“…There were also accounts of disharmony in the Relational Ring caused by poor tutor-learner relationships [61,247,252,253,269], reduced peer interactions [150,199,253] and increased isolation [206,253,293,294]. Disharmony in these rings cascaded into dyssynchrony across the Societal, Relational and Individual Rings exaggerated by gaps in knowledge, skills, and attitudes [251], and poor interprofessional practice [142,206,293,295,296]. Overall, when unsupported, such dissonance culminated in ineffectual adaptations, further indicating wider impact…”