Aug 2026· Medical Education· 0 citations· 25 references
Medicine
TL;DR
This study explored undergraduate medical students' perceptions of WBAs during clerkships, using a strengths-based approach to envision an ideal WBA system and suggested that trustworthy WBA systems are best understood as sets of deliberate compromises negotiated in ongoing dialogue with students and assessors, rather than one-size-fits-all frameworks.
Abstract
INTRODUCTION
Workplace-based assessments (WBAs) are central to evaluating clinical performance in clerkships, yet their design and implementation remain challenging. One major challenge is that WBAs inevitably rely on subjective human judgement. However, little is known about how undergraduate students perceive subjectivity in assessment and what they consider trustworthy assessment practices. We therefore explored undergraduate medical students' perceptions of WBAs during clerkships, using a strengths-based approach to envision an ideal WBA system.
Methods
We organised six focus groups (N = 24) guided by Appreciative Inquiry. Focus group discussions focused on memorable assessment experiences, underlying values, desired changes and visions of an ideal system. We used Reflexive Thematic Analysis within a constructionist paradigm through iterative coding, thematic mapping, analytic memos and team discussions to ensure rigour and reflexivity.
Results
Three themes represent foundational conditions for an ideal WBA system: (1) Being seen, acknowledging students as individuals through personalised feedback; (2) Growth, conceptualising WBAs as a longitudinal process supporting learning and career exploration; and (3) Feeling safe, emphasising a meaningful dialogue and a culture of trust. A fourth theme, Balancing ideals, captured the inherent tensions between competing ideals. Importantly, students perceived assessment as trustworthy not when subjectivity was eliminated but when it was considered accountable and conducive to fair outcomes.
Discussion
Our findings suggest that trustworthy WBA systems are best understood as sets of deliberate compromises, negotiated in ongoing dialogue with students and assessors, rather than one-size-fits-all frameworks. By adopting a strengths-based approach, this study reframes familiar assessment concepts as conditions for enabling trust, rather than as solutions to deficits. These findings advance our understanding of how to embed subjectivity into WBAs in a trustworthy manner and offer a student-informed approach for strengthening WBAs design in undergraduate medical education.
BACKGROUND
Research on ICU experiences from medical students' perspectives and their impact on professional development is limited. Reflective practices like storytelling enhance wellness and cultivate empathy among medical professionals, yet student involvement remains limited.
OBJECTIVE
To qualitatively analyze fourth-year medical student reflections from a required critical care clerkship, identify key themes, and suggest curricular improvements.
METHODS
Inductive qualitative methods were employed to develop a codebook through thematic analysis with consensus building and inter-rater reliability testing (Cohen's kappa ≥0.65). Frequency and collocation analyses identified patterns and contextual relationships.
RESULTS
Fifty-four percent of students participated, yielding 119 coded reflections. Six themes and 15 elements emerged, with top themes being "communicating with patient, family, or care team" (36.1%), "grappling with end-of-life, death, or dying" (26.1%), and "witnessing role modeling" (10.1%). Leading elements included "humanity" (44.5%), "professional development" (35.3%), "teamwork" (33.6%), and "duty" (32.8%). Reflections emphasized complex patient interactions, moral ambiguity, and personal growth over medical knowledge acquisition.
CONCLUSION
The Critical Care Sub-Internship is a formative experience in which fourth-year medical students not only learn clinical medicine but also engage in professional identity formation. Qualitative analysis of student reflections identified six dominant themes: navigating social challenges; addressing ethical dilemmas; observing role modeling; communicating with patients, families, and interprofessional teams; grappling with end-of-life care; and coping with emotional distress. Findings support targeted curricular enhancements including structured education in serious illness communication and end-of-life care, and intentional faculty development for positive role modeling.
Esther Etchinson, Brooke Hirsch, K. Pendleton et al.· ATS Scholar· 0 citations
The impact of transitioning from a traditional to an AI-aware rubric in a Health and Medicine course is evaluated, examining how this shift influenced educators’ grading practices, instructional strategies, and perceptions of student engagement.
Suzanne Estaphan, Tehzeeb Zulfiqar· Frontiers in Education· 0 citations
INTRODUCTION
Professional identity formation (PIF) research in medical education has largely examined micro-level dilemmas within relatively stable training environments. Less is known about how macro-social crises destabilizing the profession's public legitimacy shape early PIF. This study explored how first-year medical students narrated the impact of the 2024-2025 doctor-government conflict in South Korea on their professional identity development, using Transformative Learning Theory (TLT) as an interpretive lens.
METHODS
We conducted a theory-informed qualitative study using written reflective essays submitted by first-year medical students as a professionalism course assignment upon returning to the formal curriculum. Using Big Q reflexive thematic analysis, we combined deductive use of TLT as a sensitizing concept with inductive latent analysis to examine students' pre-crisis assumptions, disorienting dilemmas, critical reflection, and evolving identities.
