Validity in the Next Era of Assessment: Consequences, Social Impact, and Equity.

Validity has long held a venerated place in education, leading some authors to refer to it as the "sine qua non" or "cardinal virtue" of assessment. And yet, validity has not held a fixed meaning; rather it has shifted in its definition and scope over time. In this Eye Opener, the authors explore if and how current conceptualizations of validity fit a next era of assessment that prioritizes patient care and learner equity. They posit that health profession education's conceptualization of validity will change in three related but distinct ways. First, consequences of assessment decisions will play a central role in validity arguments. Second, validity evidence regarding impacts of assessment on patients and society will be prioritized. Third, equity will be seen as part of validity rather than an unrelated concept. The authors argue that health professions education has the agency to change its ideology around validity, and to align with values that predominate the next era of assessment such as high-quality care and equity for learners and patients.

Twelve tips for strengthening global equity in health professions education publication.

Despite recent calls to engage in scholarship with attention to anti-racism, equity, and social justice at a global level in Health Professions Education (HPE), the field has made few significant advances in incorporating the views of the so-called "Other" in understanding the nature, origin, and scope of knowledge as well as the epistemic justification of knowledge production. Editors, authors, and reviewers must take responsibility for questioning existing systems and structures, specifically about how they diffuse the knowledge of a few and silence the knowledge of many. This article presents 12 recommendations proposed by The Global South Counterspace Authors Collective (GSCAC), a group of HPE professionals, representing countries in the Global South, to help the Global North enact practical changes to become more inclusive and engage in authentic and representative work in HPE publishing. This list is not all-encompassing but a first step to begin rectifying non-inclusive structures in our field.

Risk factors and strategies for relapse prevention among individuals living with serious mental illness in South Africa: Qualitative inquiry from patients' and caregivers' perspectives.

INTRODUCTION: Relapse among individuals with serious mental illnesses in resource-limited contexts, including South Africa, is a significant concern. To date, the risks for relapse among this population is well documented, but little is known about prevention strategies to reduce its occurrence in these resource-limited settings. Therefore, this qualitative study explores the risk factors and strategies for relapse prevention from the patients' and caregivers' perspectives. METHODS: We conducted audio-recorded face-to-face in-depth interviews to capture the lived experience of relapse of inpatient study participants with serious mental illness (N = 24) at a public specialized psychiatry hospital in South Africa and their caregivers (N = 6). We conducted an inductive thematic analysis with two pre-specified themes (risk factors for relapse and strategies for prevention), with the codes devised from the data. RESULTS: Six sub-themes were identified from the analysis within the two pre-specified themes(Risk factors and strategies for relapse prevention): personal-related, family-related, and health system-related risk factors and strategies for preventing relapse, respectively. To highlight some essential findings, the importance of motivation for drug adherence, family involvement, and availability of anti-psychotic drugs in public health care were noted. More importantly, this study identified important cultural complexities where traditional healers play a significant role in some cultural understanding and treatment of mental illness, affecting medication adherence. CONCLUSION: This study calls for people-centered mental health care delivery in a public health system that listens to the voice of concern, including cultural challenges, and implements meaningful support that matters most to the patient and their family/caregivers.

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.

Shapeshifters: Global South scholars and their tensions in border-crossing to Global North journals.

INTRODUCTION: Global South researchers struggle to publish in Global North journals, including journals dedicated to research on health professions education (HPE). As a consequence, Western perspectives and values dominate the international academic landscape of HPE. This study sought to understand Global South researchers' motivations and experiences of publishing in Global North journals. METHODS: This study used a hermeneutic phenomenological perspective. Unstructured interviews were conducted with 11 authors from 6 Global South countries. Interview transcripts were analysed through a process of familiarisation, identifying significant statements, formulating meanings, clustering themes, developing exhaustive descriptions, producing a fundamental structure and seeking verification. RESULTS: Participants described being motivated by local institutional expectations, to improve reputation, to meet Global North perceptions of quality and to draw attention to their Global South context. Participants described experiences where their work was deemed irrelevant to Global North audiences, they were unable to interpret rejections and had learnt to play the publishing game by attending to both local and global imperatives. These motivations and experiences revealed several practical, academic and transformational tensions that Global South authors faced. CONCLUSION: The tensions and negotiations encountered by Global South authors who publish in HPE journals reflect a 'border consciousness' whereby authors must shift consciousness, or become 'shapeshifters', inhabiting two or more worlds as they cross borders between the Global South and Global North conventions. There is an added burden and risk in performing this shapeshifting, as Global South authors stand astride the borders of two worlds without belonging fully to either.

