My research interests are shaped by resistance to a culture of complacency, oppression, objectification, and dehumanization - in everyday practices. Through my research, I aim to reduce inequities that are sustained by colonized attitudes and processes. I apply my expert knowledge of theories of cognition, behaviour, and measurement to advance a view of clinical practice and learning as dynamic, context-dependent, and fundamentally shaped by human judgment, social interaction, and the values embedded within our institutions.
Resistance, in this sense, is not just critique; it is intervention — a commitment to evidence-informed change that confronts attitudes and structures that enable exclusion while claiming fairness.
I have challenged the assumption that more simulation, higher fidelity, or more resource-intensive design inherently leads to better learning.
I have contributed to research demonstrating the benefits of aligning purpose and objectives with education design. The allocation and optimization of human and technical resources cannot be separated from educational intent. A systems driven focus on efficiency and effectiveness limits our ability to engage with skilled educators who can implement value-driven education design. In our current system, we must constantly decide if we are to reinforce or resist harmful norms and profit based education design.
Monteiro, Sandra; Sibbald, Matthew. Choosing Wisely - Clinician Educators' Guide to High-Value Simulation-Based Education. Archives of Medicine and Health Sciences 8(2):p 302-305, Jul–Dec 2020. | DOI: 10.4103/amhs.amhs_323_20
Monteiro, S., Sibbald, M., Beecroft, J. et al. Choosing Wisely for Simulation-Based Learning in Health Professions Education. Med.Sci.Educ. 35, 2541–2554 (2025). https://doi.org/10.1007/s40670-025-02471-z
Monteiro S, Sibbald M. Aha! Taking on the myth that simulation-derived surprise enhances learning. Med Educ. 2020;54:510–516. https://doi.org/10.1111/medu.14141
Wang A, de Sa D, Darie S, Zhang B, Rockarts J, Palombella A, Nguyen L, Downer N, Wainman B, Monteiro S. Development of the McMaster Embalming Scale (MES) to assess embalming solutions for surgical skills training. Clinical Anatomy. 2023 Jul;36(5):754-63.
I have challenged the assumption that survey-based research is neutral.
Standardized approaches to gathering information about human behaviour and preferences reduces people to categories, variables, and averages, obscuring context, voice, and relational meaning. Standardized approaches are favoured when we assume that objectivity and neutrality can reduce discrimination and bias. In an education and healthcare system that prioritizes efficiency, and profit, objectivity and neutrality become weapons against humanity, compassion and community.
Cameron E, Fleming H, Mose R, Monteiro S. Exploring context and culture in clinical reasoning medical education: A qualitative exploratory study. Journal of Evaluation in Clinical Practice. 2025 Mar;31(2):e14126.
Monteiro S, Acai A, Kahlke R, Chan TM, Sukhera J. Shifting paradigms: A collective and structural strategy for addressing healthcare inequity. Journal of Evaluation in Clinical Practice. 2024 Sep;30(6):887-93.
I have challenged the assumption that improving healthcare and education is primarily a matter of refining individual skills or reasoning processes.
Recent trends in health professions education incorporate an“everything, all at once” approach to curriculum design and social accountability. Lengthy list of competencies and professional responsibilities has overburdened individuals, obscuring the structural and institutional conditions that shape practice. The pursuit of comprehensiveness in professional competencies perpetuates a harmful myth that we are all individually responsible for societal change, shifting responsibility away from systems and onto learners. Yet, we know that health and education inequities are produced and sustained by collective, structural, and cultural conditions. ominant models of reasoning privilege certain ways of knowing while excluding others.
Monteiro S, Keuhl A, Lee M, Chan TM. ReThinking clinical reasoning: a paradigm shift. J Eval Clin Pract. 2024;30:766-773. doi:10.1111/jep.13986
Alvarez AA, Monteiro S, Chen R, Cohen K, Fofana M, Powell C, Tago A, Martin L. Re‐THINK: Use of narratives to explore social justice in clinical practice and education. Journal of Evaluation in Clinical Practice. 2024 Apr 1;30(3).
