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        <title>Perspectives on Medical Education Feed</title>
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            <title>Perspectives on Medical Education Feed</title>
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            <title><![CDATA[Leveraging AI to Accelerate Competency-Based Education in the Health Professions]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2594</link>
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            <pubDate>Thu, 22 Oct 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[The concurrent uptake of both artificial intelligence (AI) and competency-based health professions education (CBHPE) represents a watershed opportunity to improve and streamline educational processes and enhance educational effectiveness. Members of the International Competency-based Health Professions Educators Collaborative (ICBHPE) explored the potential of AI to strengthen CBHPE implementation by addressing persistent challenges in meeting its five core components: defined outcome competencies; progressive sequencing; tailored learning experiences; competency-focused instruction; and programmatic assessment. Effective integration of AI tools can be guided by socio-technical systems theory (STST), which highlights the significant interdependence of technical systems and social systems. Successful application of AI in HPE will hinge on addressing the complex interactions among people and roles; goals and incentives; workflows and processes; technology; infrastructure; and organizational culture. Health professions educators should enhance their fundamental knowledge of how AI tools are developed and deployed to understand both its potential and its limitations. The HPE community must rigorously evaluate AI applications to ensure responsible and equitable integration that complements human relationships and judgment.]]></description>
            <category>ARTICLE</category>
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        <item>
            <title><![CDATA[“It’s Like a Whole Set of Things That We Do”: A Qualitative Study of the Roles of Journal Editors-in-Chief]]></title>
            <link>https://reference-global.com/article/10.5334/pme.3277</link>
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            <pubDate>Thu, 15 Oct 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Introduction: Journal editors-in-chief (EICs) play a central role in shaping scholarly publishing, yet little is known about how they understand and enact their roles. We explored how medical education journal EICs describe their roles in shaping the publication process.
Methods: We conducted a qualitative study using thematic analysis of interviews with nine medical education journal EICs. The interviews were part of a broader investigation of publication timelines and explored editorial leadership and practices, including experiences during the COVID-19 pandemic. Participants’ accounts also provided insight into the broader work of leading a journal, which became the focus of the present analysis.
Results: Participants described their work not as a set of discrete tasks, but as five interrelated roles: knowledge developer, proactive communicator, steward of time and energy, nurturer, and orchestrator. These roles were enacted simultaneously and often in tension, reflecting the need to balance scholarly rigor, relational commitments, and system constraints. EICs described actively shaping knowledge, orchestrating complex communication networks, safeguarding finite reviewer and editorial resources, supporting authors and editorial teams, and maintaining workflow continuity. Much of this work was characterized as invisible labor occurring behind the scenes and not captured in formal metrics. Participants also highlighted a structural tension between nurturing authors and stewarding limited resources, underscoring the challenges of sustaining both inclusivity and efficiency within a resource-constrained system.
Discussion: This study offers a practice-informed framework for understanding EIC work as relational, strategic, and system-oriented. By making visible the often-invisible labor that underpins academic publishing, our findings challenge reductive conceptions of editorial work and highlight the need for training, support, and systemic changes to better align expectations for rigor, inclusivity, and sustainability.]]></description>
            <category>ARTICLE</category>
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        <item>
            <title><![CDATA[Beyond Qualification: A Video-Stimulated Interview Study on What Group Discussion of Audit and Feedback Adds to Professional Development in General Practice]]></title>
            <link>https://reference-global.com/article/10.5334/pme.1954</link>
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            <pubDate>Mon, 12 Oct 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Introduction: Modern healthcare demands continuing professional development (CPD) that bridges learning and practice and motivates health professionals. Current CPD activities often prioritize qualification, while socialization and subjectification purposes are considered vital in other educational contexts and could help to foster dynamic learning. Group discussion of audit and feedback (A&amp;F) is a form of CPD that is used increasingly, and that may fulfill these needs. However, little is known about how this approach creates learning opportunities or what the group dynamic contributes.
Method: In this video-stimulated interview study we explored how a group of experienced general practitioners perceive the value of group discussion of A&amp;F in their professional development, employing a constructivist paradigm. We first inductively analyzed our findings, using Thematic Analysis. A second deductive analysis followed, using Biesta’s concept of the three purposes of education (qualification, socialization and subjectification) as framework.