Decolonial framework for applying reflexivity and positionality in global health research.

Contemporary research practices link to colonial and imperialist knowledge creation and production and may promote harmful perspectives on marginalized and oppressed groups. We present a framework for a decolonial approach to research in global health and health promotion applicable across research settings. This framework is aimed at anticipating and alleviating potentially harmful practices inherent in dominant research methods. The framework focuses from a macro- and micro-level perspective on three critical dyads: 'context' and 'accountability'; 'researcher identity' and 'positionality'; and 'procedural ethics' and 'ethics in practice' considerations. We present guidance for how to consider reflexivity and positionality as they apply in this framework in global health and health promotion research practice.

The Lancet and colonialism: past, present, and future.

The historical and contemporary alignment of medical and health journals with colonial practices needs elucidation. Colonialism, which sought to exploit colonised people and places, was justified by the prejudice that colonised people's ways of knowing and being are inferior to those of the colonisers. Institutions for knowledge production and dissemination, including academic journals, were therefore central to sustaining colonialism and its legacies today. This invited Viewpoint focuses on The Lancet, following its 200th anniversary, and is especially important given the extent of The Lancet's global influence. We illuminate links between The Lancet and colonialism, with examples from the past and present, showing how the journal legitimised and continues to promote specific types of knowers, knowledge, perspectives, and interpretations in health and medicine. The Lancet's role in colonialism is not unique; other institutions and publications across the British empire cooperated with empire-building through colonisation. We therefore propose investigations and raise questions to encourage broader contestation on the practices, audience, positionality, and ownership of journals claiming leadership in global knowledge production.

Transforming global health professions education for sustainability.

BACKGROUND: Health professions education (HPE) must keep pace with rapid shifts in learning and societal contexts, control of resources, knowledge and environmental concerns. Sustainability is increasingly seen as complex, balancing the three pillars of economy, society and the environment and addressing the current generation's needs without compromising future generations' needs. We aim to orient three-pillar sustainability in (HPE) from a decolonial global perspective. CONFERENCES AS TRUTH-REGIMES: Future-proofing imperatives compel HPE to respond to sustainability calls in contexts of globalisation and internationalisation. International conferences are sites of power in knowledge production and dissemination because themes and invited speakers determine who experts in the field are and what knowledge is important. Scholarly communities, dominating the discourse, determine the nature of reality or 'truth' (ontology), theoretical foundations of that reality and approaches to knowing (epistemology). Using one international conference as a case study, we found few scholarly presentations on sustainability, especially economic disparities. Discourse in HPE is still dominated by Global North 'experts'. IMPLICATIONS: Conferences are important discursive spaces for knowledge production and exchange. Increasing attention to social justice and planetary health must include a global perspective on three-pillar sustainability. Historical and contemporary perspectives about disparities on health should exceed Eurocentric epistemologies alone. These are areas ripe for innovative research in HPE. Promisingly, there is increasing attention to curricula around health equity, disparities and clinical rotations in rural and underserved communities among educational institutions around the world. CONCLUSIONS: Future-proofing HPE requires addressing three sustainability pillars simultaneously. Conferences as influential knowledge production spaces are mostly characterised by Global North to South flow of knowledge. Global North-dominated discourse fails to reflect on the impact of historical disparities including colonialism that thwart equivalence. Transforming HPE can occur through a sustainability perspective that advances three-pillar global approaches for inclusive global legitimacy in HPE narratives and standards.