RESULTS
Students' narratives were interpretable through four TLT-informed phases: pre-crisis frames of reference, disorienting dilemma, critical reflection, and evolving identity. Pre-crisis configurations included idealized, perfectionistic, system-naive, meritocratic, and hierarchical assumptions about medicine. Disorienting dilemmas centered on collapsing trust in the healthcare system, perceived patient harm, moral ambiguity, social rejection, and internal fragmentation within the medical community. Critical reflection involved deconstructing heroic and individualistic views of doctoring, reattributing problems to structural conditions, and renegotiating meanings of responsibility, competence, and solidarity. Many students described reconstructive identity work, culminating in more socially embedded, system-aware, and pragmatically collaborative identities. Others showed defensive retrenchment, reinforcing grievance, distrust, and a sense of professional victimhood.
DISCUSSION
Macro-social crisis can function as a collective disorienting dilemma in early medical education, extending PIF and transformative learning beyond micro-level clinical experiences. Identity development during legitimacy shocks is not uniformly growth-promoting; it depends on reflective and relational conditions under which students process disruption. Medical schools should support early identity work through structured dialogue, attention to belonging, and engagement with healthcare policy.
Y. Kang, J. Rho, Do-Hwan Kim· Medical Teacher· 0 citations
This study originated as an investigation into the impact of a 10-week nature play intervention on Year One students’ wellbeing, school engagement, sense of belonging, and academic performance. While positive student outcomes were anticipated, the findings also revealed unexpected effects on the two participating teachers. Using a qualitative case study approach, teachers’ lived experiences were explored through interviews, teacher journals, and researcher observations. Data were interpreted using reflexive thematic analysis to capture contextually grounded insights. Findings revealed strengthened teacher-student relationships, reduced behavioural management challenges, and a shift in teachers’ understanding of engagement. Teachers also reported emotional renewal and professional reflection; outcomes conceptually linked to teacher wellbeing, job satisfaction and retention. As a small case study at a single site, these findings provide preliminary insights into the professional experiences of teachers implementing nature play and suggest that such approaches may have important implications for teacher wellbeing, job satisfaction, and professional engagement.
Alexandra Harper, Tonia Gray· The Australian Educational R...· 0 citations
Learning from feedback depends not only on the feedback provided but also on how learners interpret, evaluate, and respond to it. This descriptive phenomenological study explored how preclinical medical students experienced receiving peer evaluation in a team-based learning (TBL) course. Forty-one reflective journals written by first-year medical students (27 men, 14 women) after receiving anonymous peer feedback were analyzed using Colaizzi’s seven-step descriptive phenomenological method. Five interrelated themes emerged: preparing to contribute, encountering oneself through peers’ eyes, making sense of emotional responses, transforming feedback into future practice, and becoming a responsible evaluator. Students described peer feedback as a social mirror that revealed differences between their self-perceptions and those of their peers. They reported a range of emotional responses and also reflected on the credibility and relevance of the feedback they received. Many students expressed intentions for future participation, and some reflected on their own responsibilities as evaluators. Taken together, the accounts described self-reflection, emotional appraisal, and intentions for future participation after peer evaluation. The findings suggest that peer evaluation accompanied by open-ended reflection may provide a useful context for examining how students experience and make sense of feedback. Whether such reflection contributes to subsequent changes in behavior, feedback literacy, self-regulated learning, or professionalism requires further study.
Although heutagogy is widely advocated for postgraduate education, students’ actual practices of self-determined learning in higher education institutions remain little explored, particularly in African settings. This study examined the lived experiences of postgraduate students, what enables and constrains those experiences, and how they relate to andragogical assumptions, using the conceptual lens of heutagogy.
An interpretive phenomenological design was used. Nine postgraduate students from the University of Business and Integrated Development Studies and other public universities in Ghana were purposively selected as information-rich cases: learners already demonstrably engaged in autonomous, self-directed, or self-determined practice. Data were generated through semi-structured interviews, four-week reflective journals, and learning artefacts, and analysed using Interpretative Phenomenological Analysis. Triangulation, member checks, audit trails and reflexive journaling supported credibility, dependability, confirmability and transferability.
Five group experiential themes emerged: becoming the author of one's own learning; redefining the destination rather than the route; inhabiting two curricula (the visible syllabus and a parallel learning track); the fragility of agency; and crossing the Heutagogical threshold. Participants described a reorientation of learner identity, authorship of learning goals, a parallel learning track supported by digital tools and peer networks, and contextual pivoting of academic content toward the communities they served.
Among these information-rich cases, practices exceeded andragogical assumptions: participants authored their own goals, reflected on disciplinary assumptions, learned in parallel, pivoted in context, and cultivated capability rather than competency. Rather than a linear movement beyond andragogy, however, the accounts reveal an oscillation between andragogical scaffolding and Heutagogical authorship, conditioned by confidence, supervisory stances, workload, family responsibilities, and access to resources. Self-determined learning emerged less because institutions supported it than because participants constructed alternative learning ecologies alongside, beyond, and sometimes in partial resistance to formal curricular structures. Given the small, single-country, largely single-institution sample of already-disposed learners, the findings are interpretive claims about information-rich cases rather than generalisations about postgraduate students. The study contributes to the heutagogy literature from an African higher education context and has implications for postgraduate curriculum design, supervisor practice, and institutional recognition of self-determined learning.
Linus Mwinkaar, J. Lobnibe· Frontiers in Education· 0 citations
