Investigating Parental Factors for Adolescent Problematic Gaming and Social Media Use - A Cross-sectional and Longitudinal Approach.

PURPOSE: Increasing concern has been raised on the addictive potential of digital games and socialmedia platforms, especially in adolescent users. Hence, investigating the etiology of problematic gaming (PG) and problematic social-media use (PSMU) is of great scientific and clinical interest. Parental factors have not been sufficiently addressed yet. Therefore, this study aims to investigate the predictive values of parental demographic, psychological, parenting, and role model factors for adolescent PG/PSMU. METHODS: In a representative parent-child (10-17 years) sample parental factors and adolescent PG/PSMU were assessed cross-sectionally (Ndyads = 1221) and longitudinally (Ndyads = 659) using online-questionnaires at two measurement points 14 months apart. Parental factors included parental media-use patterns, sociodemographic aspects, (digital) emotion regulation, stress perception, (digital) parental self-efficacy, and media rules. Best subset linear regression models were estimated to identify parental factors with greatest predictive values. These were included in prospective linear regression analyses. RESULTS: At the cross-sectional level, 18% of model variance predicting PG and 24% predicting PSMU could be explained by parental media-use patterns, media rules, and (digital) parental self-efficacy after controlling for adolescent age. Longitudinally, 33% of variance in the PG model and 34% of variance of the PSMU model could be explained by parental media-use patterns and parental self-efficacy after controlling for adolescent age and baseline PG/PSMU. DISCUSSION: This study is the first to differentially investigate parental factors in the context of adolescent PG/PSMU in a prospective representative parent-child study. Aspects of digital parental role modeling and parenting could be identified as promising anchors for prevention and treatment.

Medical education needs a new model for global leadership.

BACKGROUND: Like other fields in medicine, medical education relies on collaboration and cooperation between countries and regions of the world, although no single institution or position unifies the global medical education community in the way that the WHO does in public health, for example. Recent research in medical education has drawn attention to many injustices that exist in the field, where power and influence is held in relatively few Global North countries, although most practice happens in Global South countries. METHODS: In this article, we examine three positions that hold global prominence in medical education, including the presidents of the World Federation for Medical Education and the Association for Medical Education in Europe, and winners of the Karolinska Institutet Prize for Research in Medical Education. FINDINGS: We highlight that these positions have problematic histories and have perpetuated the current power disparities in the field. We argue that an alternative model for global leadership is required that should be determined democratically by those involved in medical education all around the world. Such a model should prioritise diversity and inclusivity, empowering leaders from countries who have previously been peripheral to the decision-making platforms in the field. CONCLUSION: Given the shortcomings of existing leadership positions and organisations, we suggest that a new institution is required to realise this new vision, and that the principles that govern it should be determined through debate and democracy, with a focus on inviting those voices that have not previously been heard in global medical education circles.

Perception of enhanced learning in medicine through integrating of virtual patients: an exploratory study on knowledge acquisition and transfer.

INTRODUCTION: Virtual Patients (VPs) have been shown to improve various aspects of medical learning, however, research has scarcely delved into the specific factors that facilitate the knowledge gain and transfer of knowledge from the classroom to real-world applications. This exploratory study aims to understand the impact of integrating VPs into classroom learning on students' perceptions of knowledge acquisition and transfer. METHODS: The study was integrated into an elective course on "Personalized Medicine in Cancer Treatment and Care," employing a qualitative and quantitative approach. Twenty-two second-year medical undergraduates engaged in a VP session, which included role modeling, practice with various authentic cases, group discussion on feedback, and a plenary session. Student perceptions of their learning were measured through surveys and focus group interviews and analyzed using descriptive statistics and thematic analysis. RESULTS: Quantitative data shows that students highly valued the role modeling introduction, scoring it 4.42 out of 5, and acknowledged the practice with VPs in enhancing their subject matter understanding, with an average score of 4.0 out of 5. However, students' reflections on peer dialogue on feedback received mixed reviews, averaging a score of 3.24 out of 5. Qualitative analysis (of focus-group interviews) unearthed the following four themes: 'Which steps to take in clinical reasoning', 'Challenging their reasoning to enhance deeper understanding', 'Transfer of knowledge ', and ' Enhance Reasoning through Reflections'. Quantitative and qualitative data are cohered. CONCLUSION: The study demonstrates evidence for the improvement of learning by incorporating VPs with learning activities. This integration enhances students' perceptions of knowledge acquisition and transfer, thereby potentially elevating students' preparedness for real-world clinical settings. Key facets like expert role modeling and various authentic case exposures were valued for fostering a deeper understanding and active engagement, though with some mixed responses towards peer feedback discussions. While the preliminary findings are encouraging, the necessity for further research to refine feedback mechanisms and explore a broader spectrum of medical disciplines with larger sample sizes is underscored. This exploration lays a groundwork for future endeavors aimed at optimizing VP-based learning experiences in medical education.

