International Medical Education

Clinical reasoning (CR) is the construct by which healthcare professionals assemble and interpret clinical information to formulate a diagnosis and management plan. Developing this skill can aid with medical decision-making and reduce clinical errors. Increasingly, CR is being included in undergraduate medical curricula, but the cultivation of this skill must continue in postgraduate training as doctors evolve to manage patients with increasing complexity. This is especially relevant in postgraduate training as doctors rotate through multiple specialties, assessing undifferentiated patients. Clinical trainers should therefore not only help develop their trainees’ CR skills, but also effectively evaluate their progression in this competency through placement-based assessment tools. This article introduces the reader to CR theories and principles before exploring four such methods for evaluating a trainee’s CR skills in a workplace setting. The various workplace tools described in this article are not intended to be prescriptive methodologies that must be rigidly followed, but instead offer a range of approaches that supervisors can dip into, and even combine, as suited to their trainees’ needs and level of performance to help foster this crucial aspect of professional development. Full article

Over the past decade, telehealth provision of care has become increasingly common. This shift away from in-person clinics may impact the experience of medical learners and the preceptors who train them. This study aimed to measure and compare obstetrics and gynecology resident physicians’ perceived quality of educational feedback during telemedicine compared to in-person clinical encounters. This prospective observational study recruited residents enrolled in a family planning clinical rotation at an academic residency program. After every in-person and telemedicine clinic session from January 2021 to February 2022, participating residents were sent a link to a 3 min survey via text message. Ordinal regression modeling was used to compare Likert responses between the telehealth and in-person clinical settings. All nine residents enrolled in the clinical rotation chose to participate in this study and responded to 114 of 132 survey prompts (86%). Participants positively rated the feedback they received during all clinic sessions. When comparing the two clinic experiences, there was no statistically significant difference in perceived quality of feedback or satisfaction with feedback. Residents’ perception of educational feedback during telemedicine clinic is at least similar for most measures and superior for contraception counseling when compared to an in-person clinic. Full article

Transformative digitally integrated pedagogy can enrich learning experiences, diversify the curriculum and broaden access to industry-relevant advanced clinical education for remote learners in medical education. Clinical skills are characterised as the portfolio of practical and interpersonal skills required by practicing clinicians. The purpose of this project was to design a new wholly online post-professional university subject for clinicians in different healthcare disciplines to advance these skills, which would traditionally be taught and assessed in-person. Our methodology included critically reviewing existing evidence of relevant medical skills which need to be included in the curriculum and approaches to their assessment. We designed a subject which dovetailed learning experiences with continuing clinical practice, and developed a new framework for remote video assessment of practical skills. Our pedagogical approaches included a backwards design coupled with a Four-Component Instructional Design Model (4C-ID) approach, which increased access and contextualised learning opportunities for diverse and practicing clinicians. Our narrative synthesis critically shares our experience and insights of embracing digital-technology opportunities while problem-solving to move past barriers. Our impact evaluation and experiential insights offer a platform to reimagine emerging possibilities for future digitally integrated education in medical education and other clinical-skills professions. Full article

(1) Background: Physicians and medical students face unique barriers balancing career progression and their mental health. Some medical schools and residency programs have described interventions in which senior clinicians, residents, or medical students disclose their experiences with mental health diagnosis and treatment to peers, students, and those junior in training status. (2) Methods: The authors conducted a scoping review to describe how medical training environments incorporate the self-disclosure of mental health diagnosis and treatment by senior clinicians to junior trainees. They searched six databases and hand-searched references from relevant publications. Following Arksey and O’Malley’s steps for scoping reviews, at least two reviewers independently screened all publications for eligibility and extracted data from included publications. (3) Results: A total of 2326 unique publications were identified; eight were included. Psychiatry was the medical specialty most represented by physician–authors. One publication described an intervention that impacted learner’s behaviors, while the remainder (n = 7) focused on participant satisfaction. (4) Conclusions: Research aims often sought to describe behavior changes. However, most (n = 7) of the literature included in this study did not present the behavioral outcomes of implementing these interventions. This study aims to direct future research into the role of mental health history self-disclosure in medical training environments. Full article

