical providers engaged in healthcare work and to determine the value of adopting a reflective approach to processing intense emotions. Our research questions were (1) What clinical activities prompt emotional response among providers, and how does context (system, socio-cultural, political, etc.) shape these experiences? (2) How does providers' reflectivity about their emotional experiences in context affect their understanding and outcomes? The study was conducted between 12 July 2021 and 07 January 2022 at a university hospital's general surgery clinic in the Eastern Anatolia Region of Türkiye. This narrative, ethnographic study analyzed the emotional narratives embedded in clinical work. The participant group consisted of 31 volunteers from a single clinical team: five faculty members, five residents, six nurses, 15 sixth-year medical students (interns). We analyzed narratives generated from participant observation and narrative interviewing using the "Three Stage Contextual Theme Analysis Framework" model. We created a tripartite conceptual framework to convey (a) the multi-level context in which emotional experiences occur, (b) providers' reflection on emotional experiences in context, and (c) the consequences of contextual, reflective emotional experiences. Our analysis revealed two main contexts in which emotional experiences take place: "institutional and clinical context" and "national and local context." The institutional and clinical context consists of "social, emotional," "physical," and "institutional and clinical system" subcontexts, while the national and local context consists of "health system" and "socio-cultural life" subcontexts. Given the consequences of intense emotional experiences in clinical education and healthcare work, it is important to understand them in context, using a reflective narrative approach. This approach allows educators to reframe both clinical education and healthcare work in a more humane and socioculturally sensitive manner.

: Effective pain management is essential to high-quality dental care, and its inclusion in dental curricula is vital to ensure future professionals are adequately trained. In Brazil, however, little is known about how pain-related content is integrated into undergraduate dental education. This study aimed to identify whether pain curricula are present in Brazilian undergraduate dentistry programs and analyze the content covered in these curricula, using international recommendations as a benchmark. : We examined all accredited dental education programs (DEPs) in Brazil and analyzed their curricular content based on guidelines from the International Association for the Study of Pain (IASP) and the American Dental Association (ADA). : Among 274 DEPs analyzed, only 50 (18.2%) included a dedicated pain curriculum. Regional distribution varied, with 91 programs (25.1%) in the Northeast, 141 (38.8%) in the Southeast, 43 (11.8%) in the Midwest, 26 (7.2%) in the North, and 62 (17.1%) in the South. Among the 17 programs with curricula fully available, the most frequently covered topics were related to pharmacological management, such as local anesthetics (70.6%), airway anatomy and physiology (64.7%), and drug administration routes, analgesics, and antagonists (52.9%). In contrast, topics such as pain definitions and orofacial pain conditions (23.5%), orofacial malignancies (41.2%), and pain and anxiety control (11.8%) were less frequent. Notably, non-pharmacological approaches and drug abuse prevention were almost entirely absent. : Brazilian dental education programs fall short of meeting the IASP and ADA recommendations for pain education, particularly regarding non-pharmacological content and substance misuse. These findings highlight significant curricular gaps that may affect dental students' training and preparedness. Our results can support curriculum planners and academic leaders in identifying regional disparities and thematic omissions, ultimately guiding improvements in pain education within undergraduate dental programs.

Prosocial behavior, a cornerstone of effective healthcare, is crucial for positive doctor-patient relationships and ethical medical practice. However, cultivating prosociality in medical students, particularly within diverse cultural contexts, presents a significant challenge. While mindfulness interventions show promise, the underlying mechanisms, especially the role of self-construal, remain underexplored. This study addresses this gap by investigating the effects of a seven-day online mindfulness program on prosocial behavior among Chinese medical students and the mediating role of self-construal, a culturally contingent framework. Divergent from Western research suggesting mindfulness promotes prosociality via interdependent self-construal, we explored a potentially distinct dynamic in a collectivist setting. In 2023, we randomly assigned 64 medical students without prior mindfulness experience to a mindfulness practice group (n = 33) or a control group (n = 31). Pre- and post-intervention assessments included trait mindfulness, self-construal, and prosocial behavior, using validated Chinese instruments. The mindfulness intervention significantly increased prosocial behavior and both independent and interdependent self-construal. However, mediation analysis revealed that only independent self-construal significantly mediated the mindfulness-prosociality link; interdependent self-construal showed no significant mediating effect. This unexpected finding highlights the cultural plasticity of self-construal theory, suggesting mindfulness in collectivist contexts may facilitate prosociality by activating individual agency and autonomy-a pathway diverging from Western observations. These findings have substantial implications for adapting mindfulness interventions in global medical education, advocating for culturally informed designs that leverage the dynamic interplay between mindfulness, self-construal, and prosocial development. This research refines the theoretical understanding of self-construal and offers a novel perspective on cultivating essential prosocial attributes in future healthcare professionals. Furthermore, this work suggests practical strategies for integrating mindfulness training into medical curricula, potentially enhancing student well-being, ethical decision-making, and patient-centered care.