Results: According to our participants, group discussion of A&amp;F allows for a reflective process that adds to their professional development. The group helps deepen reflection and assists with the forming of individual and collective opinions. The meetings enhanced motivation for both individual and collective learning. Key conditions included a safe learning environment and a high level of enjoyability. The group meetings offered opportunities for all three purposes of education.
Discussion: Group discussion adds value to individual A&amp;F by offering room for socialization and subjectification, as well as classic qualification purposes. It thereby offers a future proof form of CPD that could improve quality of healthcare and stimulate lifelong learning.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Medical Student Engagement and Intention to Practise Medicine Across Undergraduate Years: A Longitudinal Study]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2157</link>
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            <pubDate>Tue, 06 Oct 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Introduction: Medical students’ declining intention to practise medicine threatens workforce sustainability. Addressing this issue is critical to alleviating workforce shortages and improving healthcare delivery. While previous studies have explored factors influencing students’ career intentions, the specific role of multidimensional student engagement, and whether its associations with intention vary across undergraduate years, has not been systematically examined.
Method: We analysed a two-year (2020–2021) longitudinal dataset from the China Medical Student Survey using a cohort-sequential design. Five dimensions of engagement were measured: behavioural classroom, behavioural clinical, emotional, cognitive, and agentic engagement. Multilevel growth models were applied to examine changes in intention to practise medicine and year-specific engagement-intention associations. Bayesian Model Averaging (BMA) was employed to evaluate robustness under model uncertainty using Posterior Inclusion Probabilities (PIPs).
Results: The findings indicated that intention to practise medicine declined through Year 4, with a slight attenuation of the decline in Year 5. Engagement-intention associations varied across years: behavioural classroom engagement showed its largest association in Year 2; behavioural clinical engagement was significant in Years 4–5; cognitive engagement increased across years; and agentic engagement was stronger in Years 4–5 than in earlier years. Emotional engagement was consistently associated with intention across Years 1–5 and accounted for the largest incremental explanatory power; BMA indicated strong evidence for inclusion of emotional and agentic engagement.
Conclusion: Engagement is consistently associated with intention to practise medicine, but the salience of engagement dimensions shifts across undergraduate years. Educational strategies should be year-sensitive and developmentally strategic—supporting emotional and cognitive engagement throughout training and cultivating agentic engagement in early years.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Transforming Clinical Education While Addressing System Gaps: Student Leadership Experiences (SLEs)]]></title>
            <link>https://reference-global.com/article/10.5334/pme.1757</link>
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            <pubDate>Thu, 01 Oct 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Health and social care systems are increasingly characterized by complexity, resource constraints, and evolving service demands, requiring educational models that prepare learners to navigate and lead within dynamic environments. Student Leadership Experiences (SLEs) are proposed as a theory-informed educational model that extends beyond traditional workplace-based learning by intentionally integrating system responsiveness, collaborative leadership, and interprofessional engagement.
SLEs are structured around identified system or practice gaps and position students not only as participants in existing workflows, but as contributors to workplace-based innovation. Grounded in constructivist and transformative educational orientations, the model emphasizes dialogic engagement, adaptive expertise, and shared leadership across clinical, educational, and community partners.
This article articulates the essential elements of a Transformative SLE approach and outlines operational considerations for its enactment, including partnership development, facilitation team alignment, curriculum design, safety, evaluation, and sustainability planning. By offering a principled yet flexible framework, this work aims to support greater conceptual clarity and coherence in the design and implementation of Transformative SLEs across diverse health professions contexts.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Are You PREPAREd? A Structured Approach to Support Safe and Confident Transitions to After-Hours Care]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2504</link>
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            <pubDate>Thu, 01 Oct 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Background and Need for Innovation: Early after-hours work represents a demanding transition for newly graduated doctors. Preparation is often fragmented, with limited attention to the integrated clinical, organisational, and supervisory demands of after-hours care, contributing to uncertainty that may affect both patient safety and professional development.
Goal of Innovation: PREPARE (PREParing for After-hours caRE) is an eight-week programme designed to support new graduates during their early postgraduate transition by enabling safe and confident participation in after-hours care.
Steps Taken for Development and Implementation: PREPARE was developed through a research-informed, iterative design process. The programme integrates five interconnected components—familiarisation, workplace learning, structured teaching, guided reflection, and entrustment—within a coherent framework that runs parallel to routine clinical work. Rather than functioning as a fixed curriculum, PREPARE provides a flexible structure that aligns educational activities, workplace learning, reflection, and entrustment, while allowing adaptation to local service contexts.