Monteiro SD. Everything alone: Is medical education chasing a harmful myth in its effort to embrace societal need?. Medical Education. 2024 Apr 1;58(4).
I have challenged the assumption that women decline academic opportunities due to lack of interest, confidence, or ambition.
Our decisions about career aspirations are shaped by unequal distributions of labor, expectation, and consequence within gendered institutional structures. I reveal how narratives of choice obscure systemic inequities and shift responsibility away from the conditions that produce them.
Monteiro S, Chan TM, Kahlke R. His opportunity, her burden: A narrative critical review of why women decline academic opportunities. Med Educ. 2023;57(10):958-970. doi:10.1111/medu.15141
I have challenged the assumption that clinical reasoning can be understood as a context-free cognitive skill.
Our reasoning - our beliefs, values and priorities - cannot be separated from our cultural, social, and situational contexts. Context shapes what is noticed, how it is interpreted, and how we react. I argue that attempts to isolate or standardize reasoning risk misrepresenting expertise and overlooking the conditions that give it meaning.
Cameron E, Fleming H, Mose R, Monteiro S. Exploring context and culture in clinical reasoning medical education: a qualitative exploratory study. J Eval Clin Pract. 2025;31:e14126. doi:10.1111/jep.14126
Olson A, Kämmer JE, Taher A, et al. The inseparability of context and clinical reasoning. J Eval Clin Pract. 2024;30:533-538. doi:10.1111/jep.13969
Precision is not the same as understanding.
I have challenged the assumption that statistical methods provide straightforward, objective answers independent of context.
Across this work, we show how decisions about sample size, reliability, and analytic approach depend on purpose, design, and judgment. I emphasize that methodological rigor is not about following rules, but about aligning analytic choices with the questions, contexts, and values that shape the work.
Norman G, Monteiro S, Salama S. Sample size calculations: should the emperor’s clothes be off the peg or made to measure?. Bmj. 2012 Aug 23;345.
McConnell MM, Monteiro S, Bryson GL. Sample size calculations for educational interventions: principles and methods. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2019 Aug 15;66(8):864-73.
Monteiro S, Sullivan GM, Chan TM. Generalizability theory made simple (r): an introductory primer to G-studies. Journal of graduate medical education. 2019 Aug 1;11(4):365-70.
How we assess shapes what we conclude.
Through professional and scholarly collaborations I have contributed to the development of assessment scholarship and theory.
Across this work, we show how scores are shaped by design features, rater behavior, timing, and data capture processes. Claims of fairness and precision depend on ongoing judgment, contextual awareness, and alignment with purpose.
Monteiro SD, Walsh A, Grierson LE. OSCE circuit performance effects: Does circuit order influence scores?. Medical Teacher. 2016 Jan 2;38(1):98-100.
Monteiro S, Sibbald D. Customizing the Standard to the Purpose of the Assessment. Journal of MultiDisciplinary Evaluation. 2018 Apr 13;14(30):105-7.
Monteiro S, Sibbald D, Coetzee K. i-Assess: Evaluating the impact of electronic data capture for OSCE. Perspectives on Medical Education. 2018 Apr;7(2):110-9.
Lang VJ, Berman NB, Bronander K, Harrell H, Hingle S, Holthouser A, Leizman D, Packer CD, Park YS, Vu TR, Yudkowsky R, Monteiro S, Bordage G. Validity evidence for a brief online key features examination in the internal medicine clerkship. Academic Medicine. 2019 Feb;94(2):259-66.
Coetzee K, Monteiro S. DRIFT happens, sometimes: Examining time based rater variance in a high-stakes OSCE. Medical Teacher. 2019 Jul 3;41(7):819-23.
Smee S, Coetzee K, Bartman I, Roy M, Monteiro S. OSCE standard setting: three borderline group methods. Medical Science Educator. 2022 Dec;32(6):1439-45.