: Compassion fatigue (CF) manifests as profound exhaustion not relieved by sleep, empathy loss leading to depersonalized patient interactions, ineffective coping, inability to function, emotional overwhelm, and reduced self-care. Documentation of the experience of CF among medical students and recent medical graduates is beginning to appear in the literature, yet our understanding of the extent of its occurrence, its personal impact, and impact on patient care is currently rudimentary. The objective of this scoping review is to identify the extent and type of evidence on CF among medical students and recent medical graduates, review definitions, current terminology, associated factors, and knowledge gaps. This scoping review used the Joanna Briggs Institute (JBI) methodology for scoping reviews. We systematically searched the electronic databases MEDLINE, Embase, PsycINFO, CINAHL, and Scopus for eligible studies published between 1992 and 2025. Our inclusion criteria included the occurrence of burnout and secondary traumatic stress (STS) or equivalent terms in medical trainees. Medical trainees included medical students studying at university and recent medical graduates within two years of graduation, working under supervision at clinical institutions. We excluded more senior doctors, two years post-graduation and above. We searched electronic databases and extracted data from studies using Microsoft Excel. A narrative summary of the results is presented. Fifteen papers met the inclusion criteria. The data indicated emerging literature on CF among medical trainees. Inconsistencies in terminology confound CF conceptualization. Factors associated with CF include heavy workloads, frustrations with institutional IT systems and administrative processes, and non-supportive work environments. Medical trainees experience stress inherently associated with their professional stage, and our data suggests that recent medical graduates are aware an adverse event could occur due to their high workload. STS, a critical component of CF, was found to be associated with working in critical care, with traumatized individuals, with patients who die in traumatic circumstances, including by suicide, and interacting with distressed families. Knowledge gaps included quantifying CF prevalence among medical trainees and evaluating the efficacy of trauma-informed interventions, particularly those generated by clinical and educational institutional responses. This review indicates that CF exists among medical trainees, negatively impacts the individual, and has concerning implications for patient care. Further research is needed to determine the prevalence among medical trainees and the efficacy of interventions, in particular institutional responses to mitigate CF. Organizational responses likely may include reducing workloads of medical trainees, simplifying institutional IT systems and processes, screening medical trainees for CF, and providing education on the condition and evidence-based interventions.

Problem-Based Learning (PBL) is widely implemented in health professions education (HPE). Small-group knowledge construction plays an essential role in trainees' learning from PBL tutorials. However, there is a dearth of systematic reviews to unpack the black box of the PBL knowledge construction process. The current review tackles this gap by identifying (1) the perspectives and methods adopted to directly assess the PBL knowledge construction process and (2) the factors in group interaction processes that impact PBL knowledge construction. We conducted a systematic search of multiple databases in November 2023 and identified original studies analyzing PBL interaction processes in HPE. Two reviewers conducted a thematic synthesis of the findings. Of 2,691 citations identified, 60 empirical studies (2.2%) from 16 countries and covering eight health professions met the inclusion criteria. Most investigations adopted a social constructivist perspective to analyze recordings, observations, and digital trace data of group interactions, often triangulating with other data for deeper insights. A wide range of qualitative, quantitative, and mixed methods was used to analyze interaction processes. Our synthesis identified a series of intertwined factors that influence knowledge construction: cultural influences and linguistic strategies; interprofessional dynamics, curriculum and assessment practices; learning task design, including technology affordance; tutor facilitation; learner prior knowledge and experience; and team learning behaviors and interaction patterns, such as learner directedness, social-cognitive exchange, group climate, and group interaction patterns. Our review highlighted the complexity of PBL knowledge construction by revealing the interrelated impact of various factors. Future studies should adopt a sociocultural perspective, employ the Design-Based Research approach, and integrate multiple methods and levels of analysis to unravel the dynamic interplay of these factors. Future research directions include exploring new analytics techniques, leveraging AI to develop data-driven interventions, and enhancing the inclusivity of collaborative learning environments.

Health professions education (HPE) in the US is facing a critical disparity between the diversity of students enrolled in health professions programs and the diversity of US society. This disparity has downstream impacts on the healthcare workforce and patient care. The problem is created partly by social determinants of learning (SDOL), which are nonacademic, contextual conditions that impact students' ability to optimally participate in their education. SDOL can be facilitators or barriers and often have disproportionate effects on individuals from underrepresented backgrounds and identities. This article explores these nonacademic factors, the lack of student diversity in HPE, the resulting societal impacts, and offers practical recommendations for individuals and institutions.

