Undergraduate research training is a fundamental component of health professions education, intended to develop critical thinking and scientific inquiry. However, systematic evidence regarding the scope and alignment of student research topics with disciplinary expectations and educational program objectives remains limited. This study examined patterns in undergraduate thesis topics within a Chinese medical university context, using a computational framework to assess their alignment with institutional positioning, established disciplinary research, and peer-recognized undergraduate achievement. A total of 392 undergraduate theses from an applied psychology program (2022-2025) at a Chinese medical university were analyzed using a combination of expert evaluation and BERTopic modeling. To benchmark the currency and diversity of these topics, student work was mapped against a joint model of 2,790 peer-reviewed psychology journal articles and award-winning theses from Chinese peer institutions. The findings indicate a pronounced misalignment between the clinical resources available at the institution and the research practices reflected in student theses; despite the university's positioning as an academic medical center, fewer than 3% of student theses recruited patient populations, while 81% relied on convenience sampling of fellow students via questionnaires. Topic modeling further showed substantial concentration, with 69% of theses clustering into just four narrow domains that occupy only 30% of the available disciplinary topic space. This pattern reflects limited engagement with methodologically demanding, experimentally oriented topics that characterize much of the published disciplinary research. This concentration was associated with organizational dynamics; specifically, a 51% decline in faculty availability and the departure of medical specialists from the institution coincided with students clustering into low-resource, supervisor-centric research domains. These findings illustrate how institutional positioning and faculty constraints can create self-reinforcing bottlenecks that limit student exposure to clinical environments, even in the presence of formal goals for clinical research productivity. This study offers a scalable computational framework for examining research training and highlights the need for programs to structurally align their clinical assets with undergraduate curricular pathways.

Phenomenon: Communication is among the most valued domains in health professions education, yet communication assessment is rarely neutral. Across bedside teaching, workplace-based assessment, objective structured clinical examinations, narrative evaluations, and teaching evaluations, "good communication" can quietly become shorthand for sounding like the locally dominant linguistic group. Accent, dialect, pace, lexical choice, and perceived fluency may then be interpreted as confidence, clarity, professionalism, or fit, even when understanding is adequate and the learner's clinical reasoning and relational skills are strong. These judgments matter because communication ratings are cumulative, subjective, and often high stakes. Approach: This critical perspective uses a linguistic justice and critical sociolinguistic lens to reappraise communication assessment in health professions education. Drawing on recent literature, it distinguishes accent from comprehensibility, multilingual ability from monolingual fluency, and patient-centered communication from assimilation to dominant linguistic norms. It also examines the social meaning attached to speech and how that meaning travels through assessment systems. Findings: Experimental studies that isolate accent within controlled assessment settings have not uniformly demonstrated direct score penalties, suggesting that accent alone is not a simple or universal determinant of poorer marks. However, this does not establish neutrality. Broader literatures show that language functions as a proxy for race and belonging, that faculty accent can influence teaching evaluations, and that narrative and milestone-based assessments can encode patterned bias in impressionistic domains. Meanwhile, evidence from clinical communication, interpreter use, and language-concordant care suggests that what improves care for linguistically diverse patients is not accent conformity but comprehensibility, interpreter teamwork, respectful language, and verified multilingual competence. Current assessment systems often under-measure these capacities while over-valuing linguistic assimilation. Insights: Communication assessment should therefore move away from asking who sounds professional and toward asking what patients can understand, what teams can safely act on, and how learners adapt communication across linguistic difference. This article proposes a justice-oriented approach that makes hidden linguistic norms visible, revises assessment language, audits narrative comments for patterned bias, incorporates interpreter-mediated encounters, and creates rigorous pathways for assessing non-English language proficiency. Reframing communication in this way can make assessment more equitable without weakening standards. On the contrary, it aligns assessment with the realities of contemporary care and with the educational task of preparing clinicians for linguistically diverse health systems.

