Medicine is often viewed as a branch of sociology or social science. Scholars advocating for a social perspective on medicine have pointed to the insufficient emphasis on society or community engagement within medical education as a contributing factor to contemporary challenges in healthcare quality, health policy, and population health [21].

According to social constructivists, society is what sets humans apart from animals. As humans grow up, they assimilate the distinctive cognitive frameworks and behavioral patterns of their respective societies or communities [22]. Interactions with the community and its members are how an individual grows and develops. An individual’s interpretation of their society shapes social reality, while the collective understanding among community members establishes norms, identities, and institutions [23]. To participate in social life as a group member, one must internalize the culture—a historical construct—and live in accordance with the culture’s inherent values and behavioral expectations [23]. Society, in turn, is shaped by the traits of individuals that are forged within sociocultural relationships, leading to changes within the group. The cultural evolution of a society can be categorized into the social phase, which involves interaction with other members, and the internal psychological phase, which pertains to the individual [24].

Vygotsky’s theory of developmental psychology explains individual development in psychodynamic terms. While his research primarily addresses child development, the principles he outlines are equally applicable to the psychodynamic processes of adult learners in medical education. According to Vygotsky, learning is the internalization of cognitive development and functioning, facilitated by social interaction. Learners assess their societal roles, react to continuous social demands, and reframe their understanding and experiences. The active interpretation and re-interpretation inherent in this process culminate in learning [24].

According to Vygotsky [25], good learning is that which precedes development. The concept of the zone of proximal development describes how knowledge is constructed through the learning process and social participation [25]. This zone represents the gap between the actual and potential levels of development. The actual level of development is the stage at which the learner can solve problems independently, without assistance from others. In contrast, the potential developmental level indicates what the learner is capable of achieving with expert help.

Learners who begin as novices are progressively assigned a broader spectrum of tasks and responsibilities within the framework of continuous dialogue and interaction in social relationships [2,7]. The relationship between the novice and the expert begins with an unbalanced power dynamic. However, as the learner engages and evolves, their identity transforms, leading to the establishment of a new power structure [2]. The expert teaching methods used in this process include role modeling, feedback, questioning, teaching method, and cognitive structuring.

The concept of Vygotsky’s learning process was introduced by researchers aiming to pinpoint the key components of individualized instruction and was later refined to include the notion of scaffolding [26]. Scaffolding represents a type of social interaction between learners and instructors that facilitates the internalization of knowledge or skills. Instructor scaffolding serves as a mechanism to diminish the uncertainty inherent in the learning process, thereby broadening the potential for growth. Those who assist learners can be peers or experts in the subject matter. Rather than directly transferring knowledge, they function as guides or advisors.

The representative learning models that embody the theory of social constructivism in medical education are experiential learning and situational learning. The concept of experiential learning was formulated by integrating the social aspect of learning, as advocated by Vygotsky, into Piaget’s theory of experiential learning [5,6]. According to Kolb, who first developed the framework of experiential learning theory, learning is the process of creating knowledge through the transformation of experience [27]. In Kolb’s experiential learning theoretical framework, “experiential” or “informal” learning refers to new experiences that learners encounter in the work environment, often in an ambiguous and unstructured way. Through reflective observation of concrete experiences, learners form abstract conceptualizations of their learning. This conceptualized knowledge then advances to the stage of learning through active experimentation and application in real-life situations [28]. Experiential learning views the work environment as a learning space and translates experiences into learning with the guidance of a facilitator. This aligns with the core epistemology of knowledge acquisition in social constructivism, which emphasizes society, social interactions, and facilitation by instructors [27].

Situated learning posits that learning and development occur within a sociocultural context, transforming the learner through active participation in community activities. Initially, learners engage at the community’s periphery, interacting with and gradually integrating into the group, eventually taking on more central roles [28]. The cornerstone of situated learning is social interaction [7]. While the application of situated learning varies with context, in medical education, it effectively describes how novices evolve into competent practitioners. Novices are taught to recognize what to observe, understand how to interpret their observations, and learn how to communicate with colleagues and medical service providers within a community or social system that facilitates learning [7]. Consequently, the instructional design of situated learning focuses on creating the right context, scaffolding tasks between novices and experts, providing instructor coaching, and fostering learner interaction within the learning environment [7].

The following is an example of social constructivism applied to a physiology class. Teams are organized with consideration for the diverse backgrounds of learners. Authentic learning tasks are established, and student assessments are designed to reflect the dynamic interaction between the instructor and learners, as well as the progression of the learning experience [29].