: Increasingly, peer feedback and assessment exercises are being introduced into health professional degree programs with many proposed benefits including the unique feedback received from peers and development of clinical education skills. However, studies investigating the bidirectional significance of peer feedback in workplace-based assessments (WBAs) are limited. The peer assessed mini-clinical evaluation exercise (peer mini-CEX) is a WBA conducted as part of The University of Melbourne Doctor of Medicine course, which involves peers assessing one another in a clinical setting. : This research investigated students' perceptions of the bidirectional effects of peer feedback on medical students undertaking peer mini-CEXs. Between August and October 2023, we conducted semi-structured interviews of penultimate and final year medical students. We undertook an exploratory qualitative study based on social constructivist theory. We transcribed the interviews and analyzed them inductive thematic analysis, which led to the development of themes and the thematic map. : Fourteen students, including eight third-year and six fourth-year students, participated in the study. Students appeared to engage in two general approaches to the peer mini-CEX: a mastery approach or a compliance approach. These themes encapsulated a tension between the desire to achieve deeper learning a strategic approach to assessment. When students took a mastery approach, perceived bidirectional benefits clustered around improvements in feedback provision and reception, more intentional observation and reflection leading to enhanced clinical skills, and development of professional communication skills. If students took a compliance approach, the reported outcomes were limited or undesirable with students viewing the assessment as a tick box exercise and identifying the limitations of peer feedback. A third theme, the social milieu, illustrated the influence of the social context on peer interactions and whether a mastery or compliance approach was undertaken. : This study is the first to explore students' perceptions of the nuanced bidirectional effects of peer feedback in a WBA. Participants report benefits of the peer mini-CEX in domains such as clinical skills, professionalism, communication, and feedback provision and reception. However, even engaged students often described adopting a superficial approach to the peer mini-CEX, resulting in minimal learning. Our findings indicate the influence of the social milieu on peer assessment and feedback processes. With contemporaneous feedback training and priming, peer assessment and feedback can be a valuable exercise for medical students. Further research into peer feedback in WBAs is required.

Clinical educators aiming to develop advocacy training have few established guidelines to follow. We conducted a needs assessment to explore perspectives of physician trainees and faculty to inform advocacy curriculum development and potentially facilitate increased advocacy engagement. We conducted 45-minute focus groups with 33 faculty ( = 16) and trainees ( = 17) from the Division of General Internal Medicine at a large US urban teaching hospital between September 2021 and February 2022. Interviews were audiotaped and transcribed on Zoom and de-identified prior to analysis. We used thematic analysis to identify key themes within a constructivist paradigm. Themes relating to participants' definitions of advocacy and their role as advocates included viewing advocacy as (1) supporting health and wellbeing in its broadest sense and viewing physicians as (2) in a position of power to advocate. Themes relating to perceived facilitators and barriers to advocacy engagement included (3) the lack of political education among physicians and (4) the need for interprofessional collaboration. Finally, themes relating to institutional support for advocacy included (5) the need for exposure to role models and (6) the importance of institutional culture. Physician participants reported that structured advocacy training combined with mentorship from professionals actively engaged in advocacy initiatives and a supportive institutional culture can enhance the perceived value of advocacy and empower engagement in it. Future studies are needed to explore interprofessional perspectives, as advocacy initiatives featuring interprofessional teams and supported by an institutional culture of advocacy are more likely to be successful.

Assessment variability in formative assessment occurs when assessors observing a trainee performing the same task evaluate the trainee differently. One major contributor is uncertainty regarding assessment criteria, and efforts to clarify criteria are not always successful. This study explores the cognitive processes that occur in assessors' minds when assessment criteria are clarified. We interviewed clinical teaching faculty from one residency program in a single institution regarding their perceived expectations of select assessment items before and after providing clarifying criteria and how the clarification changed their perception. We analyzed the data thematically. Assessors' cognitive interaction with assessment clarification is a function of four factors: 1) Assessors' fixed ideation, 2) Content of the criteria themselves, 3) Context and setting of criterion interpretation, and 4) Interaction between the assessor and the trainee. The cognitive effects of clarifying assessment items depend not only on the assessor and criteria but additionally on their interactions within a professional and academic context. The complexity and multifactorial nature of assessment variability may explain the difficulty in mitigating criterion uncertainty.