Recent commentaries have urged reconsideration of the shift away from tiered grading in US medical schools and the removal of numerical scores on the US Medical Licensing Exam Step 1 examination. They suggest the move to pass/fail may negatively impact decision-making, especially affecting residency selection. By arguing for the need for data to help residency programs stratify applicants, they risk overstating the objectivity of "hard data" and overlooking the long-term goal of educating future doctors. We examine the history of tiered grading and explore the evidence that led to shifts away from such grading formats. Tiered systems often rely on multiple-choice question assessments that introduce bias and assess only medical knowledge. They show extreme variability and grade inflation, and studies have consistently demonstrated racial and gender disparities. Moreover, Step 1, which was never designed to stratify students' performances, has not been shown to predict future physician clinical success in any significant way. Claims that the shift away from tiered grading has resulted in detrimental student behaviors or bias against students from specific schools are unsubstantiated. In contrast, pass/fail grading leads to improved student well-being, intrinsic motivation, and mastery-oriented learning environments. Returning to competitive assessment, which stratifies residency applications, prioritizes a comfortable system over one with substantial validity evidence. Our efforts are better spent on developing new programmatic systems that incorporate holistic data, leverage artificial intelligence, and combine narrative feedback to assess our learners and prepare them to be competent physicians. We should strive to link assessments to long-term outcomes before using them to determine students' fates. We should not return to familiar data because they help residency programs stratify learners at the expense of their learning.

Rooted in spiritual energy and centered in Black liberation, Afrofuturism, and feminism, Hersey's "Rest is Resistance" framework encourages deliberate rest practices as a personal necessity and a form of political resistance. Inspired by her work, we are a group of health professions education scholars from minoritized backgrounds using our lived experiences to illustrate the application of our "Rest is Resistance" framework. The demands of academic medicine, defined by productivity in clinical, scholarly, and educational domains, combined with personal obligations, run counter to rest. Enduring long hours and pushing oneself to exhaustion imply that needing to rest is a sign of weakness, and this so-called "grind culture" in medicine is pervasive. The expectations of a culture of self-sacrifice and dedication come at a cost to mental health and self-care. Minoritized faculty and trainees disproportionately experience the negative consequences of these expectations, including mental and racial battle fatigue. We introduce "Rest is Resistance"-a deliberate and necessary act of self-preservation against capitalism and structural injustices-and offer practices for individuals in the health professions to consider. The call for rest is not relegated to just physically resting our bodies. Rather, our call for rest is used metaphorically as a form of political, spiritual, and cultural resistance against oppressive systems, particularly capitalism and white supremacy, to promote a conscious slowing to reclaim individual agency and humanity. We hope that introducing "Rest is Resistance" as a framework in health professions education will promote well-being and support minoritized health care professionals and trainees, in particular, so that they can be fully present and create a sustainable healthcare culture that values everyone.

Healthcare systems worldwide face escalating complexity driven by workforce shortages, increasing patient acuity, interprofessional practice demands, and rapid technological transformation, including artificial intelligence. These pressures require leadership capacity across all levels of healthcare, yet leadership development within healthcare curricula remains inconsistent, fragmented, and variably aligned with clinical realities. Although numerous national and professional frameworks provide leadership competencies, significant heterogeneity persists in how leadership is conceptualized, implemented, and evaluated. To examine the current landscape and identify priorities for advancement, the International Leadership Association convened an interdisciplinary working group at the 2024 Healthcare Leadership Conference. Working group members represented multiple health professions, countries, and leadership development traditions. Through facilitated dialogue and collective synthesis, the group examined shared opportunities, persistent implementation challenges, and future directions for healthcare leadership education. Across contexts, working group members identified common cross-cutting themes essential to effective leadership development. Despite growing consensus regarding these domains, significant challenges limit progress, including curricular constraints, limited faculty expertise, cultural hierarchies, fragmented assessment approaches, inequitable resource distribution, and lack of consensus on meaningful outcome measures. Acknowledging gaps in knowledge and workplace constraints, our working group constructed a consensus vision for the future of leadership development for healthcare providers. This vision emphasizes leadership as a core professional value for all healthcare providers; longitudinal, developmentally aligned curricula; explicit integration of followership; systems thinking and change leadership; preparedness for digital transformation; and creation of psychologically safe organizational learning environments. The group further proposes a corresponding research and development agenda prioritizing standardized competencies, longitudinal evaluation strategies, culturally responsive leadership models, and strengthened international collaboration. Advancing leadership development across healthcare providers requires coordinated multinational efforts, evidence-informed program design, and shared success metrics.