Exploring parental secretive eating of sugary foods and drinks, and its associations with food consumption in families.

As a way of modeling healthier eating habits for their children, parents may intentionally avoid consuming sugary foods and drinks (SFDs) in their presence but consume these on other occasions (later referred to as parental secretive eating). This study aimed to 1) explore the prevalence of parental secretive eating, 2) investigate the associations between parental secretive eating and SFD consumption in parents and children, and 3) qualitatively explore the reasons for parental secretive eating. Participants were Finnish mothers (n = 362), fathers (n = 123), and their 3-6-year-old children (n = 403); this data was collected in 2017 as part of the baseline assessment of the DAGIS intervention. Parents reported how often they avoided eating SFDs in the presence of their child, completed food frequency questionnaires for themselves and their child, and responded to an open-ended question of explaining reasons for secretive eating. The overall prevalence of parental secretive eating was 68%. It was more common among mothers than fathers (p < 0.001) and most prevalent in chocolate (61%) and sweets (59%). Parental secretive eating was positively associated with SFD consumption both among mothers (ꞵ = 0.274, p < 0.001) and fathers (ꞵ = 0.210, p = 0.028) in linear regression models adjusted for parents' and child's age, child's gender, parental education level, and number of household members. Mothers' or fathers' secretive eating and child's SFD consumption were not associated (ꞵ = 0.031, p = 0.562; ꞵ = -0.143; p = 0.167). Three themes describing reasons for parental secretive eating were found: family food rules, avoiding child's requests, and aspiration for healthy modeling. In conclusion, parental secretive eating may play an important role in determining SFD consumption in families with preschoolers. Additional research is needed to determine whether parents can prevent their own eating habits from influencing their child through secretive eating.

Role Modeling Kindness at the Bedside.

Compassion and kindness are interchangeable attitudes and behaviors in society. As evidence shows the importance of compassion and kindness in healthcare, there has been a push to nurture and teach compassion through experiential learning in medical schools. However, there is not much evidence of educating learners on the importance of kindness as the complement or foundation of compassion and empathy. Kindness is the ability to act positively and appropriately and can be provided without emotion, judgment, or expecting anything in return. Kindness does not require the receiver to be in severe distress or suffering. Acts of kindness can be random acts done to anyone, anytime, with or without illness or suffering. Research shows that kindness elevates the healthcare profession for both clinicians and patients. Compassion and kindness must be taught through the integrated approach of role modeling, observation, practice, experience, and reflection in the classroom and in the clinical environment. It is vital that medical schools and healthcare institutions' faculty and staff make kindness to patients, families, and staff a key behavior, along with compassion and empathy. There is more that can be done to encourage acts of kindness through everyday actions; educators can display kindness toward colleagues and medical students in their learning. Kindness can improve conversations with patients and improve the emotional and social well-being of learners. Displaying kindness during bedside or classroom teaching would engrain its importance in the professional identity formation of future generations of physicians.

Power of saying 'I Don't Know': psychological safety and participatory strategies for healthcare leaders.

As healthcare systems grow increasingly complex and integrate with other services and sectors, creating complex patient pathways, this inevitably leads to additional layers within a system. Consequently, high-tier leaders become progressively detached from the inner workings of the systems in which they operate. Several barriers exist that may deter a leader from embracing uncertainty and acknowledging the limits of their expertise in these systems. These barriers range from personal insecurities about perception to organisational stigmas that compound these concerns through expectations of infallible leadership. In this article, I draw on my experience as an embedded researcher and someone who has taught leadership in healthcare settings to examine the importance of leadership vulnerability, considering not only for the leaders themselves but also for fostering a learning and innovative culture within the organisation. I focus on two fundamental tenets: psychological safety and participatory approaches to innovation. In addition, I offer practical considerations for embracing vulnerability and discuss the ensuing benefits. Given the rapidly evolving complexities in healthcare and paradigm-shifting innovations, such as the integration of digital solutions, this article serves as a call to action. It urges leaders to embrace uncertainty, encourage participation and venture into the unknown.

