Development of a routine bedside CYP2C19 genotype assessment program for antiplatelet therapy guidance in a community hospital catheterization laboratory.

Genotype based personalized antiplatelet therapy in the setting of percutaneous coronary intervention (PCI) has been studied in clinical trials. Despite the demonstrated risk associated with CYP2C19 loss-of-function (LoF) carriage in clopidogrel-treated PCI patients, real-world implementation of genotyping for PCI has been low. The goal of the current study was to provide CYP2C19 genotype information to the interventionalist prior to the completion of the catheterization to facilitate immediate personalized antiplatelet therapy. Routine personalization of P2Y12 inhibitor therapy for PCI in a community hospital cardiac catheterization laboratory by POC genotyping with the SpartanRx system was first offered in February 2017. A best practice advisory (BPA) based on the Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 genotype and clopidogrel therapy was placed in the electronic health record prescription medication ordering system. By December 2019, 1,052 patients had CYP2C19 genotype testing, 429 patients underwent PCI with genotype guided antiplatelet therapy, and 250 patients underwent PCI without genotype testing and received antiplatelet therapy at the discretion of the treating physician. BPA compliance was 93. 87% of LoF allele carriers were prescribed ticagrelor or prasugrel whereas 96% of non-LoF allele carriers were prescribed clopidogrel. The genotyping results were available within 1 h and made immediately available for decision making by the interventional cardiologist. POC CYP2C19 genotyping is feasible in a community hospital catheterization laboratory and is associated with high rate of best practice compliance.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03040622.

Roles and competencies of medical faculty members: A competency framework.

PURPOSE: Medical education requires competent faculty members with the ability to create change in medical education. The focus on teacher competency are emerged as the results of medical education movements toward learner competency. The purpose of this study was to identify medical faculties competencies in their main roles and to provide a competency framework. METHOD: The integrative review approach was utilized for identifying competencies and expert opinions was conducted to assigned competencies to roles and academic ranks. The search strategies were conducted in online databases including PubMed, Scopus, WOS and Eric to detect studies published from May 2003 to May 2023. RESULTS: The identified competencies were classified to four themes including (1) essential personal competencies, (2) technical/functional competencies, (3) enabling competencies, and (4) meta-competencies. CONCLUSION: According to the results, a competency framework was proposed which is a valuable tool for various important decisions related to faculty, such as promotions and tenurship.

Health Workforce Planning: Designing a Specialty and Subspecialty Supply Model for Iran.

Background: One of the approaches to health workforce planning is supply-based. It has been emphasized that countries should model health workforce based on evidence and their context. The objective of this study is to "design a supply health workforce planning model for specialty and subspecialty in Iran." Methods: This is a study using Walker and Avant's (2018) theory synthesis framework to construct the model. This method has three steps. According to the viewpoint of the research team and the needs of the country, the focal concept is determined. Then, a literature review was done to determine related factors and their relationships. In the third step, according to the review, the viewpoint of the research team, the rationale of the connection between components, and the graphic model were presented. Results: "Supply" was selected as the focal concept. In the literature review, 42 components were obtained from the systematic review, 43 components obtained from the study of other texts were combined with the opinion of the research team about the field of Iran, and the connections between them were determined. In the third step, the supply model was designed using the Stock and Flow method. Finally, by applying the "functional full-time coefficient", the number of full-time equivalent physicians was calculated. Conclusion: The presented model is an evidence-based model that follows stock and flow design. Stock is the number of specialties or subspecialties that exist in the labor market. Flow includes inflow and outflow according to the educational pathway in the context of Iran.

Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis.

INTRODUCTION: The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. METHOD: For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. RESULTS: After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. DISCUSSION: This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system's resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

Hospitals during economic crisis: a systematic review based on resilience system capacities framework.

BACKGROUND: Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals' policy solutions during the economic crisis using the resilience system capacities framework. METHOD: This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system's six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). FINDINGS: After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers' competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. CONCLUSION: The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Transcendent Philosophy of Medicine: A Deductive Synthesis According to the Transcendental Wisdom (Mulla Sadra School of Thought).