Phenomenon: Residency selection has traditionally emphasized cognitive measures such as Unites States Medical Licensing Examination (USMLE) Step 1, Step 2 Clinical Knowledge (CK), and clerkship grades, even though physician performance encompasses cognitive and noncognitive competencies. Situational judgment tests (SJTs) have emerged as a promising complement, demonstrating criterion-related validity and producing smaller subgroup score differences than cognitive measures. However, smaller mean differences do not establish fairness. The Standards for Educational and Psychological Testing distinguish between mean group differences and predictive bias. The latter occurs when an assessment systematically over- or underpredicts outcomes for certain groups regardless of true construct standing. Whether residency-focused SJTs demonstrate predictive bias has not been examined-an important gap, as unknown bias risks unfairness to applicants and could undermine efforts to build a more representative physician workforce. Approach: This multiyear study investigated whether a professionalism-oriented SJT demonstrated predictive bias by gender, underrepresented in medicine (URiM) status, or international medical graduate (IMG) status relative to Accreditation Council for Graduate Medical Education (ACGME) milestone performance. Using moderated multiple regression, we tested for intercept differences (predicted outcomes differ between groups at the same SJT score) and slope differences (the strength of the predictor-outcome relationship differs by group). The study included 24 residency programs and three fellowships at a single academic medical center. Predictive bias analyses included 422 residents; mean score analyses included 2,680 applicants; and background characteristic analyses used diversity survey responses from 1,659 interns. Findings: The SJT predicted year-end milestone performance across all subgroups (B = 0.14-0.17, p < 0.05), with no intercept or slope differences by gender, URiM status, or IMG status, indicating no evidence of predictive bias. Gender differences across selection measures were negligible (d = -0.08 to 0.23). URiM applicants scored lower than non-URiM peers on all measures, with larger gaps on cognitively loaded exams (Step 1: d = 0.74; Step 2 CK: d = 0.66) than on the SJT (d = 0.30) or milestones (d = 0.28). IMG applicants scored lower on the SJT (d = 0.45) and Step 2 CK (d = 0.29) but not Step 1 (d = -0.06). URiM interns reported greater structural disadvantage; IMGs were markedly less likely to report native English proficiency. Insights: This study provides initial empirical evidence that a professionalism-oriented SJT does not exhibit predictive bias by gender, URiM status, or IMG status in relation to residency milestone performance. These findings constitute a preliminary step toward a fairness evidence base for residency-focused SJTs, pending replication in applicant populations and operational selection settings. The SJT's smaller subgroup gaps relative to USMLE exams suggest value in holistic admissions, though this inference requires validation in samples not restricted by prior selection.

Moral distress has been linked to burnout, emotional exhaustion, and intention to leave medicine. Although it has been widely studied in other health professionals, research into the experience of resident physicians, who work in unique sociocultural environments, is in the early stages. The objective of this scoping review is to identify, examine, and summarize the literature on moral distress in residents. Using the methodology described by Arksey & O'Malley, we queried five databases and screened and analyzed 2,991 articles. In the 36 included articles, authors' definitions of moral distress varied; however, external constraint was emphasized as a core feature. An analysis of quantitative, qualitative, and theoretical or commentary articles produced several key findings. First, conditions contributing to moral distress included tensions surrounding end-of-life care, hierarchical cultural norms, ambiguities associated with work-based learning, and structural factors in healthcare delivery. Second, frequency and intensity of moral distress were inconsistent across studies. Third, impacts of moral distress included callousness, burnout, depersonalization, and attrition. Fourth, residents employed a range of coping mechanisms such as seeking peer support, engaging in meaning-making, going above and beyond expectations, internalizing thoughts and emotions, or employing detachment and cynicism. Finally, suggested mitigation strategies included debriefing and reflection, culture change initiatives, and educational programming. The findings offer a unique analysis of how moral distress is defined in residency education and illuminate the interplay of relational, systemic, and sociocultural factors shaping residents' experiences. Further, the results provide a meaningful overview of the literature and identify important directions for future inquiry. .