Exploring the Impact of a Vicarious Learning Approach on Student Pharmacists' Professional Identity Formation Using a Simulated Pharmacist-Patient Encounter.

Purposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists' PIF after viewing, analyzing, and reflecting upon a simulated pharmacist-patient encounter (PPE). A 12 min role-play video was created, featuring a pharmacist counseling a standardized patient on a new medication regimen; foundational principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were included in the counseling, with some aspects intentionally performed well, others in need of improvement. Also included were the patient's varied reactions to the counseling. Students assumed the observer role and learned vicariously through viewing the PPE. Postactivity debriefs included justifying a foundational principle performed well by the pharmacist, and another in need of improvement, and a self-reflection essay expressing the impact of viewing the PPE on their PIF, from which extracts were thematically analyzed for impact. The main themes of the impact included increased awareness of counseling techniques, patient-friendly medical jargon, patient perspectives/empathy, positive and negative pharmacist role-modeling, and the value of the observer role. This PPE exercise enhanced PIF in terms of students thinking, acting, and feeling like a pharmacist, based on students' self-reflections, which most often referenced effective pharmacist-patient communication and enacting optimal patient care.

Trajectory of a medical career: a perspective regarding a proposed model.

A career as a physician offers so many options-clinical care, research, education, leadership, etc. Still, a general trajectory of a medical career can be usefully modelled. Based on a USA-centric lens, this proposed model-which is based on a personal reflection and conversation with colleagues-consists of an initial two-component linear phase, followed later by a non-linear phase. The linear phase requires mastery of a large body of knowledge, acquiring cognitive and technical skills, and achieving prescribed milestones. Two components of the linear trajectory are early education through medical school, and then graduate medical education through the initial career path. A non-linear phase follows, characteristically beginning after graduate medical training and the initial 'hitting stride' in the first post-training position.At this point, the physician's choices regarding career direction are wide open. Yet, the intense focus needed to master the prolonged linear phase of the physician's career can exert opposing effects on preparedness for the subsequent non-linear phase; years of satisfying prescribed curricula and examinations may blunt the self-directed learning and intrinsic motivation needed for the non-linear phase while also stimulating the appetite to get beyond the guardrails of the linear phase.This model has implications for early training, namely encouraging a focus on mindfulness and introducing this model as part of professional identity formation. Given differences in medical training across the globe, generalisability of the model to settings outside the United States would require validation by others.

Role Modeling of Professional Behavior in Nursing Education During the COVID-19 Pandemic: A Mixed Method Study.

This study aimed to examine professional behavior as role models in nursing education during the COVID-19 pandemic perceived by nursing students. This study applied a mixed-method design using a sequential explanatory approach. A total of 120 nursing students participated in the self-reported questionnaire, and 10 were involved in semistructured individual interviews. The Professional Nurse Educator Role-Model questionnaire developed by the authors was used to collect quantitative data, and four open-ended questions modified from a previous study as the guideline in qualitative data collection. Quantitative data were analyzed using descriptive quantitative analysis. Open-ended questions were analyzed using thematic analysis. Quantitatively, students reported that excellent professional behaviors as role models were prevalent in nursing education (Mean 3.61 out of 4). Four themes from qualitative findings were revealed to complement the quantitative data, including teaching by example, altruism, efficiently performing, and effective communication. In conclusion, nurses as educators and clinicians could be students' professional role models, particularly in clinical settings during the COVID-19 pandemic. It is essential for nurse educators and clinicians to actively create a culture of professional nursing care for self and others during the pandemic to be present in wholeness and provide holistic care.

The effect of an information intervention on the career commitment of medical students: evidence from a randomized experiment.