Medicine is dependent to definition of human being in all existential dimensions, and this study attempts to synthesize a philosophy of medicine based on transcendental wisdom that was instituted by Mulla Sadra (979-1045 AH /1571-1635 AD). Using implication eliciting methodology, in the paradigm of consensual qualitative research, ten main principles of transcendental wisdom were selected and described after being approved by experts (n = 13). Then, after more than 4 years of prolonged engagement using these principles, the transcendent philosophy of medicine was deductively synthesized. Afterward, to reach consensus, the results were reviewed in four panel discussions with experts (n=20). According to the transcendental wisdom, human being has four main dimensions including corpus, psyche, nous and soul and each contain two core aspects. These dimensions and aspects construct a real unity complex called human being (Nafs), that is the survival agent and cause of all aware and unaware biological, cognitive and behavioral capabilities in all dimensions of human existence. A holistic model of health was presented, and coherent strategies according to the ten transcendental wisdom principles were recommended in all corporeal and incorporeal aspects of human health, including environmental, biological, mental, identity-related, logical, intellectual, spiritual, ethical and social health.

Towards the third generation universities: The core innovative function approach.

Background: Undoubtedly, economic and social value added depends on the functions of universities. Moving toward third-generation universities (3rd GU) is an inevitable process. These universities need different functions than traditional ones; therefore, identifying and determining their functions is essential. The purpose of this study is to collect, match and explore the functions of universities in the transition to 3rd GU and ultimately offer a functional model of the 3rd GU for the use of professors, academics and policymakers in order to evaluate and promote universities. Methods: A critical review method was adapted. Literature was included based on their relevant empirical data to research objectives and referral rates, and texts with more conceptual richness entered the study without time limitations. Results: A total of 20 texts were included in the final analysis. While presenting the basic model, extracts the overarching concepts associated with the success of 3rd GU. These key concepts include the 7 core functions of innovative and entrepreneurial activities, supportive activities (financial and non-financial), entrepreneurial education ( curriculum and academic workforce empowerment), creation and provide applied knowledge, boundary-spanning function or communications and interactions with other elements of the national innovation system (state and industry), develop innovative and entrepreneurial culture and institutional governance and leadership in the direction of economic growth and development. Conclusion: Using new functions at universities would be a move toward 3rd GU, economic growth and development in the country. So, these functions are a practically useful guide to policymakers to estimate the rate of success in each university and deliver the necessary suggestions to provide the mechanisms for the establishment of a successful university.

Rethinking interdisciplinarity: Proposing a multilayered model.

Background: One of the efforts that solve complex real-world problems is to use an interdisciplinary approach. However, the contradictions among different disciplines and the absence of a theoretical model add to the difficulty of interdisciplinary activities. When interdisciplinary researchers face a complex problem, they need to integrate several different disciplines. It seems the first step in interdisciplinary activities is to have a theoretical model to understand and examine by what content and method the processes of integrating and crossing the disciplinary boundaries are done. The purpose of this study is to propose a new theoretical model for interdisciplinary development. It also show that a multilayered model can be formed based on the boundaries of scientific disciplines. Methods: In this study, the critical review strategy of Carnwell and Daly has been used to synthesize the theoretical model using online databases. The method consists of 5 stages: defining the scope of the review, identifying the sources of relevant information, reviewing the literature, writing the review, and applying the literature to the proposed study. Results: The results of this study showed for interdisciplinarity, the artificial boundaries of disciplines must be broken. Therefore, we first began to explain the disciplinary boundaries in 13 levels, then, we proposed interdisciplinary development by examining the views of the experts in this field and with the synthesis opinion of researchers of this study on each of the disciplinary boundaries of the multilayered model. Conclusion: This model can effectively support interdisciplinary programs and can bring the goals of interdisciplinary programs closer to practical reality.

The current understanding of knowledge management concepts: A critical review.