Evaluation of Innovation: Formative evaluation throughout development and early implementation focused on perceived value, feasibility, and alignment with after-hours responsibilities. New graduates and supervisors reported increased confidence, improved preparedness for managing uncertainty, and enhanced understanding of interprofessional collaboration.
Critical Reflection on Our Process and Innovation: Reflection highlighted how PREPARE engages with real clinical complexity and exposes tensions between educational ambition and organisational feasibility. While the programme demonstrates how after-hours transitions can be more deliberately supported, its sustainability and transferability depend on organisational commitment and protected time for learning.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Open Science in Undergraduate Medical Education: An International Framework for Transparency, Responsibility, and Professional Identity Formation]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2600</link>
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            <pubDate>Wed, 30 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Concerns about reproducibility, transparency, and research waste have intensified debates about trust in medical research and health-related sciences. Although Open science initiatives aim to address these challenges, their role in undergraduate medical education remains underexplored. Undergraduate medical education typically emphasizes appraisal of published evidence but pays less attention to how research is conducted, governed, and disseminated. This article proposes an international conceptual framework that positions Open science as part of professional formation in undergraduate medical education. The framework comprises three domains: epistemic transparency, ethical responsibility, and professional identity formation. Together, they describe how learners engage with knowledge production, uncertainty, and responsibility. Rather than prescribing curricular models, the framework offers adaptable principles that can be mapped onto existing structures such as competency-based programs in diverse contexts. By framing Open science as a formative orientation rather than a technical skill set, it links medical education to professional responsibility and the public role of medicine.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Pediatric Emergency Care Variation: Might Normothetic Data Undermine Adaptive Expertise?]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2887</link>
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            <pubDate>Wed, 30 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Purpose: Practice variation across physicians is commonly attributed to idiosyncratic tendencies. What factors contribute to physicians’ practice variation in the disposition of children with asthma exacerbation? How do metrics demonstrating variation impact physicians and learners?
Methods: In this social constructivist qualitative study, we interviewed 11 Pediatric Emergency Medicine attendings, purposively sampling across a spectrum of acute asthma exacerbation admission rates. Participants reflected on their recent care of patients with asthma, how they assess patients, and how they determine disposition. They were shown a de-identified funnel plot demonstrating disposition rates across the physician group and reflected on the 1) quality of the metric and 2) impact on practice. We used reflexive thematic analysis to describe patterns across the data that addressed the study’s research questions.
Results: Participants cited factors at the patient, caregiver, clinical care team, clinical environment, and personal practice levels that might result in variation. Participants framed the ability to weigh these sometimes competing factors as a reflection of patient-centered care. But when presented with a group-level data display, participants were surprised by the variation, valued seeing how they practiced compared to peers, and sometimes expressed a willingness to alter their practices to be “nearer the mean.”
Conclusions: Some variation in care may be driven by physician adaptive expertise, which is not fully captured through metric-driven nomothetic data. Though metrics are fundamental to understanding practice patterns, decontextualized aggregations of data may risk minimizing, or even framing as deviant, the expertise exercised by physicians when they weigh multiple factors in decision-making.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[The Faculty Development Paradox: Applying Competency-Based Education Principles to Faculty Development]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2603</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Competency-based health professions education (CBHPE) has transformed learner education through explicit competencies, sequenced progression, direct observation, coaching, and programmatic assessment. However, faculty development—the mechanism that should prepare educators to enact CBHPE—has not undergone a parallel evolution. This misalignment limits the effectiveness and sustainability of CBHPE. In this paper, the authors propose a model of Competency-Based Faculty Development (CBFD) that applies CBHPE design principles to the growth of educators and introduces the Master Adaptive Teacher (MAT) as a developmental outcome for faculty. Using Van Melle’s five core components of CBHPE as an organizing framework, the authors synthesized existing educator competency frameworks, literature on adaptive expertise, faculty development theory, and implementation science and mapped these components to faculty development structures, strategies, and assessment processes. The core components can be directly translated to faculty development. Implementing CBFD requires (1) defining educator competencies aligned with institutional roles, (2) building developmental pathways linked to outcomes, (3) integrating flexible, workplace-based learning and coaching, (4) designing instruction that models CBHPE principles, and (5) adopting a longitudinal assessment program using multiple data sources. The MAT framework further operationalizes adaptive expertise as a core capability developed through reflection, coaching, community, and system-level support. In summary, CBFD represents a structural redesign that positions faculty as learners within a developmental ecosystem. When aligned with culture and institutional infrastructure, CBFD strengthens educator identity, enhances teaching quality, and enables CBHPE to achieve its full potential.