The essay, written by Adrian Kalaw and Emily Harris of Harvard Medical School together with Karen Wood of the Center for Education at Atrius Health in Boston, appears in the journal’s Healing Arts section, a venue reserved for reflective and humanistic writing rather than empirical research. Its authors bring complementary perspectives: a medical student navigating the early stages of clinical immersion, and experienced educators who have watched generations of trainees pass through the same doors. The piece draws on that vantage point to explore how medical culture shapes the way young doctors say hello and goodbye.

At the heart of the essay is a simple observation with deep implications: medical training is structured around arrivals and departures. Students arrive on the first day of anatomy, on the first day of clerkships, on the first day of residency. They depart from classrooms, from wards, from the cities and institutions that shaped them. Each transition demands a renegotiation of identity, from observer to participant, from learner to teacher, from trainee to independent clinician. The authors suggest that medicine rarely pauses to acknowledge how disorienting these repeated thresholds can be.

The timing of these transitions is not incidental. The academic calendar of medicine concentrates change into predictable windows, most visibly the July turnover when interns begin and graduating residents leave. Studies of teaching hospitals have long noted seasonal variation in care processes around these handoffs, and institutions have developed structured sign-outs, supervision protocols, and orientation programs to manage the operational risks. What the essay adds is a different lens: the psychological and professional meaning of transition, not just its logistics. Arriving somewhere new, the authors imply, is not merely a change of location but a change of self-understanding.

For medical students, the first arrival that matters is often the anatomy laboratory, where the abstraction of textbooks gives way to the reality of the human body. Later arrivals follow in rapid succession: the first patient interview, the first overnight call, the first time a nurse or attending addresses a student as a future colleague rather than a visitor. Each of these moments quietly rewrites the trainee’s sense of who they are. The essay’s reflective stance invites readers to consider how much of professional identity is formed not in formal curricula but in these accumulated threshold experiences.

Departures carry their own weight. Leaving a clinical team mid-rotation means handing over patients one has come to know, often without closure on their outcomes. Graduating from residency means leaving the safety net of supervision, a transition widely recognized as one of the most stressful in a physician’s development. The authors’ framing suggests that medicine’s culture of relentless forward motion, in which trainees are always moving to the next rotation, the next service, the next stage, can leave little room to process what is being left behind. Unacknowledged departures, they suggest, may contribute to the emotional attrition that accompanies training.

The essay also speaks to the educators on the other side of these transitions. Faculty who teach in academic medical centers experience the same cycle from the opposite direction: every July brings new learners who must be oriented, assessed, and integrated into teams, and every June takes away colleagues-in-training who have become familiar and trusted. The authors, based at institutions that train large cohorts of students and residents, write from within this recurring rhythm. Their acknowledgment section thanks William C. Taylor, MD, for his encouragement and lifelong commitment to medical education, a detail that situates the essay within a tradition of mentorship and reflective teaching at Harvard Medical School and its affiliated teaching practices.

Why does this matter beyond the personal? Research on the therapeutic relationship, health communication, and care systems, the subject categories under which the journal indexes the piece, has repeatedly shown that continuity and relational trust affect patient outcomes. Transitions interrupt continuity. When trainees arrive and depart frequently, the relationships that anchor care are repeatedly rebuilt. A reflective literature that examines how trainees experience these thresholds may therefore connect to patient experience in ways that operational fixes alone cannot address. The essay’s contribution is to keep that connection visible.

The Healing Arts genre itself deserves note. Journals of general internal medicine have long reserved space for narrative, poetry, and essay alongside original research, on the premise that medicine is practiced by whole people whose experiences of meaning, loss, and belonging shape the care they deliver. Work in this tradition does not test hypotheses; it offers testimony and interpretation. Kalaw, Harris, and Wood’s essay joins a body of writing that treats the emotional architecture of medical training as a legitimate subject of professional attention, not a private matter to be set aside at the hospital door.