Background: Higher education institutions include experts who are knowledgeable. Knowledge management facilitates institutions to enhance the capacity to collect information and knowledge and apply it to problem-solving and decision making. Through the review of related studies, we observed that there are multiple concepts and terms in the field of knowledge management. Thus, the complexity and variety of these concepts and definitions must be clarified. Considering the importance of clarifying these concepts for utilization by users, this study aimed to examine the concepts related to this filed. Methods: The methodology used in this study was based on the Carnwell and Daly's critical review method. An extensive search was carried out on various databases and libraries. A critical and profound review was carried out on selected articles. Many wandering concepts were found. Identified concepts were classified into seven categories based on conceptual proximity. Existing definitions and evidence in relation to extracted concepts were criticized and synthesized. The definitional attributes for them were identified and a conceptual identity card was provided for each of the concepts. Results: Thirty-seven concepts with the most relevance to the field of knowledge management were extracted. There was no clear boundary among them, and they wandered. To avoid more confusion, concepts were classified according to semantic relation. Eight categories were created; each category consisted of a mother concept and several other concepts with similarity and proximity to the meaning of the original concept. Their attributes have been identified, and finally, each of them was presented in the form of a conceptual identity card. Conclusion: Through critically reviewing the literature in this field, we were able to identify the concepts and realize their attributes. In this way, we came to a new interpretation of the concepts. At the end of the study, we concluded that some of the concepts have not been properly defined and are not properly located in the knowledge management field; also their application is uncertain.

Medical student selection and society: Lessons we learned from sociological theories.

The aim of this study was to show the interaction between the society, applicants and medical schools in terms of medical student selection. In this study, the trends to implement social factors in the selection process were highlighted. These social factors were explored through functionalism and conflict theories, each focusing on different categories of social factors. While functionalist theorists pay attention to diversity in the selection process, conflict theorists highlight the importance of socio-economic class. Although both theories believe in sorting, their different views are reflected in their sorting strategies. Both theories emphasize the importance of the person-society relationship in motivation to enter university. Furthermore, the impacts of social goals on the selection policies are derived from both theories. Theories in the sociology of education offer an approach to student selection that acknowledges and supports complexity, plurality of approaches and innovative means of selection. Medical student selection does not solely focus on the individual assessment and qualification, but it focuses on a social and collective process, which includes all the influences and interactions between the medical schools and the society. Sociological perspective of medical student selection proposes a model that envelops the individual and the society. In this model, the selection methods should meet the criteria of merit at the individual level, while the selection policies should aim at the society goals at the institutional level.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

BACKGROUND: Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers. METHODS: A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound. RESULTS: 732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively. CONCLUSIONS: Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

Understanding communication among health care professionals regarding death and dying in pediatrics.

OBJECTIVE: Effective communication regarding death and dying in pediatrics is a vital component of any quality palliative care service. The goal of the current study is to understand communication among health care professionals regarding death and dying in children. The three hypotheses tested were: (1) hospital staff (physicians of all disciplines, nurses, and psychosocial clinicians) that utilize consultation services are more comfortable communicating about death and dying than those who do not use such services, (2) different disciplines of health care providers demonstrate varying levels of comfort communicating about a range of areas pertaining to death and dying, and (3) health care staff that have had some type of formal training in death and dying are more comfortable communicating about these issues. METHODS: A primary analysis of a survey conducted in a tertiary care teaching children's hospital. RESULTS: Health care professionals who felt comfortable discussing options for end of life care with colleagues also felt more comfortable: initiating a discussion regarding a child's impending death with his/her family (r = 0.42), discussing options for terminal care with a family (r = 0.58), discussing death with families from a variety of ethnic/cultural backgrounds (r = 0.51), guiding parents in developmentally age-appropriate discussions of death with their children (r = 0.43), identifying and seeking advice from a professional role model regarding management concerns (r = 0.40), or interacting with a family following the death of a child (r = 0.51). Among all three disciplines, physicians were more likely to initiate discussions with regards to a child's impending death (F = 13.07; p = 0.007). Health care professionals that received formal grief and bereavement training were more comfortable discussing death. Significance of the results: The results demonstrated that consultation practices are associated with a higher level of comfort in discussing death and dying in pediatrics.

From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare.

Background: The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method: A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result: Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion: The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.

Factors predicting physical activity among children with special needs.