Achieving equity in assessment remains a persistent challenge in medical education. While research has focused predominantly on psychometric approaches to fairness, exploration has been limited into how racial equity is embedded at foundational stages of assessment development. In particular, the influence of test developers' racial composition on assessment design has been largely overlooked. This study investigated how the racial makeup of test development teams impacts the incorporation of justice-oriented principles into assessment design. Guided by critical theory and a justice-oriented assessment framework, we employed Foucauldian Critical Discourse Analysis to examine the design processes of three groups of assessment developers (N = 16) purposefully sampled from the US academic medical education community. We grouped participants by racial identity: Group A (white-identifying, n = 5), Group B (non-majority-identifying, n = 5), and Group C (mixed racial composition, n = 6). Following an interactive session on equitable assessment principles, groups collaboratively designed a mock OSCE station assessing communication skills. The data collected included transcribed group discussions, the OSCE station, and participant group reflections on their experiences. Our findings reveal a pervasive gap between equity awareness and equity action. Despite demonstrating clear conceptual understanding of equity principles, participant groups struggled to operationalize these principles in practice. We identified four themes from the discourse analysis: an absence of explicit equity discussions despite the study's stated focus; the sanitization of assessment and weaponization of "culture" as a dividing practice; the treatment of learners as erased, ghostlike figures-homogenous and without agency-while patients were centered as diverse and significant; and the framing of equity as a weapon or curveball rather than a foundational design element. Participant groups frequently defaulted to traditional standardized approaches, expressing discomfort about incorporating equity without introducing stereotypes. Power dynamics and professional norms emerged as significant barriers, with participants deferring to clinical expertise and avoiding confrontation on equity-related issues. Notably, racial diversity among test developers alone did not substantially advance equity in the designed assessment. This study underscores that the test developer's equity awareness and racially diverse representation, while necessary, are insufficient for achieving justice-oriented assessment design. Without intentional structural changes and cultural shifts in how assessment is conceptualized, equity will remain peripheral rather than foundational. These findings offer actionable insights for national licensing bodies, medical schools, and residency programs seeking to embed equity more meaningfully into high-stakes assessment practices, suggesting that frameworks such as Design Justice may provide pathways for inclusive, community-centered approaches to assessment development.

Introduction: Clinically significant adverse events (CSAE) place medical students at risk for secondary traumatic stress, feelings of guilt, anxiety, failure, decreased confidence, and alterations of career trajectories and specialty choice. The CSAE literature focuses on clinicians or nursing students, leaving medical students relatively understudied. Understanding medical students' CSAE experiences, within the context of their role as a learner, is important because students may be uniquely vulnerable due to their relative lack of experience with adverse events, lower position in the medical hierarchy, and absence of formalized CSAE curricular or co-curricular support. Thus, the purpose of this study is to explore medical students' experience of CSAE and identify ways to support learning during the recovery process. Methods: We used a constructivist narrative approach to explore medical students' stories of CSAE holistically. From December 2024 through February 2025, we conducted semi-structured interviews with 16 second- through fourth-year civilian and military medical students in the United States. This study is constructivist in that both the authors' and the participants' experiences of CSAE are contextually specific realities where meaning is relational and often co-created. We elected to use a narrative approach, which is a story-centered methodology, because CSAE is a chronological phenomenon and stories are one way that humans make sense of traumatic events. We followed a chronological approach to develop the interview protocol and used narrative analysis to interpret the data. The Institutional Review Board at the Uniformed Services University of the Health Sciences in Bethesda, MD approved this research (DBS.2024.783). Results: Narratives highlighted intense emotional responses to CSAEs, including helplessness, guilt, fear, and grief, shaped by their limited power, inexperience, and pressure to perform. Their role as learners often left them excluded from care decisions, debriefings, and formal support, leading to feelings of invisibility within the medical hierarchy. While emotional and social support from faculty and residents was often absent, students sought help from peers, therapists, or medically trained family members. Informational and esteem support, especially when faculty explained clinical reasoning, helped students process events and regain a sense of competence. Conclusion: Medical students often feel unprepared for the emotional impact of CSAEs and face barriers to seeking support due to hierarchy and fear of negative evaluation. Participants described experiences of isolation, emotional distress, and invisibility within clinical teams but also identified moments of growth when supported by faculty and peers. These findings highlight the need for curricula that prioritize emotional preparedness and social support.