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Competency-Based Health Professions Education in Evolution: Challenges and Adaptations After Implementation]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2580</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Health professions education is experiencing a paradigm shift, from a focus on the structures and processes of education to a focus on the outcomes health professionals must demonstrate to meet the healthcare needs of the public served. The Competency-based Health Professions Education (CBHPE) movement now has two decades of implementation experience in some contexts. Educators across health professions working on the design, planning, implementation, or maintenance of competency-based systems can benefit from the lessons learned through implementation efforts to date. In this manuscript, the authors capitalize on the experiences of the International Competency-based Health Professions Educators Collaborative (ICBHPE), a multinational and interprofessional group of educators, to summarize some of the common challenges faced and adaptations made after implementation. The lens of post-implementation challenges allows a view of CBHPE programs as they have matured. The challenges are organized by the five core components of CBHPE: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. For each component, the authors review those challenges that are most common and provide examples of adaptations that have been successful. The challenges and their adaptations are synthesized through “lessons learned” to provide practical insights for designing, planning, implementing, and maintaining CBHPE programs to continue driving the evolution of CBHPE globally.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Approaches to the Evaluation of Competency-Based Health Professions Education Implementation from Around the Globe]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2628</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Competency-based health professions education (CBHPE) is in various stages of implementation around the globe. While program evaluation is essential to drive improvement, adaptation, and the evolution of CBHPE, it may be intimidating for educators given the breadth of program evaluation methods and wide variation globally in local resources and expertise. In this manuscript, the authors summarize key examples of program evaluations highlighting an array of CBHPE implementations, evaluation methods, and settings. The examples are organized by five evaluation focus areas: readiness to implement, fidelity of implementation, assessment program validity, educational outcomes, and clinical outcomes. Illustrative examples from around the globe provide a roadmap featuring program evaluation methods that may be adapted to the setting, goals, size, and resources of individual programs. Capturing the evaluation of CBHPE implementation is essential for informing ongoing implementation efforts and iterative improvements to CBHPE.]]></description>
            <category>ARTICLE</category>
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        <item>
            <title><![CDATA[Validity in the Era of Competency-Based Health Professions Education: Tensions and Potential Solutions]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2593</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Assessment in health professions education has evolved dramatically in the past hundred years. The way in which we conceptualize validity has also required evolution, particularly in the era of competency-based health professions education (CBHPE). The CBHPE approach compels us to reexamine a historical focus on objectivity, individual assessments, and standards of achievement alone. In this manuscript, the authors explore the implications CBHPE places on validity, highlighting three tension points: the paradigm of assessment, levels of validation, and the reference for competence. The authors examine health profession education’s historical orientation toward the post-positivist paradigm including an emphasis on standardization, reliability, and truth-seeking. This is contrasted with two alternative paradigms, constructivism and pragmatism, which prioritize different data sources to build validity arguments. In the section on levels of validation, the authors explore tensions between validity arguments that are holistic (considers the entire picture of performance) and those which use a decomposition approach (distilling competence into individual components). Finally, the authors consider the value in measuring learner competence using norm-referenced standards, criterion-reference approaches, or the measurement of growth throughout (and beyond) their training. Ultimately, the authors propose a balanced approach to address each tension, considering the strengths and weaknesses of traditional methods with the modern needs of CBHPE.]]></description>
            <category>ARTICLE</category>
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        <item>
            <title><![CDATA[Assessment Fit for (More Than One) Purpose? Reconciling the Dual Purposes of Assessments in Competency-Based Health Professions Education]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2592</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Assessments serve several purposes in competency-based medical education (CBME) and competency-based health professions education (CBHPE) programs. These purposes are commonly termed ‘assessment for learning’ and ‘assessment of learning.’ Historically, educational scholars have advised against using an assessment for multiple purposes, arguing that doing so undermines its primary purpose. However, at times, such an approach may be required from a pragmatic standpoint. In this Eye Opener, the authors consider the competing purposes of assessment in CBHPE programs from a practical lens. They propose specific strategies to maximize benefits and minimize risks of dual-purposing when such an approach is necessary. First, the authors describe the importance of setting the stage for dual-purposing by creating a culture of trust, which requires clear institutional commitment to learner orientation and faculty development, infrastructure, and appropriate channels of communication with all constituents. Second, data considerations are discussed. The authors focus on adoption of programmatic assessment principles, opportunities for frequent formative observations, and strategies for leveraging available technology. Finally, the focus turns to the learner, highlighting their essential function as a key agent in driving their own growth and development. Balancing learner- and supervisor-initiated assessments, implementing longitudinal coaching programs, and considering “ultra-low-stakes” assessments are identified as mechanisms to support learner agency and development. Taken together, these specific design conditions may be used to promote learner growth and acquisition of competence when practical constraints require assessment data to serve a dual purpose.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[The Wicked Problem of Selection and Competency-Based Education: Applying TRIZ Inversion to the Graduate Medical Education Selection Process]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2596</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Introduction: Graduate medical education (GME) selection processes may pose significant barriers to implementing competency-based health professions education (CBHPE). Current selection metrics are largely nonpredictive of future success, and the removal of clerkship grades has given rise to a shadow economy of effort focused on publications, research hours, and other activities that detract from clinical training. This misalignment between selection practices and CBHPE principles constitutes a wicked problem that requires innovative approaches to develop new solutions.