INTRODUCTION: Obesity is especially prevalent among children with special needs. Both lack of physical activity and unhealthful eating are major contributing factors. The objective of our study was to investigate barriers to physical activity among these children. METHODS: We surveyed parents of the 171 children attending Vista Del Mar School in Los Angeles, a nonprofit school serving a socioeconomically diverse group of children with special needs from kindergarten through 12th grade. Parents were asked about their child's and their own physical activity habits, barriers to their child's exercise, and demographics. The response rate was 67%. Multivariate logistic regression was used to examine predictors of children being physically active at least 3 hours per week. RESULTS: Parents reported that 45% of the children were diagnosed with attention deficit hyperactivity disorder, 38% with autism, and 34% with learning disabilities; 47% of children and 56% of parents were physically active less than 3 hours per week. The top barriers to physical activity were reported as child's lack of interest (43%), lack of developmentally appropriate programs (33%), too many behavioral problems (32%), and parents' lack of time (29%). However, child's lack of interest was the only parent-reported barrier independently associated with children's physical activity. Meanwhile, children whose parents were physically active at least 3 hours per week were 4.2 times as likely to be physically active as children whose parents were less physically active (P = .01). CONCLUSION: In this group of students with special needs, children's physical activity was strongly associated with parental physical activity; parent-reported barriers may have had less direct effect. Further studies should examine the importance of parental physical activity among children with special needs.

One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial.

OBJECTIVES: Root canal therapy (RCT) and tooth extraction have been conventional treatment options for management of human mature teeth with irreversible pulpitis. Excellent short-term treatment outcomes of vital pulp therapy with calcium-enriched mixture cement (VPT/CEM), as a new treatment option, on postoperative pain relief was demonstrated; if intermediate- and long-term treatment outcomes of the new treatment are also non-inferior compared to RCT, then VPT/CEM may become a viable treatment option for management of mature teeth with irreversible pulpitis. MATERIALS AND METHODS: In 23 healthcare centers, 407 9- to 65-year-old patients were randomly allocated into two study arms including one-visit RCT (reference treatment; n = 202) and VPT/CEM (alternative treatment; n = 205). Six- and twelve-month clinical and radiographic successes were assessed. RESULTS: Mean follow-up times at 6- and 12-month follow-ups were "6.70 ± 0.68 and 6.72 ± 0.71 months" and "12.96 ± 0.67 and 12.90 ± 0.66 months" in the available cases of RCT and VPT/CEM arms, respectively. Favorable clinical success rates in the two study arms did not show statistical difference; however, the radiographic success rate in the VPT/CEM was significantly greater than RCT arm at the two follow-ups (P < 0.001). The patients' age had no effect on the treatment outcomes (P = 0.231). CONCLUSIONS: Treatment outcomes of VPT/CEM may be superior to RCT in mature molars with irreversible pulpitis. The performance of biomaterials such CEM cement may assist in the shift towards more biologic treatments. CLINICAL RELEVANCE: VPT/CEM may be a realistic alternative treatment for human mature molar teeth with symptoms of irreversible pulpitis; the use of VPT/CEM is highly beneficial for patients as well as general dentists.

Development of a socioeconomic status index to interpret inequalities in oral health in developing countries.

PURPOSE: To develop an instrument to measure socioeconomic status (SES) in order to assess SES-related inequalities in oral health in a developing country. MATERIALS AND METHODS: In order to develop a SES measurement tool, an expert panel generated a primary item pool from which the items were revised after validity and reliability testing. The final instrument was used in a 1100-sample survey in Tehran. SES was calculated using the weights produced by both principal component analysis (PCA) and expert panel two-stage paired comparisons (TSPC) methods. RESULTS: The final instrument contained 10 items. Standardised SES scores derived from TSPC and PCA methods were significantly correlated (r = 0.749, P < 0.001). Five-level SES stratification by the two methods revealed a correlation coefficient of 0.701 (P < 0.001) for SES class. CONCLUSION: The newly developed SES index was appropriate to be used in exploring oral health inequalities in the studied sample of the Iranian population. When formulating SES, domestic experts' opinions could help the researchers explore and weight sub-construct factors.

Community-engaged medical education is a way to develop health promoters: A comparative study.