For readers outside medicine, the essay offers a window into a profession that is, in many respects, a sequence of arrivals and departures compressed into a decade. For those inside it, the piece is an invitation to slow down at the thresholds: to mark the leaving of a team as deliberately as the joining of one, and to recognize that the doctors patients meet are always in motion between who they were and who they are becoming. The full essay is available in the Journal of General Internal Medicine under the title Arrivals and Departures, published on 15 October 2026.

Subject of Research: Reflective essay on professional identity and transitions in medical training

Article Title: Arrivals and Departures

Article References: Kalaw, A., Harris, E., & Wood, K. (2026). Arrivals and Departures. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10909-2

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10909-2

Keywords: medical education, medical training transitions, professional identity, therapeutic relationship, health communication, primary care, general internal medicine, residency, medical students, reflective writing, mentorship, teaching hospitals

The premise behind the model is deceptively simple. Residents, who are several years further along in their clinical development, possess knowledge and practical skills that interns are actively trying to acquire. Interns, in turn, bring fresh theoretical grounding and an eagerness that can motivate residents to consolidate their own understanding. By formalizing this relationship into a teaching unit, the researchers hypothesized that residents would strengthen their teaching ability and clinical competence while interns would gain more individualized mentorship than a busy attending physician alone could provide. The approach also addresses a practical tension in teaching hospitals, where attending faculty must divide limited time between two overlapping cohorts of learners.

To test the idea rigorously, the team enrolled 72 resident physicians and 162 medical interns who were rotating through the gastroenterology department during the same period. Participants were randomly divided into two groups, each containing 36 residents and 81 interns, ensuring that both arms had an identical composition of trainees. In the paired group, each resident was matched with two to three interns and the pair-unit was taught together. In the unpaired control group, residents and interns received their instruction separately, following the conventional departmental teaching routine. This design allowed the investigators to isolate the effect of the pairing structure itself, rather than differences in curriculum, faculty, or patient exposure.

Evaluation relied on comprehensive assessments of clinical practice, spanning multiple measurable competencies. For interns, the researchers examined the quality of medical document writing, performance on the Subject-Objective-Assessment-Plan framework known as SOAP, clinical skill operations, doctor-patient communication, and clinical thinking ability. For residents, the evaluation covered cooperative consciousness, teaching ability, the quality of their modifications to medical documents, theoretical knowledge, clinical skill operations, and the same communication and clinical thinking measures. This dual-track assessment was essential because the paired model is intended to be mutually beneficial; a teaching innovation that improved intern performance at the expense of resident learning would represent a poor trade for training programs.

The results were striking across most domains. Interns in the paired group significantly outperformed their unpaired counterparts in medical document writing quality, with a t-statistic of 9.385 and a p-value below 0.001, indicating an extremely unlikely chance finding. Their SOAP documentation scores also rose markedly, as did their clinical skill operation performance. These gains are clinically meaningful: accurate documentation and structured clinical reasoning are foundational competencies, and deficiencies in medical record writing are among the most commonly cited weaknesses of early-career physicians worldwide.

The residents in the paired group benefited just as clearly, and in some ways more broadly. Compared with residents taught separately, those in the paired units showed significantly higher cooperative consciousness, stronger teaching ability, better quality in their modifications of medical documents, improved theoretical knowledge, and superior clinical skill operation scores, all with p-values below 0.001. The improvement in teaching ability is particularly noteworthy because teaching is a core professional responsibility of attending physicians, yet formal training in how to teach is often absent from residency curricula. By making residents responsible for guiding interns, the paired model appears to convert daily clinical work into deliberate practice for the very skill of instruction.

Not every measured competency improved, however, and the pattern of null results is as informative as the positive findings. Doctor-patient communication skills showed no statistically significant difference between the paired and unpaired groups, for either interns or residents. Clinical thinking ability likewise failed to reach significance in both cohorts. The researchers report t-statistics of 1.265 for interns and 1.030 for residents on communication, and 0.896 and 1.152 respectively on clinical thinking, none of which reached the threshold for statistical significance. This suggests that the benefits of pairing are concentrated in skills that can be transmitted through direct observation, correction, and repetition, such as documentation and procedural technique, while capacities like communication and clinical judgment may require different pedagogical tools, such as simulated patient encounters or dedicated case-based reasoning sessions.