Methods: We conducted a TRIZ (Theory of Inventive Problem Solving) exercise, a Liberating Structure that challenges assumptions by asking what would make a process fail spectacularly. Eight participants representing three countries, two continents, and four medical specialties convened via video conference in October 2025. Participants served as proxies for key stakeholder groups (students, program directors, medical school leadership, and patients/society), identified elements of the worst-possible selection system, compared them to current practices, and proposed solutions.
Results: Participants identified numerous elements characterizing suboptimal selection systems, including inequitable and biased processes, arbitrary decision-making, gaming of metrics, resource-intensive processes that fail to differentiate candidates, misinformation from training sites, and prioritization of self-interest over patient needs. Many of these elements were recognized as present in current GME selection systems worldwide.
Discussion: Recommendations to align selection with CBHPE included embedding social accountability throughout selection, leveraging coproduced competency frameworks, prioritizing workforce diversity, ensuring equity in assessment and selection, incentivizing a growth mindset through a transparent learner handover, and implementing structural innovations, including preference signaling or potentially lottery systems, to better align CBHPE and selection.]]></description>
            <category>ARTICLE</category>
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        <item>
            <title><![CDATA[CBE and the Missing ‘E’: Making Competency-Based Education an Equitable Framework for Global Health Professions Education]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2551</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[It is generally assumed that competency-based health professions education (CBHPE) is a positive and ongoing educational reform. However, the assumption that CBHPE naturally leads to more equitable outcomes has not been thoroughly examined. This ‘Eye Opener’ identifies global challenges in implementing equitable CBHPE, with particular attention to majority-world (low- and middle-income) contexts. These tensions include: 1) variable approaches to adoption that limit transferability, 2) uneven infrastructure for implementation and innovation, 3) export of predeveloped conceptual frameworks that may not be locally fit for purpose or implemented alongside collaborative knowledge exchange, and 4) pressures for fidelity in implementation that impede flexibility and compromise effectiveness in local contexts. In each area of tension, the authors outline challenges to equity and suggest potential ways forward. From their analysis, the authors propose that equity must be deliberately embedded in CBHPE at multiple levels, and the proposed solutions include addressing equity on three levels – the micro level of individual learner access and assessment; the meso level of curricula, faculty development, and program learning culture; and the macro level of national accreditation standards and education policies. Examples of opportunities at each level and for each of the five core components of CBHPE are also provided. The authors argue for a shift in perspective—from “outside-in,” in which Western nations export CBHPE to the majority world, to “outside-in, inside-out and all around,” in which CBHPE frameworks are co-created to leverage contributions from both Western and majority-world education systems. They believe that more thoughtful adaptation and embracing Global South ways of knowing, doing, and being, rather than simple replication, alongside the continuous application of a social justice lens, are needed to ensure that CBHPE serves all communities and contributes to equitable, high-quality learning and healthcare without discrimination.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Systems Thinking: Identifying Leverage Points for Achieving a Continuum of Competency-Based Health Professions Education]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2573</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Competency-based education is widely endorsed in health professions education (CBHPE) as an outcomes-focused approach to ensuring that all graduates demonstrate the competencies needed to improve patient and population health. Despite adoption of outcomes frameworks, accreditation requirements, and CBHPE tactics, interventions remain siloed within programs and training levels rather than spanning the education to practice continuum. Consequently, learners and teachers experience fragmented educational journeys that can fall short of addressing each learner’s needs for continuous learning and growth. To advance efforts toward a CBHPE continuum, this systems-informed conceptual analysis uses a systems thinking perspective to analyze leverage points, places within complex systems where small, strategic interventions can cause large-scale, lasting changes. Drawing on Meadows’ framework for understanding leverage points in complex systems, we examined barriers and opportunities to achieve a continuum and present five theoretically informed, literature-based, and expert-derived recommendations for transformation.
