Bioecological Theory of Human Development and Medical Education: Scoping Review.
Abstract
Introduction: Postgraduate medical education is a critical stage for consolidating clinical professionalism, specialized competencies, and professional identity. The clinical environment—including mentors, regulations, and institutional culture—influences resident development. Bronfenbrenner's Bioecological Theory of Human Development (BETHD), and its operationalization in the Process-Person-Context-Time (PPCT) model, offers a framework for understanding how multiple contextual levels interact and influence the training experience. Objective: To map studies that apply BETHD in postgraduate medical education, identify levels of analysis, describe methodologies and key findings, and identify research gaps. Method: A scoping review was conducted following the guidelines of Arksey and O'Malley, Levac, and PRISMA-ScR. Studies were searched in PubMed, Scopus, Web of Science, BVS Salud, and Epistemonikos (2015–2025), in English and Spanish, limited to peer-reviewed, full-text publications. Theoretical and empirical studies that explicitly applied the PPCT model to postgraduate medical education were included. Results: Six relevant studies were identified. These range from conceptual frameworks (Ellaway, Gruppen) to qualitative research (Nolan, Jones, Kelly) and institutional interventions (Zwemer). The most explored bioecological levels were micro, meso, and macro, while the chronosystem appears in studies on curricular and contextual changes. The findings show that factors such as mentor relationships, inclusion, organizational culture, and policies influence residents' learning and well-being in a multiscalar manner. Conclusion: The PPCT constitutes a robust and versatile framework for analyzing postgraduate medical education, allowing us to understand learning as a complex and contextual phenomenon. However, its empirical use is still limited, underscoring the need to expand research that integrates this approach into the design of health education policies and programs.
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