While US health systems are implementing language proficiency assessments to verify skills needed to ensure meaningful language access for patients, there is no consensus on best practices for multilingual medical students who want to demonstrate language proficiency for direct patient care. Many medical students who report non-English language skills face challenges navigating when and how to appropriately use those skills in clinical interactions. We used a modified Delphi process to seek consensus from an expert panel through the National Association of Medical Spanish (NAMS) for a Qualified Multilingual Assessment (QMA) policy for medical students. The survey included five topics related to QMA logistics and five topics related to QMA implementation guidance for clinical affiliates: QMA purpose, language access standards, responsibilities of supervising physicians, guarding against implicit bias, and monitoring learning opportunities. We set 80% as the threshold for consensus and revised topics that yielded <80% consensus. We circulated the revised topics in a second survey to establish consensus. Following two rounds of surveys among expert stakeholders, we reached consensus across all topics, yielding a first-of-its-kind QMA policy that administrators may adapt for clinical learning environments and institutions with health professional trainees. This policy includes key QMA policy recommendations for medical students: selecting a QMA, QMA logistics, and QMA implementation guidance for clinical affiliates.

The health professions education literature often assumes that diversity, equity, and inclusion (DEI) efforts naturally uplift Black, Indigenous, and People of Color (BIPOC). However, when the most common manifestation of DEI efforts, DEI trainings, are examined, there is little evidence to support this assumption. Metanalyses show evaluation and research studies on DEI trainings seldom ask about the experiences of BIPOC participants, and the few that do complicate this happy narrative. To do DEI work that is transformative, we need to center the perspectives and experiences of individuals who share a history of oppression. This study began in 2022 as an evaluation of a DEI training program. It evolved into a case study after the discovery of identity-based harm in a subset of participant surveys. Using a critical lens, this research centers the experiences of those who identified as BIPOC. A semi-structured interview guide based on the evaluation findings was used to interview eight BIPOC individuals, five faculty and three staff members. Two researchers analyzed the interviews using reflexive thematic analysis to generate themes. Then, the primary author used Critical Race Theory's counterstorytelling methodology to synthesize the interview themes, evaluation findings, fieldnotes and research artifacts into a counterstory on DEI trainings. The counterstory confronts the dominant narratives about DEI training. Such training is not always a transformative education process that uplifts everyone. The counterstory problematizes pedagogies that instrumentalize racial trauma for the benefit of white learners, instructional content that activates racial trauma without the means to process it, and DEI efforts that are performative rather than transformative. This counterstory identifies the ways in which oppressive and racist structures are felt and reproduced in settings meant to uproot it. Although there are no neat answers as to how we might interrupt these systems, critical questions can help to interrogate our assumptions about DEI trainings and (re)-center those pushed to the margins so that we may find our way forward.

Health professions education (HPE) institutions in the United States (US) are increasingly calling for health justice for 'historically excluded' groups. However, the language and concepts within many HPE equity frameworks offer insufficient attunement to historically-informed, locally-relevant lived expertise of racialized healthcare trauma. These present-bound, race-based, frameworks obscure the distinct and generationally-transmitted healthcare inequities borne by foundationally minoritized populations - the modern-day descendants of Indigenous and/or enslaved people whose land and labor have been continuously stolen throughout a colonized nation's history since its first founding settlements. Unfortunately, prevailing equity frameworks in the US presume that a racially minoritized identity automatically confers US-specific relevance to their multigenerational rights and knowledges, regardless of the sociopolitical context those historic harms and knowledges occurred. In doing so, these equity efforts erase the critical role of sociohistorical identity - honors the unique sociopolitical construction of race within a defined geographic region and/or nation, and differentiates the temporal aspects of endured harm for contemporary minoritized persons (i.e., ancestry, ethnicity, chronicity of endured harm within a given social context). An epistemological variant of racial essentialism occurs whenever HPE institutions legitimize locally-relevant, history-based knowledge claims about racism for anyone who looks a certain way, regardless of their history. Therefore, to honor the epistemology of subjugated knowledge, HPE institutions must clearly define the 'historical' elements of minoritized peoples' experiences within societies that are historically, racially, ethnically, and nationally diverse. Without historical nuance, justice efforts risk misallocating opportunities, perpetuating injustice, and undermining their own goals. Herein, we introduce the Sociohistorical Justice vocabulary and framework, which gives HPE institutions a nuanced language to disaggregate racialized groups not just by present identity, but by how oppression is carried across lineages and rooted in place and time. Moreover, not all historic harms were enacted along race-based lines, as historic exclusions were executed by location, class, and gender, too. We argue that HPE institutions must critically interrogate whether proclaimed equity efforts for 'historically excluded' populations are tangibly benefiting lineages bearing historically-compounded harm caused by these institutions' own actions. If HPE institutions truly desire to centralize representation of historically excluded clinicians and scholars, justice efforts must invite history-based knowledge claims and offer targeted benefit only to people whose lineages have been directly and continuously deprived by a named historic harm (i.e., people whose ancestors were present at the indicated place and time of the original harm).