Service learning across medical schools is non-standardized and the skills that they learn can vary. Project HEART, a volunteer-based outreach program focused on teaching cardiovascular health and cardiopulmonary resuscitation (CPR) at public high schools, was implemented to encourage greater community engagement and equilibrate skill acquisition across different service projects. This pilot study characterized the benefits of providing service learning opportunities to first-year medical students. First-year medical students at a single institution were recruited to Project HEART. Following service sessions, all students completed a retrospective pre/post survey. They provided self-reported scores on a five-point Likert-type scale, grading their didactic and communication skills before and after the event. Subjective feelings of community engagement were also queried. Overall, 30 students were recruited across nine different community programs. Following participation, significantly increased confidence was seen in performing hands-only CPR (p < 0.001), public speaking (p = 0.003), teaching effectively (p < 0.001), and explaining medical terminology to laypersons (p < 0.001). Volunteers had an increased sense of community engagement (p < 0.001) and 17/30 students expressed greater consideration towards specializing in cardiology, primary care, or entering academia after participation. The study supported the proposal that service learning may promote self-determined altruism, positively influence perceptions of community stewardship, and have positive subjective benefits on medical student education. Full article

High levels of stigma among the healthcare workforce impede efforts to increase access to effective substance use disorder (SUD) treatments. Education on SUDs that (1) is tailored to physicians in training and (2) directly addresses and attempts to combat SUD stigma may help produce lasting reductions in SUD stigmatization within the healthcare setting. This study aims to describe the development of a technology-based, interactive SUD stigma intervention for medical students, created in collaboration with medical students, practicing clinicians, and experts in the fields of psychology and addiction medicine. This intervention is unique in its interactive application-based approach and the use of a computerized intervention authorizing system (CIAS) to guide the participant through the training. The final intervention includes four interactive online modules focused on SUD education using a biopsychosocial model, including stigma acknowledgment, an examination of patient perspectives, and the application of skills. Planned future studies will examine the feasibility, acceptability, and preliminary efficacy of the intervention among medical students. This intervention leverages the existing CIAS to provide interactive training that can be used as a part of medical student training and be expanded to other healthcare professionals (e.g., nurses and community health workers). Ultimately, this work will be used to drive a reduction in SUD stigma in medical settings. Full article

Integrating artificial intelligence (AI) and mixed reality (MR) into orthopedic education has transformed learning. This review examines AI-powered platforms like Microsoft HoloLens, Apple Vision Pro, and HTC Vive Pro, which enhance anatomical visualization, surgical simulation, and clinical decision-making. These technologies improve the spatial understanding of musculoskeletal structures, refine procedural skills with haptic feedback, and personalize learning through AI-driven adaptive algorithms. Generative AI tools like ChatGPT further support knowledge retention and provide evidence-based insights on orthopedic topics. AI-enabled platforms and generative AI tools help address challenges in standardizing orthopedic education. However, we still face many barriers that relate to standardizing data, algorithm evaluation, ethics, and the curriculum. AI is used in preoperative planning and predictive analytics in the postoperative period that bridges theory and practice. AI and MR are key to supporting innovation and scalability in orthopedic education. However, technological innovation relies on collaborative partnerships to develop equitable, evidence-informed practices that can be implemented in orthopedic education. For sustained impact, innovation must be aligned with pedagogical theories and principles. We believe that orthopedic medical educators’ future critical role will be to enhance the next generation of competent clinicians. Full article

This commentary explores the innovative introduction of English Problem-Based Learning (PBL) scenarios into child and adolescent psychiatry at Nagoya University, Japan. Recognizing the increasing need for multicultural competence and English proficiency among Japanese medical students, our initiative aims to enhance clinical problem-solving skills and cultural awareness. Developed in collaboration with the Norwegian University of Science and Technology, these PBL scenarios address the unique challenges of treating patients from diverse cultural backgrounds. Implemented since 2018, our curriculum integrates these scenarios for fourth-year medical students, fostering an environment of active learning and intercultural communication. Surveys conducted in 2019 and 2021 reveal positive student attitudes towards this approach. This commentary highlights the significance of English PBL in modernizing medical education in Japan, promoting global readiness among future medical professionals and addressing the demographic challenges faced by Japanese universities. Full article

(1) Background: While the benefits of digital assessments for universities and educators are well documented, students’ perspectives remain underexplored. (2) Methods: This study employed an exploratory mixed-methods approach. Three examination cohorts were included (winter semester 2022/23, summer semester 2023, and winter semester 2023/24). Written emotional responses to receiving just-in-time summative or formative feedback were analyzed, as well as examining the impact of formative feedback on learning attitudes. All cohorts completed qualitative open-ended research questions. The responses were coded using Kuckartz’s qualitative content analysis. Descriptive statistics were generated using jamovi. (3) Results: Students generally responded positively to formative and summative feedback. The majority expressed a desire to receive feedback. The categories created for formative feedback indicate a tendency toward self-reflection and supported the learning processes. In contrast, the summative feedback categories suggest that students primarily value feedback’s transactional aspect. (4) Conclusions: Integrating formative and summative feedback in digital just-in-time assessment offers the potential to capitalize on the “sensitive periods” of study reflection that occur during assessment. This approach enables assessment for learning while simultaneously reducing emotional distress for students. Full article

