ArticlePerspectives on medical education2026
How Time, Narrative, and Discomfort Shape Learning: A Realist Evaluation of Behavioral Science Education for Medical Students.
Article in Perspectives on medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Medical students are increasingly expected to navigate uncertainty, emotional complexity, and value conflicts, yet little is known about how behavioral science education fostered these capacities. This study aimed to identify the mechanisms through which a third-year behavioral science course influenced students' cognitive, emotional, and relational development. Methods: We conducted a realist evaluation of a course that integrated structured (Cognitive Behavioral Therapy; CBT)-based reflection, narrative immersion using complex clinical cases, and conceptual framing from the humanities and social sciences. Slow Education served as a sensitizing concept in developing initial program theories. Data were drawn from written reflections, group discussions, classroom observations, and field notes from two cohorts of students (N = 210). Abductive and retroductive coding strategies were used to refine context-mechanism-outcome (CMO) configurations. Results: We identified five learning mechanisms: (1) emotional articulation that enabled readiness for deeper engagement; (2) narrative destabilization of biomedical certainty; (3) positional reframing supported by structured questioning; (4) epistemic disruption that fostered tolerance for ambiguity; and (5) conceptual reframing that legitimized discomfort and supported meaning-making. These mechanisms operated sequentially, forming a cumulative learning pathway. A certainty-seeking response functioned as a competing mechanism for some students, leaving intended mechanisms unactivated under particular contextual conditions. Discussion: The findings demonstrated how behavioral science education activated interconnected mechanisms that supported students' development of reflective capacity, perspective-taking, and tolerance for ambiguity. The resulting middle-range explanation clarifies why structured emotional work, narrative complexity, guided questioning, and conceptual scaffolding enabled deeper engagement with the psychosocial dimensions of clinical practice.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.