Students form teams of five to six members. Each team is thoughtfully composed, considering various factors such as the students’ levels of experience, gender, age, and social backgrounds. As they study physiology, each team reflects on their own physiological processes—how biological principles manifest in their daily lives—and identifies three challenges they wish to prioritize during the course. Outside of regular class hours, student groups convene to define their roles. Instructors establish critical milestones to oversee the teams’ progress on their projects, offering feedback on the students’ objectives, experimental designs, and data interpretation. The groups carry out their experiments and are assessed based on their collaborative report writing and group presentations. The final product will include an analysis of the experimental design process, the implementation of the plan, the physiological interpretation of the results, and the limitations of the design. Approximately 10% of the final grade is allocated to self-assessment and peer assessment, evaluating teamwork, professionalism, and teammate feedback.

The preceding example illustrates how the core concepts of social constructivism can be adapted for classroom use. While the specific implementation may differ based on the objectives, subject matter, and audience of the educational program, this example offers practical insights into incorporating the fundamental principles of social constructivism into instructional design. Notably, the practice of reflecting on physiology (biological principles) plays a crucial role in facilitating development and learning through instructor-led intervention, or scaffolding, within each learner's zone of proximal development.

The application of a social constructionist perspective as a teaching and learning principle in medical education carries several important implications. First, it emphasizes social and cultural learning experiences. The aim of social constructivist learning is to facilitate an individual’s social integration and fit. Knowledge is not simply discovered; it is actively created within the social and cultural context to which one belongs. In medical education, the knowledge that learners construct is shaped by the situational, social, and cultural factors of medicine and healthcare. Therefore, it is essential to provide realistic, contextual, and field-based learning experiences that learners are likely to encounter or perform in practice [3,7,27]. Second, scaffolding is established within the zone of proximal development. Assistance tailored to the individual learner's zone of proximal development is meaningful. Even within the same environment, students have varying levels and backgrounds and can reach different levels of achievement with support. Moreover, the construction of learners’ knowledge is heavily influenced by their pre-existing knowledge systems [30]. Effective teaching interventions ensure that the level of achievement with assistance surpasses what learners could achieve on their own. Here, the instructor’s adaptive scaffolding for each learner aids in the internalization of knowledge or skills through social interactions between the learner and the instructor. Third, continuous interaction is crucial. Social interaction is the most significant factor in constructing learners’ understanding and meaning [30]. It provides opportunities to engage with learning experiences and is a means to construct one’s own knowledge by internalizing these experiences. In medical education, learners adopt the cultural behaviors of the existing community through sociocultural interaction and internalize their experiences by reflecting on them through interactions with experts or peers within the same community. Lastly, there is the growth of expertise. The zone of proximal development is not static; it is a dynamic area that evolves through continuous experience and reflection. In medical education, novices develop expertise by receiving guidance from experts within the zone of proximal development through legitimate peripheral participation [7]. Over time, learners who start as novices can evolve into responsible medical professionals capable of achieving expertise independently, without the need for expert assistance.

One aspect of social constructivism theory that is particularly relevant to medical education is the sociocultural assimilation of individuals within a community. As individuals engage in dialogue with their peers, they exchange ideas and thoughts within a specific context [2,3]. In such scenarios, diverse structures of understanding may be assimilated, or cultural reproduction may occur through processes of shared participation and negotiation with others. During these interactions, the learner assumes the role of an interpreter of new information and becomes an “active co-constructor of meaning.”

Educational interest encompasses what learners encounter and assimilate upon joining the community. It pertains to the social and cultural elements within the medical community that learners are implicitly taught—or not taught—through a hidden curriculum, an unstructured and unintended educational layer [31]. Doja et al. [32] conducted interviews with members of the medical community and uncovered that students are being subtly indoctrinated with (1) the “privileges of experts in certain fields,” (2) the “reinforcement of hierarchy within the medical community,” and (3) a “culture of mutual tolerance for non-specialized content” as part of this hidden curriculum. Bryden et al. [33] observed that medical school faculty members recognized a discrepancy between their intended educational professionalism and their actual interactions with students, leading to feelings of inadequacy and failure in their inability to act as effective role models. Furthermore, studies have explored the perception and experience of unprofessional behaviors by healthcare providers or students—behaviors to which students are primarily exposed during clinical practice [34-36]. Research has also investigated the failure and fear of reporting medical errors [37], and educational approaches to address these issues through challenging their internalization [33,38,39].