The integration of Generative Artificial Intelligence (GenAI) into health professions education (HPE) is rapidly transforming learning environments, raising questions about its impact on teaching and learning. This mixed methods study explores clinical educators’ and undergraduate students’ perceptions and attitudes about using GenAI tools in HPE at a tertiary hospital in Singapore. Using the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) as theoretical frameworks, we designed and administered a survey and conducted interviews to assess participants’ perceived usefulness, ease of use, and concerns related to GenAI adoption. Quantitative survey data were analyzed for frequencies and percentages, while qualitative responses underwent thematic analysis. Results showed that students demonstrated higher GenAI adoption rates (68.7%) compared to educators (38.5%), with GenAI perceived as valuable for efficiency, research, and personalized learning. However, concerns included over-reliance on GenAI, diminished critical thinking, and ethical implications. Educators emphasized the need for institutional guidelines and training to support responsible GenAI integration. Our findings suggest that while GenAI holds great potential for enhancing education, structured institutional policies and ethical oversight are crucial for its effective use. These insights contribute to the ongoing discourse on GenAI adoption in HPE. Full article

A major aspect of transition of care is the patient handover, during which miscommunication can significantly cause medical error and harm in patient care. Few medical schools in the U.S. offer formalized instructions on patient handovers, with most medical students learning from interns and residents through unstructured teaching. The aim of this study was to assess the effectiveness of a patient handover curriculum we developed for fourth-year medical students to increase their confidence and skills. Graduating fourth-year medical students (N = 98) enrolled in a two-week Transition to Residency (TTR) course attended an interactive session on patient handovers. During this session, students were presented with the I-PASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic, went over case vignettes, and practiced giving and receiving handovers with a partner using the I-PASS template. At the end of TTR, students participated in an OSCE (Objective Structured Clinical Exam) activity that consisted of two standardized patient cases on blood transfusion and informed consent. Overall, our students did well with including important information in their Patient Summary (P: Case Scenario 1 Mean Score 56%; Case Scenario 2 Mean Score: 68%) and Action List (A: Case Scenario 2 Mean Score; 78%; Case Scenario 2 Mean Score: 87%) in their simulated patient case scenario. Pre-and-post survey results also indicated a significant improvement on student level of confidence (agreed or strongly agreed) in giving a patient handover (Pre: 53.1%; Post: 93.6%, p < 0.001), in receiving a patient handover (Pre: 58.2%; Post: 92.5%, p < 0.001), and in knowing what pertinent information to include in a patient handover (Pre: 62.2%; Post: 89.4%, p < 0.001). This study underscores the importance of systematic and repeated patient handover education throughout medical school training. Full article

This study assessed the needs and perceptions of mentorship among students and staff at the Faculty of Medical Sciences (FMS) across all University of the West Indies (UWI) campuses. A cross-sectional survey was conducted from February to May 2023, targeting FMS students and staff across four UWI locations. Data analysis included descriptive statistics and inferential tests, with results presented in proportions and averages. A total of 234 responses were received (138 students, 96 staff). The majority of students (88%) and staff (71%) were affiliated with the Bachelor of Medicine, Bachelor of Surgery (MBBS) programme. Both groups agreed that mentoring should focus on career guidance, professional goals, networking, and role modelling. Interest in mentorship was high among students (77%) and staff (89%), with no gender preference. Most mentees (72%) preferred faculty mentors, and mentors preferred to guide two to five mentees. A blended mentorship model was most preferred. While 29% of students had a mentor, 65% of staff reported prior mentorship experience (p < 0.001). These findings highlight the need for structured mentorship programmes in Caribbean medical education. Implementing and monitoring mentorship initiatives within UWI’s FMS can enhance professional development and academic success for both mentors and mentees. Full article