Introduction: The needs-based shortage of healthcare workers is severe worldwide and it would be exacerbated if many medical students switch to other careers after graduation. Maintaining and improving the career commitment of medical students, which could be a feasible, effective, and scalable way to reduce the attrition rate, is essential in medical education. We designed a randomized experiment to test whether an information intervention based on role modeling could enhance medical students' career commitment. Methods: In the randomized experiment, the sample (N = 36,482) was divided into the treatment group (N = 18,070) and the control group (N = 18,412). The intervention information consisted of image-text messages on Zhong Nanshan, who is an inspiring role model for he went to the frontline of COVID-19 in the most critical circumstances and received praise and affirmation from the public. Α difference-in-differences model was employed to identify the effect of the information intervention. Heterogeneous treatment effects were identified using sub-sample analyses. Results: The results showed that the information intervention statistically significantly reduced medical students' dropout intention by 2.7 percentage points (95% CI: -0.037 to -0.016, t = -4.95, p < 0.001), equivalent to 14.6% of the control group mean. This estimate indicates that the information intervention could significantly increase the career commitment of medical students. Finally, male and senior students were influenced more than their female and junior counterparts, which can be explained by their relatively high dropout intention. Conclusion: Role model-based information intervention improves the career commitment of medical students. The underlying behavioral model is that, when students use a role model as their reference point, they consider dropout as a substantial welfare loss. Role modeling is an effective way to improve the career commitment of medical students, especially for males and senior students.

Examining the Relationship Between Health Behaviors of Adults and Preschool Children.

INTRODUCTION: Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. METHOD: Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. RESULTS: Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). DISCUSSION: The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children.

Reflections and intersections: disability, 'ableism' and metamodern leadership.

In this article the author, the eightieth President of the Medical Women's Federation and a clinical academic, reflects on disability, gender, and leadership. She draws on lessons from her sixteen-year NHS career in HIV Medicine in East London, UK. She explores her experiences and challenges as a Consultant Physician who became invisibly disabled and reflects on how her chosen leadership style has evolved in parallel. Readers are encouraged to reflect on invisible disability, 'ableism' and how to navigate conversations with colleagues.

Effect of Elite Sport on Physical Activity Practice in the General Population: A Systematic Review.

BACKGROUND: Our study investigated the effect of elite sport on physical activity (PA) practice in the general population. METHODS: Structured Boolean searches were conducted across 5 electronic databases (PubMed, JSTOR, Web of Science, SPORTDiscus, and PsycInfo) from January 2000 to August 2021. Peer-reviewed studies in English were included if the effects of hosting elite sport events, elite sport success, and elite sport role modeling on PA/sport practice in the general population were measured. RESULTS: We identified 12,563 articles and included 36 articles. Most studies investigated the effect of hosting elite sport events (n = 27), followed by elite sport success (n = 16) and elite sport role modeling (n = 3). Most studies did not observe a positive effect of hosting elite sport events, elite sport success, or elite sport role modeling on PA/sport practice in the general population. No evidence of a lagged effect of elite sport was observed. No evidence of elite sport effects was observed according to age range and geographical scale. CONCLUSION: There is no evidence supporting the effect of elite sport in increasing PA or sport participation in the general population. Decision makers and policymakers should be aware of this and invest in strategies such as those recommended by the World Health Organization.

Outstanding qualities of a successful role model in medical education: Students and professors' points of view.

Introduction: Role models play a crucial role in determining the professional development of medical trainees. The purpose of this study was to gain in-depth understanding of the outstanding qualities of successful role models. Material and methods: In this qualitative-descriptive study, data were collected through conducting interviews, and the inductive content analysis was performed. The study was done at the school of medicine of Tehran University of Medical Sciences in Iran. Twenty-five medical students, medical graduates, and faculty members participated in 25 interviews from April to December 2019. The participants were recruited via purposive sampling. Results: five categories and 13 subcategories were extracted from the data. The results of this study illustrated five crucial qualities of a good clinical role model including an excellent character, effective coach and mentor, inspiring medical leader, expert clinical teacher, and a professional physician. Our results also highlighted the lasting effects of positive role modeling of clinical teachers on medical trainees' professional careers. Another category in the present study was connected to future consequences of being a role model in a clinical setting. Conclusion: The result of this study illustrated crucial qualities of a good medical role model. This result can assist the leaders to engage with medical educators to better understand the process of role modeling and design the best plan for development of role modeling in medical education.

A multisite randomized trial of implicit versus explicit modeling in clinical teaching.