The study carries practical implications for teaching hospitals far beyond gastroenterology. Departments in China and elsewhere routinely absorb large cohorts of interns and residents simultaneously, and the resulting competition for faculty attention can dilute the educational experience of both groups. A “1 + N” structure effectively multiplies teaching capacity without hiring additional faculty: each resident becomes a near-peer teacher, a role that educational research has long associated with deeper learning for the teacher through the protégé effect. The finding that residents’ theoretical knowledge also improved supports this mechanism, since preparing to explain concepts to juniors forces seniors to organize and consolidate their own understanding.

The study was conducted with appropriate ethical oversight, with approval from the Medical Ethics Committee of Henan Provincial People’s Hospital and informed consent from all participants, in accordance with the Declaration of Helsinki. The work was funded through several Chinese educational reform programs, including a Higher Educational Reform Research and Practice Project of Henan Province and postgraduate education research initiatives at Zhengzhou University, reflecting institutional interest in reforming how clinical trainees are taught. The research team, led by co-first authors Ling Lan, Wen-Jing Yuan, Peng-Fei Li, and Rui-Qi Liang, with corresponding authors Feng-Yu Cao, Xu-Dong Fu, and Yi-Bin Hao, positions the paired mode as a direct answer to the challenge of simultaneous resident and intern training rather than a general-purpose teaching gimmick.

Several caveats temper the enthusiasm that these results deserve. The study was conducted in a single gastroenterology department at one Chinese hospital, and specialty-specific factors, such as the volume of endoscopic procedures and the documentation intensity of gastrointestinal care, may have shaped the outcomes. The evaluation also occurred within a single rotation period, leaving open the question of whether the measured gains persist over months or years of training. And because communication skills and clinical thinking did not improve, programs adopting the model should treat it as a complement to, not a replacement for, teaching methods that target those competencies. Still, the randomized design, the balanced group composition, and the consistent statistical signals across documentation, procedural, and teaching outcomes make this one of the more convincing demonstrations that near-peer pairing can be engineered deliberately rather than left to chance. If replicated in other departments and institutions, the “1 + N” model could offer teaching hospitals a low-cost, structurally elegant way to raise the floor of clinical education for two generations of physicians at once.

Subject of Research: Evaluation of a paired near-peer teaching model for resident physicians and medical interns in clinical training

Article Title: Exploration and evaluation of “1 + N” paired teaching mode for resident physicians and medical interns

Article References: Lan, L., Yuan, W.-J., Li, P.-F., Liang, R.-Q., Zhang, H.-H., Fang, X.-H., Xie, J.-B., Lu, J., Zhang, L.-Q., Liu, B.-K., Shen, L.-X., Yuan, L.-N., Zhang, Y.-N., Zhang, B.-C., Zhang, Y., Cao, F.-Y., Fu, X.-D., & Hao, Y.-B. (2026). Exploration and evaluation of “1 + N” paired teaching mode for resident physicians and medical interns. BMC Medical Education. https://doi.org/10.1186/s12909-026-09105-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-09105-x

Keywords: medical education, resident training, medical internship, paired teaching, near-peer teaching, gastroenterology, clinical skills, SOAP documentation, teaching hospitals, randomized trial, clinical competence, China

The study, published in BMC Medical Education by Masoumeh Fuladvandi of Aligoudarz School of Nursing, Shirin Ghazi of the Determinants of Medical Education & Development Center, and Mohamad Masoud Ahmadi Chegeni of the School of Medicine, all at Lorestan University of Medical Sciences, was conducted in 2025 and published on 9 October 2026. The researchers set out to examine faculty-led clinical assessment practices in teaching hospitals affiliated with the university, a setting where high patient loads, limited resources, and dense clinical schedules are common. Their central question was deceptively simple: what is it actually like to be a medical student being assessed in these hospitals?