The use of electronic cigarettes (e-cigarettes), or vaping, has risen significantly over the past decade as an alternative to traditional smoking. Despite growing evidence of vaping’s adverse health effects, limited data exist on medical students’ knowledge, attitudes, and behaviors regarding vaping, as well as the extent of education they receive on this topic. This study aimed to assess medical students’ perceptions of vaping-related harms and their evaluation of vaping education in medical school. A cross-sectional online survey was conducted among currently enrolled students at St. George’s University’s School of Medicine (n = 5794) over a five-week period from February to March 2024. The survey focused on students’ experiences, behaviors, attitudes, and perceptions toward e-cigarettes and vaping and their assessment of vaping-related education. Of 5794 invited students, 1400 (24%) responded, with 1193 (94%) completing the survey. While 82% had never used conventional tobacco cigarettes, 29% reported having vaped at least once. Nearly all respondents (97%) recognized vaping as a health risk; however, 75% reported receiving no formal education on vaping in their curriculum, and 68% rated their education on the topic as poor or very poor. Despite awareness of vaping’s risks, a notable proportion of medical students have engaged in the practice. The findings highlight a gap in medical education, underscoring the need for improved curriculum coverage to equip future physicians with the knowledge necessary to address vaping-related health concerns. Full article

Nazarbayev University School of Medicine selected the University of Pittsburgh School of Medicine to guide their curricular development. University of Pittsburgh faculty members teaching in the medical school were asked to help develop the curriculum in Nazarbayev. Some were asked to travel to Nazarbayev University to provide mentoring. Realizing that this would be a new activity, we wanted to investigate the perceived motivations, rewards, and barriers to participation. We conducted open-ended interviews of University of Pittsburgh faculty members, who were asked to participate in a project about motivations for accepting or rejecting the offer. We asked those accepting about the benefits and negatives. Nineteen faculty members agreed to 30 min interviews, which were digitally recorded and transcribed. All interviews were coded. Participating faculty members felt that reviewing their courses improved them. Most noted increased altruism and felt improved as educators. Some felt angst in providing their curricula. Several felt that traveling was challenging, but video conferencing technologies facilitated communication. Interviewees desired tangible rewards. This study highlights faculty perceptions of international curricular development. Faculty members felt that rewards included an improved native curriculum and personal and professional enrichment. Time constraints and distance were the main challenges and the primary reason others declined. The faculty perceived multiple benefits from this curricular development and collaboration. More transparency regarding expectations and the degree of assistance Nazarbayev University needed may have assuaged these fears. Full article

Background: The traditional presentation of results of cognitive test and surveys using simple percentages or average score obscures topics failed or mastered by test takers. However, the Rasch technique revolutionises the presentation of a test result by connecting respondent latent knowledge (or ability) with the test items using Wright maps. Aim: To assess nurses and midwives’ knowledge of managing primary postpartum haemorrhage using a Wright map Methods: A twelve-item dichotomous (YES/NO) computer-based test developed from the recently updated WHO’s treatment bundle was presented to the respondents for fifteen minutes. A nine-member panel reviewed the test to ensure clarity and relevance to Nigeria’s public maternity setting. All the respondents were nurses and midwives with previous experience of responding to primary postpartum haemorrhage. Ethical approval was provided by the University of Huddersfield and the nurses’ association. After eight weeks of data collection, both descriptive and inferential analyses were conducted using a Wright map. Results: The 180 responses analysed on a Wright map showed that the lowest, average and highest measures to be 476.3 logits, 495.9 logits and 521.7 logits respectively. Also, 178 (98%) respondents incorrectly answered the question on the source of treatment evidence but correctly answered that uterine atony is the main cause of postpartum haemorrhage. However, all the respondents who scored below average (495.6 logits) incorrectly answered the question on oxytocin as the best uterotonic. Conclusions: Wright map analysis confirms the problem of the inadequate knowledge of maternity staff as a major barrier to the effective treatment of maternal bleeding. A significant difference was found in the knowledge of the treatment among the three levels of maternity settings, implying the need for effective educational intervention strategies. Full article