PURPOSE: Faculty modeling of desired behaviors has historically been a part of the apprenticeship model of clinical teaching, yet little is known about best practices for modeling. This study compared the educational impact of implicitly versus explicitly modeled communication skills among U.S. medical students. METHOD: Fourth-year medical students from six U.S. academic medical centers were randomly assigned one simulated clinical encounter in which faculty provided either implicit or explicit modeling of important communication skills. Outcomes were assessed by electronic surveys immediately before and after the simulations. Students were blinded to the purpose of the study. RESULTS: Students in the explicit arm were more likely to correctly cite two of the three key specific communication elements modeled by faculty: deliberate body position (53.3% vs. 18.6%, p < 0.001) and summarizing patient understanding (62.2% vs. 11.6%, p < 0.001). More students in the explicit study arm reported faculty 'demonstrated a key behavior that they wanted me to be able to perform in the future' (93.2% versus 62.8%, p = 0.002). Participating faculty stated they would modify their teaching approach in response to their experiences in the study. CONCLUSIONS: In a multi-center randomized trial, explicit faculty role-modeling led to greater uptake of communication knowledge, greater recognition of skills, and a greater sense that faculty expected these skills to be adopted by students. These results must be considered in the context, however, of a simulated environment and a short timeframe for assessing learning with students who volunteered for a simulated experience.

[Vegetables and fruits in early childhood: maternal nutritional practices]. / Vegetales y frutas en la primera infancia: prácticas alimentarias maternas.

INTRODUCTION: Global consumption of vegetables and fruits is currently below recommendations, impacting the prevalence of obesity and non-communicable diseases. In addition to environmental factors, mothers' feeding practices influence children's eating patterns. METHODS: Questionnaires were conducted with mothers of children 7 months to 7 years of age (n = 727), in 12 Primary Health Care Centers in the capital cities of three Argentine provinces. Fruit and vegetable consumption was evaluated with the Children's Dietary Questionnaire (CDQ). We tested the association with maternal feeding practices distributed across three domains: role modeling, accessibility, and socialization of the products in the home. We tested 11 practices separately and a variable summing the 11 practices. RESULTS: The majority of children (86%) had low fruit and vegetable intake. In regression models, each of the 11 practices showed a significant association with children's fruit and vegetable intake (beta 0,6-1,8). However, the variable testing the sum of the 11 practices showed a larger association parameter with intake, even in multiple regression (beta 3,9). Proximity of sale points and cost of products also showed a significant association with intake. CONCLUSION: Results provide information on home based strategies to promote children's fruit and vegetable intake that do not require complex resources and can be incorporated into community health education programs.

Introducción: El consumo de vegetales y frutas a nivel global está por debajo de lo recomendado, incidiendo sobre la prevalencia de obesidad y enfermedades crónicas no transmisibles a corto y largo plazo. Además de factores ambientales, las prácticas maternas influyen sobre los patrones alimentarios de hijos e hijas. Métodos: Se aplicaron cuestionarios a 727 madres con hijos/hijas de 7 meses a 7 años de edad, en 12 Centros de Atención Primaria de Salud en las ciudades capitales de Tucumán, Santiago del Estero y Jujuy, Argentina. La ingesta de vegetales y frutas se evaluó mediante el Cuestionario de Dieta para Niños (CDQ por sus siglas en inglés) y se evaluó su asociación con prácticas maternas en 3 dominios conceptuales, rol modélico, accesibilidad, y socialización de esos alimentos en el hogar. Con regresión simple se analizaron 11 prácticas en forma separada, y con regresión multivariada una variable compuesta por la sumatoria de las 11 prácticas. Resultados: El 86% de niños/niñas tenía un bajo consumo de vegetales y frutas. Cada una de las 11 prácticas alimentarias mostró una asociación significativa con el consumo (beta 0.6 a 1.8). Sin embargo, la sumatoria de las distintas prácticas, su utilización en forma combinada, mostró un mayor efecto (beta 3.9). Cercanía a locales de venta y costo también estaban asociados significativamente con el consumo. Conclusión: Los resultados informan sobre estrategias para promover el consumo de vegetales y frutas, que pueden aplicarse en el contexto del hogar no requieren de recursos complejos y pueden incorporarse a programas de educación para la salud a nivel comunitario.