Reconsidering a Global Agency for Medical Education: Back to the Drawing Board?

Issue: The World Federation for Medical Education (WFME) was established in 1972 and in the five decades that followed, has been the de facto global agency for medical education. Despite this apparently formidable remit, it has received little analysis in the academic literature. Evidence: In this article, we examine the historical context at the time WFME was established and summarize the key decisions it has taken in its history to date, highlighting particularly how it has adopted positions and programmes that have seemingly given precedence to the values and priorities of countries in the Global North. In doing so, we challenge the inevitability of the path that it has taken and consider other possible avenues that such a global agency in medical education could have taken, including to advocate for, and to develop policies that would support countries in the Global South. Implications: This article proposes a more democratic and equitable means by which a global organization for medical education might choose its priority areas, and a more inclusive method by which it could engage the medical education community worldwide. It concludes by hypothesizing about the future of global representation and priority-setting, and outlines a series of principles that could form the basis for a reimagined agency that would have the potential to become a force for empowerment and global justice in medical education.

How should we do equity, diversity and inclusion work in health professions education?

This is an editorial for the special collection on equity, diversity and inclusion (EDI) for MedEdPublish. In this article, the guest advisors of this collection first reflect on the paradoxes in EDI in health professions education (HPE), then on the importance of recognising the existence of multiple authenticities on the basis of different contexts and settings, and finally encourage authors and readers to reflect on their position on the continuum of EDI work. They conclude the editorial by outlining the direction they wish to set for articles in the collection.

The personal is political in the struggle for equity in global medical education research and scholarship.

Medical education research is rooted in a long tradition of objectivity, evidence-based methods, and clinical surety. However, the inexorable confidence, health professions research education, and scholarship have in the manifest supremacy of western science as the foundational epistemology is questionable. Is this bravado legitimate and if so by what authority? How does this dominance of western epistemic frames determine how we are seen and how we see ourselves as health professions educators scholars and researchers? In what ways does western epistemic dominance influence how and why we conduct research? What do we consider as important to research in health professions education (HPE)? The answers are different depending on where we position ourselves or are placed in a hierarchy of scholarly privilege. I pose that the supremacy of Western scientific epistemology in modern medical education, research, and practice blurs differently colored scientific lenses and silences marginalized voices from legitimate contribution to HPE.

Developing and testing unconditional cash transfer strategies among young adults with first-episode psychosis in South Africa: a study protocol for a pilot randomised control trial (PRS-FEP trial).

INTRODUCTION: Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse. METHODS AND ANALYSIS: This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively. ETHICS AND DISSEMINATION: The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement. TRIAL REGISTRATION NUMBER: DOH-27-092022-5894.

Modern Medicine Is a Colonial Artifact: Introducing Decoloniality to Medical Education Research.

Modern medicine is an artifact of colonialism because the science that underpins modern medicine emerged from Western knowledge structures based on a history of colonialism. The author suggests the colonial roots of Western-based modern medicine must be reexamined. While there are various critical theories that may be applied in this reexamination, most do not adequately account for intersectional, intergenerational, and sociohistorical inequities encountered in the multiplicity of global contexts in practice teaching and research within medicine. The author presents decoloniality as a theoretical perspective from which to interrogate sociohistorical, geopolitical, and economic perspectives on gender, race, and heteropaternalistic influences in medicine emanating from a basis in colonially developed systems of knowledge production. The author offers definitions of relevant theoretical terms and suggests that decolonial praxis begins with an initial realization or awareness of one's position within the colonial matrix of power followed by the reflecting or deliberation, or a grappling with real-life struggles that are encountered in confronting the oppressive operations of the colonial matrix of power. Decolonial praxis involves action through challenging mainstream foundational theories-the questions they generate, the research methods they support, and the writing styles they employ. In medical education, this may involve changing powerful actors, such as medical journal editors and researchers, with historical privilege; shifting the balance of power in research spaces; and dismantling physical and intellectual structures and institutions established on colonial epistemologies.