Productive struggle in medical education: what, why, and how?

Productive struggle may be conceptualized as an educational construct which incorporates mental stress and 'struggle' within ongoing instruction to develop perseverance and deepen understanding rather than focus on the solution. Medicine, which involves diagnostic uncertainty and varied clinical presentations, necessitates the development of adaptive reasoning and critical thinking-skills that can be honed by the productive struggle process. In this article, we sought to discuss the concept of productive struggle in medical education, by exploring why it is important to facilitate clinical learning and highlight practical strategies and potential pitfalls such as patient and psychological safety with this pedagogical model. We proposed three strategies to incorporate productive struggle in medical education-namely core tutoring, case-based discussions, and clinical simulations.