Social constructivism deals with the nature of reality and how we come to know it [1]. It is characterized as a theoretical framework, meta-theory, or social theory. Within medical education, it emphasizes the interpretation of meanings that are created and shared in social and cultural contexts, as well as the experiences of individuals within the social structures upheld by these meanings [40]. Rees et al. [1] categorize the application of social constructivism theory in medical research into two categories: micro-constructivism and macro-constructivism. Micro-constructivism examines the everyday conversations that occur during social interactions, whereas macro-constructivism investigates the generative power of language in shaping social structures, relationships, and the influence of educational institutions. Rees et al. [11] explored the dynamics of power in the student-patient-doctor relationship by analyzing video or audio recordings of interactions at the bedside during clinical training in a hospital. They focused on the social processes at play. Another study analyzed the structure of everyday conversations by examining reflective conversations among a group of medical students [12]. The findings indicated that despite individual differences, all participants consistently engaged in activities such as identifying meaningful events, discussing reasons for sharing, addressing learning issues, and participating in learning. Research on discourse within the social organization of medical schools includes an investigation into the identity formation of Canadian medical students with disabilities. Stergiopoulos et al. [41] analyzed data from student interviews, institutional documents, and student blogs at cultural, social, and relational levels. Their research aimed to understand how medical students with disabilities construct their identities. They uncovered potential curricular content and examined how students defined the concepts of a “good student” and a “good patient,” as well as the idea of wellness within the context of developing an identity that encompasses “my disability” and becoming “professionals who must objectify disability.”

One of the key principles in social constructivism is the evolution of the learner’s role within the zone of proximal development. Initially, learners take a passive role, following the guidance of a mentor. However, they transition to an active role as they engage in problem-solving. Through this process, they not only rely on their newly acquired knowledge but also develop cognitive strategies for transferring this knowledge. They learn new concepts and apply them to novel situations. In the realm of professional development in medicine, this shift in the learner’s role is often equated with professional growth. Medical education views the learner as both a social and institutional entity, evolving from a peripheral participant to a core member of the medical community [42]. A transformation of identity from novice to expert is expected as students continue to participate in the community and broaden their participation through the experience of solving tasks in real-world situations with an expert instructor [43]. Hansen et al. [44] applied the social constructivist framework to explore the process of identity transformation among family medicine physicians. By comparing three cohorts—before, during, and after family medicine residency training—over approximately 12 years, they documented the broadening of expertise. This progression saw family physicians move from being under the tutelage of supervising physicians to treating patients independently, and eventually to conducting research in family medicine. The study highlighted that the experiences of the learner and the influence of role models are pivotal in shaping the identity of a specialist physician.

Another debate related to professional identity formation revolves around the conflict between the diversity of physician identities and the standardization that medical education promotes. According to Frost and Regehr [14], diversity in identity formation involves individualization, difference, and multiple possibilities, suggesting that heterogeneity is beneficial to medical education and patients. In contrast, the argument for standardization centers on uniformity, similarity, and restricting possibilities to establish a single way of being a competent and professional physician. The authors propose leveraging the conflicting and contentious contexts of these discourses to shape the professional identity of medical students.

Learners in medical education often identify learning challenges when they encounter unfamiliar rules or contexts. In such instances, the instructor’s role is to facilitate the learning process as a guide, rather than merely transmitting knowledge [30].

The concept of social constructivism’s zone of proximal development and scaffolding in learning situations is more akin to a metaphorical expression of phenomena than concrete teaching and learning methods. Since metaphorical expressions do not constitute explicit tools or methods in themselves, it is challenging to standardize their application in experimental or practical contexts. Consequently, much of the research on the development and effectiveness of teaching methods within medical education has been confined to the creation of web-based support tools. These tools include features such as instructor advice or pre-set “help” options for learners who encounter difficulties in digital learning environments [45-47]. In the field of medicine, these concepts have primarily been applied to the learning process that leads to a medical diagnosis. The scaffolding methods identified include visual or conceptual hinting [46], the presentation of representative cases [48], and cognitive activation through questioning [49]. Mixed results have been reported for the effectiveness of the training, with some studies showing that providing appropriate representations of the diagnostic process through medical reasoning increased the efficiency of subsequent diagnoses [48] and others showing no significant difference in the virtual environment compared to other comparison groups [47].