Our analysis revealed that strategic intervention points, including paradigm shifts from ‘time-served’ to ‘competence-demonstrated’ readiness, structural changes through cross-continuum governance alignment, and process modifications via shared competency language and data systems, enable meaningful transformation beyond surface-level adjustments. Key recommendations include: (1) restructuring system architecture to enable seamless learner progression through competency committees and joint governance bodies; (2) shifting mental models to normalize time-variable progression and reconceptualize assessment as growth-supporting; (3) implementing high-impact approaches to assessment with longitudinal learner analytics; (4) changing rules and incentives to reward competency achievement; and (5) establishing continuous data-driven feedback systems. Understanding these leverage points informs targeted approaches, enabling a cohesive, coordinated, learner-centered CBHPE continuum.]]></description>
            <category>ARTICLE</category>
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        <item>
            <title><![CDATA[CORE-HPE Reporting Guidelines: Standardizing Reporting for Competency-Based Health Professions Education Outcomes Research]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2554</link>
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            <pubDate>Tue, 29 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Background: Competency-Based Health Professions Education (CBHPE) is increasingly implemented; however, CBHPE outcomes research remains difficult to interpret and synthesize when studies incompletely report the CBHPE model and other elements.
Objective: To develop structured reporting guidelines for CBHPE outcomes studies to improve transparency, interpretability, and transferability across educational contexts and professions.
Methods: A multi-phase, iterative consensus-development process was used to create a CBHPE outcomes reporting checklist aligned with a CBHPE Outcomes Theory of Change. Draft reporting elements were generated and refined through structured writing-group deliberations, broad stakeholder feedback gathered through interactive town hall sessions within the ICBHPE Collaborative, and iterative revision cycles. The checklist was then pilot-tested with non-expert users to assess clarity, feasibility, and usability, and revisions were made to reduce redundancy, harmonize terminology, and strengthen guidance for high-impact reporting domains.
Results: The final product is a structured reporting checklist, organized by manuscript section, accompanied by brief item descriptions and rationales, and registered with EQUATOR. The guidelines prioritize reporting elements that support causal interpretability in CBHPE outcomes research, including specification of the CBHPE intervention architecture and core components, program theory and intended mechanisms, implementation fidelity and adaptations, assessment system design and governance for progression decisions, multi-level outcomes and indicators across developmental timeframes, contextual enablers and constraints, and equity considerations.
Conclusions: These CBHPE outcomes reporting recommendations provide a practical tool and guideline for authors, reviewers, and editors to strengthen the completeness and consistency of CBHPE outcomes reporting and should be considered before beginning a study. Adoption of this checklist may improve interpretability and evidence synthesis across programs and accelerate actionable learning about what works in CBHPE, for whom, in what contexts, and why.]]></description>
            <category>ARTICLE</category>
        </item>
        <item>
            <title><![CDATA[Teaching Slow Clinical Observation Through Art: A Museum-Based Innovation in Undergraduate Nursing Education]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2891</link>
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            <pubDate>Fri, 25 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Background &amp; Need for Innovation: Health professions education needs learning experiences that help students practise careful observation, evidence-based description, interpretive reasoning and attention to the human dimensions of illness. Undergraduate nursing education still needs clearly described, theory-informed and transferable museum-based models that move beyond cultural enrichment.
Goal of Innovation: We designed a curriculum-embedded museum-based innovation for first-year nursing students. Its central contribution is a transferable sequence for slow, deliberate and dialogic observation: preparation, slow looking, evidence-based description, facilitated interpretation, humanistic reflection and clinical transfer.
Steps taken for Development and Implementation of innovation: The activity was delivered at the Museo Nacional del Prado across two academic years and was informed by visual thinking approaches, experiential learning and reflective practice. Students engaged with selected artworks as complex visual and human situations rather than diagnostic riddles.