Problem: In Taiwan's hierarchical medical culture, postgraduate year (PGY) physicians face significant workplace challenges, exacerbated by Confucian values of hierarchical deference and collective harmony, which discourage open discussion of power imbalances. Approaches rooted in individualism, such as speaking-up initiatives and direct feedback pedagogies, encounter cultural barriers in this high-power-distance, collectivist context. While digital-native trainees increasingly use medical memes to express workplace frustrations, these community-generated expressions have not been systematically used for structured reflection in hierarchical medical education contexts. Intervention: In this pilot study, we designed a meme-based reflective learning curriculum integrating Kolb's experiential learning cycle, Palmer's "third things" approach, and Schön's mediating artifacts. Eight PGY physicians completed six monthly 90-minute sessions (January-June 2024), with follow-up interviews conducted six months post-intervention (December 2024). We curated memes from Taiwanese medical social media that depict workplace challenges, including hierarchical powerlessness, interprofessional tensions, emotional regulation, unclear workplace rules, time management, and patient-doctor communication. Sessions guided participants through Kolb's cycle: concrete experience (meme viewing), reflective observation (discussions), abstract conceptualization (consensus-building), and active experimentation (implementation). Context: The study was conducted at a medical center in Taiwan, where PGY physicians, competing for residency positions through an informal but widespread internal recruitment practice, faced intense pressure to maintain favorable impressions among seniors. This precarious status fostered reluctance to voice concerns as they navigated monthly rotations across departments with different cultures and unwritten rules. Impact: Participants demonstrated learning across all Kolb stages. Framed as an untested feasibility, the approach made previously unspeakable experiences discussable, creating resonance as participants recognized shared struggles. They developed practical strategies for emotional regulation and for navigating interprofessional relationships. However, encountering systemic barriers to implementation prompted an unexpected transformation: participants developed critical consciousness, shifting from seeking adaptation strategies to questioning the structures themselves. They articulated, "The problem isn't us. It's the whole unreasonable system," shifting the focus from coping to why this system exists. This evolution, which moves beyond an adaptation-focused curriculum toward Freire's dialogical education, emerged alongside a sense of powerlessness, as participants lacked the authority to enact structural change. Lessons learned: Drawing on Freire's concept of generative words, we theorize that community-generated memes functioned as generative artifacts: culturally embedded materials that fostered both workplace reflection and critical consciousness. This approach reframes Confucian collectivist orientations as empowering resources through what we term "safe subversion," in which humor's incongruity, ambiguity, and collective ownership keep critique within culturally tolerable limits. However, translating consciousness into structural change requires strategic alliances with educators who wield hierarchical authority in service of learning, bridging trainee awareness and institutional reform.

In this narrative recounting of a Malaysian academic medical department's mystery-seed project, lecturers reflect on the parallels between cultivating plants and supervising students. As the seeds grow, struggle, or fail to germinate, the participants examine how patience, intervention, adaptability, and environmental conditions influence development. Through experimentation and shared reflection, they discover that effective supervision requires recognizing individual needs, responding creatively to setbacks, and providing the conditions in which growth can occur.

Competency-Based Education (CBE) has become the dominant paradigm for structuring medical training worldwide. Yet its foundational constructs (e.g., Entrustable Professional Activities (EPAs), milestones, and competencies) were conceived within resource-rich, institutionally stable, and culturally specific contexts. Their diffusion across global landscapes has not been neutral. When such frameworks travel, they carry embedded assumptions, epistemic values, and implicit universalizing authority. This article describes how The East, Central, and Southern Africa College of Paediatrics and Child Health (ECSAPACH), in partnership with the Center for Research, Innovation, and Scholarship in Health Professions Education (CRIS) at Baylor College of Medicine, reimagined CBE for African pediatric training through a process guided by design justice and implemented using knowledge brokering. Anchored in Homi Bhabha's concept of the Third Space and Culture's In-Between, we argue that the translation of CBE into new contexts is not merely a technical or linguistic act but an ethical, dialectical, and generative one. ECSAPACH's translation process demonstrates that when frameworks encounter contextual resistance and epistemic contestation, they can be reconstituted into hybrid forms that unsettle universality while deepening both global and local understanding. The resulting hybrid framework represents not a replication or simple adaptation of imported theory but a co-created, contextually anchored model for pediatric education that emerges from ongoing negotiation under conditions of asymmetrical power. We position this work as an instance of hybrid knowledge production in Bhabha's Third Space, offering lessons for equitable global partnerships and for the future evolution of CBE as a living, revisable theory.