Acknowledgement of the importance of students interacting with faculty in a social context has prompted the development of Learning Communities (LCs) in many medical schools. Understanding successful LC and fruitful mentor–mentee relationships is essential to recognize the perspective of multiple stakeholders, i.e., both mentors and mentees. This study used inductive qualitative analysis methods to compare the key attributes and competencies of mentors that are most important to mentors with those most important to mentees in LCs. Six mentor focus groups (N = 50) and four mentee focus groups (N = 22) were conducted. Thematic analysis revealed twelve distinct themes. Three were categorized as mentor/mentee similarities: (1a) individualized approach, (1b) history and physical skills, and (1c) group interaction. Three were categorized as mentor/mentee differences: (2a) teaching versus relationship competence, (2b) mentor as a relatable figure, and (2c) faculty development. Four themes were unique to mentees: (3a) cultural competence and role modeling, (3b) feedback to students, (3c) one-on-one sessions, and (3d) clinical pearls, and two themes were unique to mentors: (4a) communication and (4b) peer development. Formative evaluation is needed to recognize new styles of learning preferences and new forms of feedback. Awareness of the similarities and differences in the perspectives of mentors and mentees can inform modifications to LCs that can potentially improve the experience of both mentors and mentees. Full article

Background: Interprofessional education in the healthcare sector is becoming increasingly recognized in Germany; it is increasingly being included in the curriculum. The learners are usually the focus of the research. This study focusses on the teachers, as they are the ones who carry out the teaching and thus prepare the learners for practice. The aim of this study is to find out what skills interprofessional teachers should have for joint teaching and how the joint assumption of responsibility can be achieved in an interprofessional setting. Methods: Using a mixed-methods design, interprofessional courses were first identified across Germany in relation to the three professions of medicine, nursing and physiotherapy. Based on 76 fully completed quantitative questionnaires, the respondents’ views were surveyed with regard to the competences of the teachers, among other things. In 15 interviews based on these results, experts were asked more in-depth questions about competence limits and the assumption of responsibility, and the resulting data material was analyzed using Kuckartz’s structuring qualitative content analysis. Results: The quantitative results show that 70% of respondents (n = 53) consider it important to recognize profession-specific boundaries, while only 46% (n = 35) consider it important to assume joint responsibility. The qualitative part of the study shows that a basic understanding of the other professions is seen as conducive to dialog and collaboration. Furthermore, a shared assumption of responsibility is seen as an essential component of interprofessional teaching. Conclusions: In order to develop a shared assumption of responsibility, (self-)reflection is required; this also requires a conscious negotiation and development process on the part of the teachers. Teachers must align their joint actions with the needs of the learners so that they can later think and act across professions in patient care. As the process of (self-)reflection rarely takes place in mono-professional training programmes, opportunities to learn it are needed. Full article

Community engaged learning (CEL) is a teaching methodology which aims to bridge the gap between academia and society by collaborating on community-based projects. Inspired by theories of experiential learning and social constructivism, CEL celebrates learning by doing and is a rather novel teaching methodology within the predominantly theoretical bachelor medical curriculum. Despite CEL’s potential benefits, its implementation faces significant challenges. Here, we investigated how students, accustomed to traditional academic teaching, learn during CEL-infused courses, specifically studying student perception of their learning and identifying the various facilitators and barriers to learning during CEL. The study conducted at Utrecht University’s Faculty of Medicine included second-year medical students participating in a newly introduced CEL course. Using thematic analysis, the study analyzed students’ written reflections collected before and after completion of the course. CEL contributed to developing valuable competencies like empathy, leadership, and communication skills, which go beyond the realm of textbook and classroom-based knowledge. The study further identified key barriers and facilitators, both at personal and organizational levels influencing learning outcome of students. Based on these data, several recommendations have been formulated for all involved parties (students, academic institutions, community partners) which could contribute towards a sustainable embedding of CEL. Full article

The field of radiology heavily relies on image interpretation and reporting. Radiology residents undergo evaluations primarily based on their interpretation skills, often encountering varied cases with differing complexities. Assessing resident performance in such a diverse setting poses challenges due to variability in judgment among assessors. One aspect of training that can be standardized is the reporting process. Developing a structured reporting system could aid in evaluating resident milestones and achievement of Entrustable Professional Activities (EPAs), facilitating standardized assessment and comparison among peers. From our experiences, we describe a logical reasoning pathway followed by residents in their training, progressing from recognizing abnormalities to describing findings, identifying associated positive and negative findings, and recommending appropriate management. Each step provides evidence of milestone achievement and can be assessed through structured reporting. We propose that a grading system can be applied to assess perception skills, description accuracy, recognition of associated findings, formulation of differential diagnoses, recommendations, and consultation with clinicians. Comparison between junior and senior resident reports allows for monitoring progression and identifying areas for improvement. Although implementing this grading system poses challenges, it offers potential benefits in providing standardized assessment and guiding individualized learning curves for residents. Despite its limitations, once established, the system could enhance residency training in diagnostic imaging. Full article