Evaluation of Innovation: We used anonymous pre- and post-activity questionnaires across two cohorts, supported by open-ended responses, faculty field notes and voluntary student reflections. A total of 874 valid questionnaires were analysed as unmatched group-level responses. Students reported higher post-activity scores in perceived knowledge, observational skills and educational value, with smaller differences in empathy. Descriptive qualitative content analysis suggested that students valued close looking, art-medicine integration and clinical relevance.
Critical Reflection on your process: The evaluation supports feasibility, acceptability and implementation stability, not objective improvement in clinical performance. Key lessons concern how to design and facilitate museum-based learning: preserve the slow observation sequence, avoid reducing artworks to diagnoses, and pair humanistic reflection with transfer to nursing practice.]]></description>
            <category>ARTICLE</category>
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            <title><![CDATA[Why Controlling Teaching Persists in Medical Education: A Self-Determination Theory Perspective]]></title>
            <link>https://reference-global.com/article/10.5334/pme.2417</link>
            <guid isPermaLink="false">/article/10.5334/pme.2417</guid>
            <pubDate>Thu, 24 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Autonomy-supportive teaching is widely promoted in medical education for its benefits to learner motivation and well-being. Yet many learners continue to experience clinical education as controlling, even in environments that explicitly endorse learner-centred values. This persistent gap suggests that barriers to autonomy-supportive practice extend beyond lack of knowledge or skill. This paper offers a theory-informed analysis of why psychologically controlling teaching persists in high-stakes clinical learning environments. Using Self-Determination Theory (SDT) as its organizing framework and drawing on complementary perspectives from psychological reactance, stress and coping, motivating styles, and medical education systems, the paper advances four interconnected arguments. Controlling teaching may emerge when educators experience pressure, threatened agency, responsibility, and uncertainty; be reinforced when authority and instructional structure are mistaken for psychological control; be legitimized through professional norms that associate control with competence; and be reproduced through assessment, administrative, and curricular systems. Its persistence is understandable because controlling approaches often produce the immediate outcomes educators seek—compliance, efficiency, predictability, and reduced uncertainty—even while carrying longer-term motivational costs. Control is therefore conceptualized not simply as an individual pedagogical failure, but as a downstream behavioural expression of pressure travelling through educational systems. By making these mechanisms visible, the paper provides a conceptual foundation for developing autonomy-supportive practices that remain viable under pressure and offers practical implications for educators, faculty development, and educational systems.]]></description>
            <category>ARTICLE</category>
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            <title><![CDATA[Taking Fun Seriously: A Scoping Review of Frameworks, Outcomes, and Definitions of Fun in Education]]></title>
            <link>https://reference-global.com/article/10.5334/pme.3030</link>
            <guid isPermaLink="false">/article/10.5334/pme.3030</guid>
            <pubDate>Fri, 18 Sep 2026 00:00:00 GMT</pubDate>
            <description><![CDATA[Introduction: Researchers studying the concept of fun in education encounter challenges because frameworks, covariates, outcomes, and definitions vary across studies and fields. The authors conducted a scoping review to map the field of fun in education, identify key psychological associations, and synthesize a working definition of fun.
Methods: The authors searched multiple databases in April 2024 for peer-reviewed articles focusing on fun in education and adjacent disciplines. Articles targeting any age group, topic, and educational or workplace setting were included. The authors extracted data on outcomes of fun, conceptual frameworks related to fun, features of fun activities, and definitions related to fun.
Results: Of 1,073 articles screened, 40 were included. The psychological construct of fun was commonly associated with positive emotions experienced in relation to an enjoyable activity. The authors identified 120 distinct features of fun and grouped these into seven categories: safety, novelty, autonomy, playfulness, purpose, immersion, and social connection. Synthesizing findings from all included articles, the authors propose the following definition of fun: “Fun is a positive emotional experience arising from active engagement in enjoyable activities or experiences, often of a playful or amusing nature, that naturally fosters a desire to sustain or revisit the activity.”
Discussion: These findings suggest a theory-informed conceptual framework of fun in learning that may provide a foundation for guiding future research into fun as an educational tool. This synthesized working definition of fun addresses gaps in prior research by incorporating recurring themes that are adaptable across diverse contexts, including health professions education.]]></description>
            <category>ARTICLE</category>
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