The role of physician apprenticeship models in the cost of caring: an AI-assisted systematic scoping review.

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.