Time as a Teacher: Using Historical Analysis to Shape Professional Identity in Health Professions Education

Abstract

Health professions education (HPE) is undergoing rapid transformation, yet the historical foundations of healthcare remain underexplored in most educational curricula. This paper presents a conceptual and instructional innovative model designed to integrate historical inquiry into HPE, with a focus on geriatric care and rehabilitation. Grounded in transformative learning theory, the model uses historical materials as disorienting dilemmas to challenge students’ assumptions about aging, healthcare, and professional identity. Implemented within a blended learning format, the framework includes asynchronous engagement with curated historical sources, collaborative in-class analysis, and individual reflection. The pilot, launched in the Master of Science in Physiotherapy, Specialty Sports physiotherapy at Bern University of Applied Sciences, is designed to be adaptable across healthcare disciplines, including medicine, nursing, occupational therapy, and public health. The model promotes critical reflection, empathy, and ethical awareness by exposing students to the socio-cultural evolution of elderly care. It highlights how societal narratives have shaped clinical priorities, funding structures, and professional roles, insights often missing from traditional HPE. By engaging with historical voices and contexts, learners develop a deeper understanding of the contingent nature of healthcare practices and the importance of socially responsive care. Scalable and adaptable, the framework aligns with global trends in competency-based education, digital integration, and lifelong learning. It provides a replicable approach for institutions aiming to enrich curricula with historical depth and foster transformative learning. Ultimately, this model equips future health professionals to navigate complex clinical environments with contextual awareness, ethical principles, and a historically informed outlook.

Introduction

Health professions education (HPE) is undergoing rapid transformation in response to evolving healthcare systems, demographic shifts, and technological innovation. ¹ Hamdy ² has argued that medicine and the health professions should be understood as social sciences, given their deep entwinement with human behavior, societal structures, and cultural contexts. Across health disciplines, including medicine, physiotherapy, nursing, and public health, educators are rethinking curricula to better prepare learners for complex, interprofessional, and ethically demanding clinical environments.

Future educational models will build on social constructivist principles, integrating students into clinical settings from the outset and fostering collaboration between academic health systems and higher education.^3,4 Partnerships, both public and private, will drive regulated innovation in education and research. ⁵ Admissions in health education programs will prioritize adaptability and contextual awareness. ⁶ Competency-based curricula, grounded in entrustable professional activities and early research engagement, have been shown to foster scientific thinking and inquiry.^7,8

This essay proposes a model that not only aligns with these trends observed in modern higher education but also prioritizes ethical grounding and social responsiveness, equipping future professionals for the evolving realities of healthcare.

Yet, amid this shift toward competency-based education, digital integration, and lifelong learning, a critical dimension remains underexplored: the historical foundations of health professions and their educational practices. Historical inquiry offers a powerful lens through which contemporary challenges in healthcare can be better understood and addressed. ⁹ It enables learners to critically examine the origins of professional norms, the evolution of care models, and the socio-political forces that shape clinical practice. Despite its importance, history is rarely integrated into HPE curricula. This gap may foster the perception that current practices are fixed and universal, rather than contingent and culturally constructed. ¹⁰

This omission is particularly evident in areas such as geriatric care, where shifting societal attitudes toward aging have profoundly influenced healthcare delivery. Older adults were historically excluded from clinical trials, resulting in guidelines that lacked evidence-based relevance for aging populations. Funding structures often deprioritize geriatrics, reflecting societal undervaluing of aging and leading to underinvestment in elderly care services and education. Professional roles were shaped by stereotypes, with geriatrics perceived as less prestigious, discouraging students from entering the geriatric or gerontology field. These narratives continue to echo in clinical priorities and educational design, yet they are seldom critically examined in medical and health professions curricula.

By the 1970s and 1980s, the emergence of gerontology as a distinct field in healthcare began to challenge these assumptions. ¹¹ Scholars advocated for a more holistic understanding of aging, emphasizing autonomy, functional capacity, and social participation. This shift informed age-friendly healthcare models such as the World Health Organization’s (WHO's) Active Ageing framework ¹² and later the Decade of Healthy Ageing, ¹² promoted inclusive, person-centered care. Despite these advances, the historical evolution of geriatric care, including its ethical debates, policy shifts, and cultural representations, remains largely absent from medical education and HPE. Without exposure to these historical trajectories, students may enter practice with limited awareness of the contingencies underpinning current best practices, such as fall prevention, frailty management, and rehabilitation for older athletes.