To answer it, the team turned to qualitative methodology rather than surveys or test scores. They recruited eighteen undergraduate medical students who had reached the clinical phase of training—the eleventh academic semester or beyond—using purposive sampling with maximum variation, a technique designed to capture a wide range of perspectives rather than a statistically representative sample. Data came from thirteen semi-structured individual interviews and one focus-group discussion held in two sessions. The researchers continued collecting data until no substantively new codes or meanings emerged and the analytic categories were sufficiently developed, a saturation-based stopping rule that is standard in rigorous qualitative work.

Analysis followed the conventional content analysis approach of Graneheim and Lundman, in which researchers read transcripts line by line, assign codes to meaningful units, and inductively cluster those codes into subcategories and categories. Crucially, the analysis ran concurrently with data collection, allowing early interviews to inform later probing. The team established trustworthiness using Lincoln and Guba’s well-known criteria—credibility, dependability, confirmability, and transferability—through member checking with participants, iterative review with the research supervisors, and a documented audit trail. Reporting followed the COREQ guidelines, the accepted checklist for qualitative research, and the study received ethics approval from the Lorestan University of Medical Sciences Research Ethics Committee under code IR.LUMS.REC.1404.300, with verbal informed consent approved by the same committee.

From this painstaking process, three main categories and eleven subcategories emerged, and together they form the intellectual heart of the paper. The first category describes assessment as a hindering process. Students reported that assessment was often non-transparent: they did not clearly know what criteria they were being judged against or how their performance translated into a grade. They described faculty inattentiveness, in which assessors seemed distracted or insufficiently engaged with the student’s actual performance. Environmental constraints—the pressures of busy wards, limited time, and scarce resources—compounded these problems. Perhaps most strikingly, students described psychological insecurity: the anxiety of being watched and judged in high-stakes clinical settings without a sense of safety, which itself can degrade performance and learning.

The second category reframes assessment as a source of motivation. When assessment worked well, it did so through effective feedback—specific, timely, and constructive information that told students not just what they got wrong but how to improve. Faculty support emerged as a parallel driver: assessors who took a genuine interest in the student’s development transformed evaluation from an ordeal into an opportunity. Students also linked well-handled assessment to personal and professional growth, describing how the process of being evaluated, when done thoughtfully, helped them mature into more confident and self-aware clinicians. This duality is important: the same institutional practice could either block or fuel development depending on how it was enacted.

The third category characterizes assessment as an enabling process, identifying the conditions under which it functioned at its best. These included assessor training, meaning faculty who had been prepared for their evaluative role rather than simply assuming it; modern assessment tools, which can structure observation and scoring in ways that reduce arbitrariness; student participation, giving learners a voice in the process; and a supportive environment in which assessment is embedded in a culture of learning rather than pure judgment. Taken together, the enabling subcategories read almost like a checklist for institutions seeking to reform clinical evaluation.

The research team synthesized these findings into an interpretive conceptual model, and they are careful to note its epistemological status: the model was developed by the researchers from participants’ accounts rather than empirically tested, so it should be read as a hypothesis-generating framework rather than a validated causal structure. Its central claim, however, is compelling. Students’ experiences of clinical assessment were shaped by the interaction of three domains—organisational conditions, interpersonal relationships, and psychological safety—rather than by assessment methods alone. In other words, switching to a new scoring instrument or checklist will accomplish little if the ward is chaotic, the assessor is disengaged, and the student is terrified.

This interactionist insight has implications well beyond Lorestan. Medical education research worldwide has documented the gap between intended and enacted curriculum, and assessment is where that gap becomes most visible and most consequential. A grade is a communication, and if students cannot decode the criteria behind it, if the assessor’s attention is divided, or if the emotional climate punishes honest uncertainty, the communication fails. The Iranian context adds a valuable dimension: teaching hospitals in resource-constrained settings face pressures that elite academic centers may not, yet the students’ core needs—clarity, feedback, support, and safety—are universal. The findings suggest that psychological safety, a concept popularized in organizational research, deserves a central place in how medical schools design and train for clinical evaluation.

