JMIR Publications

ABSTRACT

“First, do no harm” is a fundamental principle in healthcare, and clinical researchers carefully monitor adverse drug reactions to ensure patient safety. However, educational researchers and clinical educators rarely apply the same level of scrutiny to potential adverse effects arising from their own interventions. This reflects a persistent misconception that educational interventions are inherently harmless, an assumption that warrants critical examination. In this review, we highlight the underrecognized concept of adverse effects in medical education by introducing twelve representative educational adverse effects and offering corresponding tips for mitigating them. These include the Dunning-Kruger effect, in which increased confidence does not align with actual competence; the undermining effect, whereby external rewards reduce intrinsic motivation; spoon feeding that stunts independent learning; cognitive overload resulting from excessive information delivery; patient dehumanization when education prioritizes technical proficiency over empathy; and the expertise reversal effect, in which instructional strategies beneficial for novices become counterproductive as expertise grows. Additional adverse effects include compromised psychological safety despite formal safeguards, authority and confirmation biases that reinforce outdated practices, developer bias in intervention evaluation, the Hawthorne effect influencing observed behavior, and concerns that overreliance on generative artificial intelligence may hinder the development of critical thinking and metacognitive skills. To better understand the nature of these adverse effects, we categorize them into three overarching domains. Cognitive and psychological adverse effects occur within the learner. Structural and cultural adverse effects result from features of the educational environment. Methodological and evaluative adverse effects arise from how educational interventions are designed and assessed. While these domains overlap, they provide a practical framework for identifying how well intended educational strategies may lead to harm. Some may argue that these phenomena represent unintended consequences rather than adverse effects. However, the term unintended consequence presumes that sufficient effort was made to anticipate and manage possible effects, an assumption that may not always hold true in medical education. We argue that educators and educational researchers should explicitly recognize adverse effects, critically evaluate educational interventions, and adopt mitigation strategies with a level of rigor comparable to that applied in clinical research, in order to better protect learners and improve the quality of medical education.