Building on this conceptual foundation, the next section introduces an instructional model that responds to the identified challenges. By embedding historical analysis into teaching strategies, the model aims to foster critical reflection, strengthen professional identity, and promote societal responsive practice. In doing so, the proposed model bridges theoretical insights with practical approaches for curriculum design and implementation. This paper presents a conceptual and instructional model addressing 2 key gaps: (i) The limited integration of historical analysis in medicine and health professions curricula, particularly in geriatrics and rehabilitation, and (ii) the underexplored potential of historical inquiry to foster critical reflection, shape professional identity, and promote socially responsive practice across disciplines.

While the innovation originates within the Master of Science in Physiotherapy, specialty Sports physiotherapy at Bern University of Applied Sciences (BFH), the proposed model is designed to be adaptable and transferable to a wide range of HPE contexts. It provides a framework for integrating historical inquiry into blended learning environments, utilizing curated materials, collaborative analysis, and reflective writing for transformative learning. In doing so, it invites educators to reconsider the role of history, not as a peripheral subject, but as a catalyst for deeper understanding, ethical engagement, and curricular innovation.

Turning Insight into Action

To address the educational challenge of integrating historical awareness into HPE, particularly in the context of geriatric care and rehabilitation, we developed a theoretically grounded instructional model that translated conceptual insights into practical strategies. Rooted in transformative learning theory,^13,14 this model uses historical materials as disorienting dilemmas to prompt critical reflection and perspective shifts. These principles are operationalized through a 3-phase design that can be adapted across health professions curricula.

This model will be pilot tested in January 2026 within the Master of Science in Physiotherapy, Specialty Sports Physiotherapy program at BFH, embedded in the module entitled “Integration” (5 ECTS), which focuses on sport and rehabilitation in persons of older age. Historically, this module lacked any historical perspective, an omission addressed through this redesign.

The instructional design unfolds in 3 interconnected phases, each of which can be adapted to other HPE curricula (Figure 1):

Figure 1.

Illustration of the 3 phases model (self generated illustration).

Phase 1, preclass preparation (3 h): Students access historical materials via a digital learning platform. These materials will include early physiotherapy manuals, public health campaigns addressing aging, excerpts from interviews with older patients and early practitioners, and policy documents such as the WHO's Decade of Healthy Ageing. ¹⁵ These sources introduce disorienting dilemmas, initiating critical questioning, a key step in transformative learning. The asynchronous format promotes autonomy and accommodates diverse learning styles.

The second, in-class activity phase (1.5 h): Small groups of 3 to 4 students analyze historical sources using the following guiding questions: (i) How was aging portrayed in these materials? (ii) What assumptions shaped physiotherapy practice? (iii) How did these practices reflect or challenge societal norms?

This phase deepens transformation through dialogue and peer learning. A plenary discussion follows, linking historical attitudes to contemporary ethical responsibilities such as advocacy, dignity, and inclusion. Educators in medicine, nursing, occupational therapy, physiotherapy, and public health can adapt this format to explore historical shifts in their own fields (eg, evolution of medical ethics or public health campaigns).

Phase 3: Individual reflection (1 h). Students write a 200–300 words reflection on how their understanding of aging and healthcare has changed and how historical insights might inform their future clinical practice. This phase consolidates new frames of reference, supporting professional identity formation, a central goal of HPE.

Faculty Preparation

Educator readiness is critical for success. Faculty will receive a facilitation guide outlining historical content, discussion prompts, and strategies for managing sensitive topics such as ageism. A short training session will prepare instructors to foster critical dialogue and connect historical insights to contemporary practice.

Evaluation Plan

The educational impact of the planned pilot test will be evaluated through a mixed-methods approach: (1) Qualitative: Thematic analysis ¹⁶ of reflective texts for evidence of perspective shifts and identity formation. (2) Quantitative: Pre/post surveys on attitudes toward aging and historical awareness. (3) Student feedback: Perceived relevance and engagement.

Broader Impact and Transferability

This model offers potential benefits for global HPE. Its modular structure, comprising asynchronous engagement, collaborative analysis, and reflective synthesis, can be tailored to diverse cultural, political, and institutional contexts. ¹⁰ For example, a medical school could adapt the model to a public health ethics course by using historical case studies on vaccination policies and pandemic responses.

The model is designed for scalability and is transferable to other disciplines. Educators in other disciplines can substitute physiotherapy, specific materials with sources relevant to their fields, such as historical case studies in medicine, nursing ethics, or public health policy, while maintaining the same structure: asynchronous engagement, collaborative analysis, and reflective synthesis. This flexibility supports integration into undergraduate, postgraduate, and continuing professional development educational programs. ¹⁷

Comparable initiatives, such as narrative medicine,^18,19 history of medicine modules, and ethics curricula, have demonstrated the value of humanities-based approaches in fostering empathy and reflective practice. Our model builds on these efforts by embedding historical inquiry within competency-based frameworks, aligning with global HPE reform trends.