The authors’ conclusions are correspondingly practical. They argue that strengthening assessor competence, standardizing assessment practices, and fostering psychological safety may enhance the educational value of clinical assessment in teaching hospitals. Each recommendation maps directly onto a category of findings: assessor competence addresses faculty inattentiveness and the lack of training; standardization addresses non-transparency and environmental inconsistency; and psychological safety addresses the insecurity that students identified as a pervasive hindrance. Because the study is qualitative, it cannot quantify how common each experience is, and the single-institution design limits generalizability; the interpretive model awaits empirical testing. But for educators, the study offers something surveys cannot: a rich, internally coherent account of what assessment feels like from the other side of the clipboard.

What makes the findings resonate is their reframing of assessment as a relational and organizational phenomenon rather than a purely technical one. The study, which formed part of an MD thesis at Lorestan University of Medical Sciences and received no external funding, reminds the medical education community that every observed history-taking exercise and every ward-round question is embedded in a web of institutional constraints, human relationships, and emotional stakes. When that web supports the learner, assessment becomes one of the most powerful engines of clinical growth; when it does not, the same procedure quietly undermines the competence it is meant to certify. The task for medical schools, the study suggests, is not merely to choose better assessment methods, but to build the organizational, interpersonal, and psychological conditions in which any method can succeed.

Subject of Research: Medical students' experiences of clinical assessment in teaching hospitals

Article Title: Medical students’ experiences of clinical assessment in teaching hospitals affiliated with Lorestan University of Medical Sciences: a qualitative content analysis

Article References: Fuladvandi, M., Ghazi, S., & Chegeni, M. M. A. (2026). Medical students’ experiences of clinical assessment in teaching hospitals affiliated with Lorestan University of Medical Sciences: a qualitative content analysis. BMC Medical Education. https://doi.org/10.1186/s12909-026-10589-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10589-w

Keywords: clinical assessment, medical education, medical students, qualitative content analysis, psychological safety, feedback, teaching hospitals, clinical learning environment, workplace-based assessment, faculty development, Iran, BMC Medical Education

The research team, led by biomedical engineers and health policy specialists from Jimma University and collaborating institutions, surveyed facilities across the country between September and December 2024. Their facility-based cross-sectional design captured a snapshot of healthcare technology management as it actually operates in these hospitals, using structured data collection tools with double-entry verification to reduce recording errors. Rather than modeling equipment failure statistically with independent and dependent variables, the researchers treated their findings as descriptive indicators, a choice that reflects the exploratory nature of the work and the scarcity of prior systematic data on this problem in low-resource settings.

The headline result is striking in its uniformity. Delayed spare-part procurement was reported in every single one of the seven hospitals studied, a perfect 7 out of 7, making it the factor most consistently associated with equipment malfunction. Close behind were budget shortages, lack of spare parts, and skill gaps among staff, each reported by six of the seven facilities, or 85.71 percent. In other words, the problem is not that a handful of hospitals are mismanaging their technology; it is that nearly every institution faces the same interlocking barriers at nearly the same intensity.

Below the top tier of causes, the study identified a second layer of operational stressors. Power fluctuations were reported by five of the seven hospitals, as was a shortage of capacity-building training for the technicians expected to keep equipment running. Equipment mishandling and inadequate maintenance tools rounded out the list. Each of these factors points to a different failure mode: unstable electricity stresses sensitive electronics and power supplies, while untrained or under-equipped technicians cannot perform the preventive maintenance that would catch small faults before they become total failures.

