The role of physician apprenticeship models in the cost of caring: an AI-assisted systematic scoping review
- 1Duke-NUS Medical School
- 2Division of Supportive and Palliative Care, National Cancer Centre Singapore
- 3Division of Cancer Education, National Cancer Centre Singapore
Abstract
Background Emotionally and psychologically demanding specialties place physicians at heightened risk of compassion fatigue, moral distress, vicarious trauma, secondary traumatic stress and burnout. Collectively, this cost of caring can impede professional identity formation, the developmental process through which individuals learn to think, act, and feel as physicians. Apprenticeship models, characterized by longitudinal mentored relationships, progressive entrustment, and guided socialization into communities of professional practice, offer a theoretically promising approach to addressing these burdens. However, systematic evidence on how apprenticeship models influence physicians experiencing the cost of caring remains limited. This systematic scoping review synthesizes evidence on apprenticeship characteristics, reported burdens and observed outcomes. Methods This review was guided by the modified Systematic Evidence-Based Approach, which integrates artificial intelligence (AI) tools to supplement manual searching and analysis. Literature searches were conducted for publications between January 1, 2000 and December 30, 2025 on PubMed, Embase, ERIC, Scopus and Google Scholar databases, supplemented by Elicit AI. Of 7,334 abstracts identified, 481 full-text articles were reviewed, and 99 met the inclusion criteria. Human-led thematic and directed content analyses were performed to synthesize themes, with findings triangulated against outputs from ChatGPT 5 Pro. Results Five themes were identified: socialization of apprentices, situated learning, critical reflection, impact on supervisors, and limitations of apprenticeship. Across included studies, apprenticeship features, including mentor-facilitated discussion of moral challenges, structured reflective practice, and sustained supervisory relationships, were associated with reduced moral distress, lower burnout, and preserved empathy. Applying Krishna and Alsuwaigh’s Ring Theory of Personhood and Krishna’s Internal Compass frameworks suggest that apprenticeship, when functioning well, may support physicians across multiple dimensions of personhood simultaneously, offering a developmental architecture that symptom-specific interventions do not reliably provide. Conclusion Direct empirical evidence linking specific apprenticeship mechanisms to cost of caring outcomes remains limited, and the connections proposed in this review are largely theory-informed. The synthesis presented offers a theoretical foundation for intervention design and future empirical research. Future studies should employ longitudinal designs to examine whether strengthening the Internal Compass through apprenticeship features produces reductions in the cost of caring, with attention to cross-cultural applicability and the sustainability of the supervisory role. Trial registration 10.17605/OSF.IO/GHTA6
Related
- Understanding the cost of caring in medicine through personhood: A systematic scoping review of compassion fatigue, vicarious trauma and secondary traumatic stress
- Caring for the Caregivers: A Narrative Review of Physician Health Protection Across High-Income Countries and Lessons for Low- and Middle-Income Countries.
- A protocol for a scoping review of language and cultural considerations when screening, assessing, and caring for people living with dementia or mild cognitive impairment from minoritised ethnic groups
- Canine-Assisted Interventions and Symptoms Associated with Borderline Personality Disorder: A Scoping Review
- Laser-assisted remineralization of dental hard tissues: A scoping review.
BibTeX
@article{goh2026role,
title = {{The role of physician apprenticeship models in the cost of caring: an AI-assisted systematic scoping review}},
author = {Suzanne Pei Lin Goh and Wesley Teck Wee Loo and Nur Amira Binte Abdul Hamid and Priyadarshini A and Vengadasalam Murugam and Lalit Kumar Radha Krishna},
journal = {BMC Medical Education},
year = {2026},
month = jul,
doi = {10.1186/s12909-026-09932-y},
url = {https://doi.org/10.1186/s12909-026-09932-y},
note = {CC BY},
}
RIS
TY - JOUR
TI - The role of physician apprenticeship models in the cost of caring: an AI-assisted systematic scoping review
AU - Suzanne Pei Lin Goh
AU - Wesley Teck Wee Loo
AU - Nur Amira Binte Abdul Hamid
AU - Priyadarshini A
AU - Vengadasalam Murugam
AU - Lalit Kumar Radha Krishna
PY - 2026
DA - 2026/07/01
JO - BMC Medical Education
DO - 10.1186/s12909-026-09932-y
UR - https://doi.org/10.1186/s12909-026-09932-y
AB - Background Emotionally and psychologically demanding specialties place physicians at heightened risk of compassion fatigue, moral distress, vicarious trauma, secondary traumatic stress and burnout. Collectively, this cost of caring can impede professional identity formation, the developmental process through which individuals learn to think, act, and feel as physicians. Apprenticeship models, characterized by longitudinal mentored relationships, progressive entrustment, and guided socialization into communities of professional practice, offer a theoretically promising approach to addressing these burdens. However, systematic evidence on how apprenticeship models influence physicians experiencing the cost of caring remains limited. This systematic scoping review synthesizes evidence on apprenticeship characteristics, reported burdens and observed outcomes. Methods This review was guided by the modified Systematic Evidence-Based Approach, which integrates artificial intelligence (AI) tools to supplement manual searching and analysis. Literature searches were conducted for publications between January 1, 2000 and December 30, 2025 on PubMed, Embase, ERIC, Scopus and Google Scholar databases, supplemented by Elicit AI. Of 7,334 abstracts identified, 481 full-text articles were reviewed, and 99 met the inclusion criteria. Human-led thematic and directed content analyses were performed to synthesize themes, with findings triangulated against outputs from ChatGPT 5 Pro. Results Five themes were identified: socialization of apprentices, situated learning, critical reflection, impact on supervisors, and limitations of apprenticeship. Across included studies, apprenticeship features, including mentor-facilitated discussion of moral challenges, structured reflective practice, and sustained supervisory relationships, were associated with reduced moral distress, lower burnout, and preserved empathy. Applying Krishna and Alsuwaigh’s Ring Theory of Personhood and Krishna’s Internal Compass frameworks suggest that apprenticeship, when functioning well, may support physicians across multiple dimensions of personhood simultaneously, offering a developmental architecture that symptom-specific interventions do not reliably provide. Conclusion Direct empirical evidence linking specific apprenticeship mechanisms to cost of caring outcomes remains limited, and the connections proposed in this review are largely theory-informed. The synthesis presented offers a theoretical foundation for intervention design and future empirical research. Future studies should employ longitudinal designs to examine whether strengthening the Internal Compass through apprenticeship features produces reductions in the cost of caring, with attention to cross-cultural applicability and the sustainability of the supervisory role. Trial registration 10.17605/OSF.IO/GHTA6
SN - 1472-6920
ER -