Potential Barriers and Mitigation Strategies

Implementing this model may encounter several challenges. First, curricular overload is a common concern in HPE. Integrating historical inquiry without displacing essential clinical content requires careful alignment with existing learning outcomes and accreditation standards. Second, limited faculty expertise in the humanities can hinder effective facilitation. To address this, we propose targeted faculty development, including short training sessions and detailed facilitation guides that provide historical context, discussion prompts, and strategies for managing sensitive topics such as ageism. Finally, institutional resistance may arise when introducing nontraditional content. Demonstrating how the model supports competency-based education and professional identity formation can help secure buy-in from curriculum committees and leadership.

Additional Benefits

Emotional engagement with historical voices, patients, practitioners, and policymakers cultivates empathy and ethical sensitivity. Combined with critical analysis, this supports the formation of a socially responsible professional identity. Digital integration and time-variable learning enhance accessibility and flexibility, aligning with trends in competency-based training, lifelong learning, and technology-enhanced education.

In summary, this model offers a replicable, adaptable framework for embedding historical inquiry into HPE. It supports transformative learning, fosters professional identity formation, and prepares students to engage critically and ethically with the evolving realities of healthcare.

What are the Potential Benefits to Wider Global Educational Institutions?

The instructional model presented in this paper offers significant potential benefits for HPE globally. By embedding historical inquiry into curricula, institutions can foster deeper critical reflection, ethical awareness, and professional identity formation outcomes that are increasingly valued in competency-based and socially responsive education systems.

Adaptability Across Context

The model's modular structure comprises asynchronous engagement with curated historical materials, collaborative in-class analysis, and reflective writing that can be tailored to diverse cultural, institutional, and disciplinary contexts. Medical schools, nursing programs, and allied health faculties can substitute physiotherapy-specific content with historical sources relevant to their own fields, such as the evolution of medical ethics,^20,21 public health campaigns, ²² or nursing roles in wartime care. ²³ For example, a medical school could adapt the model to a public health ethics course by using historical case studies on vaccination policies and pandemic responses.

Interprofessional and Interdisciplinary Learning

Historical inquiry naturally invites exploration of intersections between medicine, society, policy, and ethics. This supports the development of learners who are not only clinically competent but also socially attuned and capable of navigating complex healthcare environments.

Digital Integration and Global Equity

The integration of digital platforms and flexible learning formats enhances accessibility and scalability. Institutions in low-resource settings or those with geographically dispersed learners can implement the model without major infrastructural investment. ²⁴ The use of open-access historical materials and global policy documents (eg, WHO frameworks) further strengthens applicability in resource-constrained contexts.

Alignment With Global Trends

The model aligns with global HPE priorities, including transformative learning, lifelong education, and global citizenship. By encouraging students to critically examine the historical roots of healthcare practices, institutions can cultivate professionals equipped to address contemporary challenges with humility, empathy, and contextual awareness.

Acknowledging Barriers

Challenges such as curricular overload, limited faculty expertise in humanities, and institutional resistance remain. These barriers can be mitigated through alignment with existing learning outcomes, structured faculty development programs, and clear demonstration of how the model supports accreditation standards.

Cultural and Historical Adaptations

While the model is designed for global applicability, implementing it across diverse cultural and historical contexts may require thoughtful adaptation.^25,26 Historical narratives, ethical frameworks, and societal attitudes toward aging vary significantly between regions. For example, concepts of autonomy and family roles in elder care differ across collectivist and individualist cultures, which may influence how historical materials are interpreted. Educators should therefore select sources that resonate with local histories and values while maintaining the model's core principles of critical reflection and dialogue. Additionally, sensitivity to cultural norms is essential when discussing topics such as ageism, gender roles, or wartime care. Providing optional regional case studies and encouraging comparative analysis can enhance relevance and foster global citizenship without imposing a single cultural lens. ²⁷

Conclusions

This instructional model integrates historical inquiry into HPE to foster transformative learning and professional identity formation. Grounded in social constructivism and transformative learning theories, it uses historical materials as catalysts for critical reflection on aging, healthcare, and professional roles. Delivered through a blended format, students engage asynchronously with curated sources, collaborate in class to analyze societal narratives, and reflect individually on their evolving perspectives. Adaptable across healthcare disciplines and contexts, the model promotes empathy, ethical awareness, and contextual understanding while aligning with global trends in competency-based education, digital learning, and lifelong development.