BACKGROUND: Although the importance of health promotion and empowerment of the community has been recognized for many years, there are still many barriers to adopting health promotion in the world. One of the solutions is socially accountable medical education and community engagement. OBJECTIVE: This study aimed to compare the medical programs of five medical schools that practiced community-engaged medical education to medical education in Iran. MATERIALS AND METHODS: This comparative study has been performed in 2022 by the four-stage Bereday method, including description (the educational programs of the selected medical schools were examined), interpretation (a validated checklist was prepared according to community-based strategies), proximity (similar and different information was identified), and comparison (solutions were recommended to improve health promotion and community engagement in Iran's medical education program. The purposive sampling method was used to select five universities. RESULTS: Although successful initiatives have been attempted to integrate public health promotion and community orientation into the Iranian curriculum, they do not appear to be sufficient in comparison to leading countries. The main distinction is that the community is actively engaged in all stages of curriculum design, implementation, and evaluation. CONCLUSIONS: Although Iran's medical education program has a long way to go in terms of social accountability, by including more community-oriented initiatives into the curriculum, health needs of the community can be met and physician shortages in poor areas can be alleviated. It is recommended to implement modern teaching methods, to recruit diverse faculty and community members, and to increase the community placement in medical education.

Clinical reasoning in emergency medical technicians and its compliance with the illness script theory: A pilot study.

BACKGROUND: Emergency medical technicians (EMTs) play a pivotal role in the management and treatment chain of emergency patients and their health outcomes. Knowing the clinical reasoning pattern in prehospital procedures is of particular importance that can help to develop a correct clinical decision-making process in this group. Therefore, this study aimed to clarify the clinical reasoning in EMTs and evaluate its compliance with the "illness script" theory. MATERIALS AND METHODS: This descriptive-analytical study was conducted in 2021 at Hormozgan University of Medical Sciences (HUMS) by involving EMTs in two groups of experts and novices. To collect and analyze participants' mental script-based information, the "think aloud" method was used. In the content analysis of extracted protocols, two main steps were considered: 1) preparing a suitable map to compare the protocol with the base pattern and 2) quantifying the relationship between the protocol and the base pattern. Statistical Package for the Social Sciences (SPSS)-21 software, the Shapiro-Wilk test, and the independent t-test were used for analyzing quantitative data. RESULTS: After exploring the concordance of the clinical reasoning of EMTs with the base pattern, results showed that the components of Enabling condition and Management were consistent with the illness script strategy. Pathophysiology and Diagnosis components did not conform to the base pattern. Regarding Signs and Symptoms, these were significantly different from the classic pattern of illness script. A new component called Contextual insight was suggested for this pattern. Generally, on comparing the clinical script content of experts and novices, only two components of Pathophysiology and Diagnosis did not show any significant difference (P > 0.05) between these two groups. CONCLUSION: Results of evaluating the clinical reasoning of the under-study groups showed that in some components of the pattern, they practiced as in other medical groups, but in relation to some components, this was not the case. It is due to the different nature of the prehospital conditions. Also, there is a need to add new components to the base model, which should be considered in distinguishing between expert and novice EMTs.

Value-Rich Exposures in Medical Education; Synthesizing the Concept.

Introduction: Proper transfer of professional values is an essential part of medical education. Real-life experiences in the educational process are one of the most effective methods for achieving values and assisting students in developing their value framework. This study aimed to develop and characterize the concept of value-rich exposures in medical education to bring this concept closer to the practice. Methods: In order to perform the synthesis, according to Walker and Avant, a combination of hermeneutic phenomenological method and literature review was used. At first, researchers characterized the concept of value-rich exposures based on the lived experiences of medical students who had participated in a program based on value-rich exposures at Shahid Beheshti University of Medical Sciences in Iran. After that, the literature was reviewed using an integrative review approach. Then we looked at the similarities and differences between the results of the interviews and the literature review and chose the best word to name the themes and subthemes. Finally, to describe the concept of value-rich exposures in medical education, we created a conceptual matrix. Results: We defined the concept of value-rich exposure in medical education under five themes while implementing the steps of Walker and Avant's concept synthesis: probing self-inner values, value-rich program, value mentor, value-rich interactions, and value-rich environment. The elements and relationships of the themes were depicted in the form of a conceptual matrix. Conclusions: A value-rich exposure is a type of lived experience that occurs during a student's professional life, a necessity that, with proper planning, can play an important role in shaping medical students' professional identities. A preprint of this study was published at . DOI: .