Vegetales y frutas en la primera infancia: prácticas alimentarias maternas / Vegetables and fruits in early childhood: maternal nutritional practices

Resumen Introducción: El consumo de vegetales y frutas a nivel global está por debajo de lo recomendado, incidiendo sobre la prevalencia de obesidad y enfermedades crónicas no transmisibles a corto y largo plazo. Además de factores ambientales, las prácticas maternas influyen sobre los patrones alimentarios de hijos e hijas. Métodos: Se aplicaron cuestionarios a 727 madres con hijos/hijas de 7 meses a 7 años de edad, en 12 Centros de Atención Primaria de Salud en las ciudades capitales de Tucumán, Santiago del Estero y Jujuy, Argentina. La ingesta de vegetales y frutas se evaluó mediante el Cuestionario de Dieta para Niños (CDQ por sus siglas en inglés) y se evaluó su asociación con prácticas maternas en 3 dominios conceptuales, rol modélico, accesibilidad, y socialización de esos alimentos en el hogar. Con regresión simple se analizaron 11 prácticas en forma separada, y con regresión multivariada una variable compuesta por la sumatoria de las 11 prácticas. Resultados: El 86% de niños/niñas tenía un bajo consumo de vegetales y frutas. Cada una de las 11 prácticas alimentarias mostró una asociación significativa con el consumo (beta 0.6 a 1.8). Sin embargo, la sumatoria de las distintas prácticas, su utilización en forma combinada, mostró un mayor efecto (beta 3.9). Cercanía a locales de venta y costo también estaban asociados significativamente con el consumo. Conclusión: Los resultados informan sobre estrategias para promover el consumo de vegetales y frutas, que pueden aplicarse en el contexto del hogar no requieren de recursos complejos y pueden in corporarse a programas de educación para la salud a nivel comunitario.

Abstract Introduction: Global consumption of vegetables and fruits is currently below recommendations, im pacting the prevalence of obesity and non-communicable diseases. In addition to environmental factors, mothers' feeding practices influence children's eating patterns. Methods: Questionnaires were conducted with mothers of children 7 months to 7 years of age (n = 727), in 12 Primary Health Care Centers in the capital cities of three Argentine provinces. Fruit and vegetable consumption was evaluated with the Children's Dietary Questionnaire (CDQ). We tested the association with maternal feeding practices distributed across three domains: role model ing, accessibility, and socialization of the products in the home. We tested 11 practices separately and a vari able summing the 11 practices. Results: The majority of children (86%) had low fruit and vegetable intake. In regression models, each of the 11 practices showed a significant association with children's fruit and vegetable intake (beta 0,6-1,8). However, the variable testing the sum of the 11 practices showed a larger association parameter with intake, even in multiple regression (beta 3,9). Proximity of sale points and cost of products also showed a significant association with intake. Conclusion: Results provide information on home based strategies to promote children's fruit and vegetable intake that do not require complex resources and can be incorporated into community health education programs.

Explaining Internal Medicine and Surgery Residents' Perceptions of Mentor as a Role Model: A qualitative Study.

Background: Role modeling is the essence of the teaching process and one of the important functions of educators and clinical instructors. In clinical education situations, many clinical instructors are responsible as mentors. On the other hand, clinical instructors, although not obvious, are seen as role models. This study is aimed at explaining the internal medicine and surgery residents' perceptions of mentors as role models. Methods: This qualitative (content analysis) study was carried out using purposive sampling and conducting semi-structured interviews with 18 medical residents (internal medicine and surgery departments) at Iran University of Medical Sciences. The resulting data were analyzed using inductive qualitative content analysis. Results: Based on the results of the analysis of the transcribed interviews, 60 initial codes, 31 subthemes, and 5 main themes were identified. The dimensions of the mentor's role modeling were as follows: structural, executive, managerial, ethical, and scientific. Conclusion: Role modeling is a very effective learning method, especially for medical students. Role modeling in clinical learning environments seems to be valuable to facilitate students' learning. Using the role of clinical instructors as an educational model is one of the important ways of teaching professional ethics in clinics.

A long and winding road: non-traditional routes into medical leadership.

INTRODUCTION: Clinicians enter the medical profession through a variety of routes. This paper explores how non-traditional routes into the medical profession can follow through into subsequent medical leadership practice, influencing issues of confidence, self-image and assumptions about leadership as a concept. METHOD: The first-person reflections of a doctor who entered the profession and the National Health Service from the German system and with a non-standard background are considered. We then discuss how those involved in leadership education can use diversity as a developmental tool. The article starts and ends with personal reflections and observations from a Consultant Opthalmologist, interposed with insights from the pedagogy of leadership development by a University academic. CONCLUSIONS: We conclude that medical leadership development can be enriched through recognising the value that non-traditional routes in clinical leadership can bring, and that educators can use the leverage of difference and diversity to create positive loops of development activity.