The technical logic behind these findings is worth unpacking. Modern medical devices, from computed tomography scanners to infusion pumps, depend on reliable electrical power, calibrated components, and periodic servicing according to manufacturer specifications. When voltage fluctuates, power supplies and circuit boards degrade faster. When spare parts take months to arrive through procurement channels, a device that could be repaired in an afternoon sits unused for a season. When biomedical engineering staff lack training on specific equipment models, they may be unable to diagnose faults at all, forcing hospitals to rely on scarce external service engineers or to declare devices beyond repair prematurely.

The consequences cascade directly into clinical care. The study links these management failures to equipment downtime, delayed care, and reduced service availability. In a teaching hospital, an out-of-service machine affects not only the patients who cannot be diagnosed or treated today but also the students and residents who cannot learn to use it. Equipment downtime in diagnostic imaging, laboratory medicine, and intensive care can force patient referrals to distant facilities, add out-of-pocket costs for families, and delay diagnoses in diseases where time is decisive. The authors frame these disruptions as a health system problem, not merely an engineering nuisance.

What makes the Ethiopian case instructive for the broader global health community is its resonance with patterns documented across low- and middle-income countries. The World Health Organization has long estimated that a large share of medical equipment in resource-limited settings is out of service at any given time, and studies across sub-Saharan Africa have repeatedly implicated procurement bottlenecks, funding gaps, and workforce shortages. The abbreviation list of the new paper reads like a map of the field’s institutional landscape: health technology management frameworks, computerized maintenance management systems, medical equipment management information systems, and national supply agencies such as the Ethiopian Pharmaceutical Supply Service all appear as pieces of the machinery that should, in principle, keep devices running.

The study’s methodology deserves attention for its transparency about what it can and cannot show. As a descriptive cross-sectional survey of seven university hospitals, it establishes association and prevalence of reported challenges, not causal proof that any single factor produces equipment failure. The authors are explicit that variables were treated as descriptive indicators rather than modeled as predictors. Structured tools and double data entry strengthen the reliability of the reported figures, but the underlying data are self-reported by facilities, which means the study captures institutional perceptions of failure causes as well as objective breakdowns. Still, the near-universal agreement across seven independent hospitals lends the findings considerable weight.

Ethically and administratively, the research followed a careful protocol. Approval came from the Institutional Review Board of Jimma University, and the study was conducted in accordance with national regulations and the Declaration of Helsinki. Although the work was a non-clinical survey, informed consent was obtained from all participants before data collection, and the data collection tools themselves were reviewed and approved by the board. The work was funded by the Korea Foundation for International Healthcare under its KGA-2024 Regional Activity Project in Ethiopia, an example of international partnership supporting locally led health systems research. The authors declare no competing interests, and the article is open access under a Creative Commons license.

The policy implications are clear, and the authors do not soften them. Fixing this problem, they argue, requires systemic, policy-based reform rather than piecemeal repairs: streamlined spare-part procurement pipelines, dedicated maintenance budgets, structured training for biomedical engineering staff, stable power infrastructure with uninterruptible power supplies for critical devices, and information systems that track equipment status and maintenance history. None of these interventions is glamorous, and none involves a new machine. But the study’s central message is that the machines Ethiopia already owns could deliver far more care if the systems around them worked. In a country investing heavily in medical education and hospital expansion, ensuring that the technology already installed actually functions may be one of the highest-return health investments available.

Subject of Research: Medical equipment management and healthcare technology maintenance in Ethiopian teaching hospitals

Article Title: Medical equipment management challenges in Ethiopian teaching hospitals: a cross-sectional study of systemic and operational gaps in health technology

Article References: Yihunie, E. B., Wako, B. D., W/Amanuel, A. M., Tufa, S. G., Chala, T. K., Chala, S. L., & Gemechu, T. D. (2026). Medical equipment management challenges in Ethiopian teaching hospitals: a cross-sectional study of systemic and operational gaps in health technology. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15719-0

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15719-0

Keywords: medical equipment management, healthcare technology management, Ethiopia, teaching hospitals, spare parts procurement, biomedical engineering, equipment downtime, low- and middle-income countries, health systems, maintenance, hospital management, medical devices