International Medical Education

Identifying knowledge gaps and predictors of performance are proven ways to implement changes to a curriculum. This cross-sectional study investigates the subjective and objective competency of 52 medical students at McGill University in musculoskeletal (MSK) medicine, with a focus on orthopaedic surgery. We surveyed medical students to assess their confidence levels in orthopaedic surgery and their perceptions of its teaching. The students then completed a 25-question orthopaedics-focused exam as an objective assessment of their knowledge. Descriptive statistics were calculated, exam performance was compared across academic years, predictors of exam scores were analyzed, and student self-assessment accuracy was evaluated. Students reported lower confidence in orthopaedic surgery than in many other specialties, exam scores varied significantly across academic years (p = 0.007), and predicted exam performance was the only significant predictor of test score in multiple linear regression (R² = 0.313, p = 0.025). Calibration analysis revealed a substantial miscalibration, where students with higher predicted scores tended to overestimate their performance, while those with lower predictions tended to underestimate themselves (intercept = 27.2, slope = 0.54). A Bland–Altman plot demonstrated wide limits of agreement between predicted and actual scores (mean bias −1.2%, 95% LoA −35.0% to +32.6%). These findings highlight meaningful orthopaedic knowledge gaps and miscalibrated self-assessment, emphasizing the need for targeted, structured educational interventions in the MSK curriculum. Full article

The integration of Artificial Intelligence and Robotics (AI/R) in healthcare presents both opportunities and challenges, especially in developing countries. This study assessed the attitudes and perceptions of Vietnamese healthcare undergraduates towards AI/R applications in healthcare and elderly care. In 2023, a cross-sectional survey was conducted among 1221 Vietnamese healthcare undergraduates. The questionnaire covered demographic, academic, social, and mental factors, as well as attitudes towards AI/R applications measured by a five-level Likert scale. Key findings revealed that respondents were primarily majoring in medicine (60.9%) and pharmacy (29.4%). Awareness and interest in AI/R were high (89.9% and 88.3%, respectively), but formal training was significantly lacking (5.9%). A substantial majority (89.9%) expressed a need for AI/R training. Respondents perceived considerable benefits of AI/R, particularly in data synchronization (mean [M] = 3.83), workload reduction for medical staff (M = 3.79), and delivering multiple healthcare benefits (M = 3.82). Moderate concerns were noted regarding security and privacy (M = 3.46), potential over-reliance on technology (M = 3.43), and AI/R potentially replacing medical staff (M = 3.38). Overall, perceived benefits (M = 3.67) outweighed concerns (M = 3.38), (p < 0.001). Additionally, participants aware of AI/R and those planning to study abroad showed greater interest and training needs in AI/R. Higher GPA and self-esteem were associated with a greater interest in AI/R research. The study highlights a significant gap in formal AI/R training, not only in availability but also in the absence of structured, outcome-based curricula, despite the strong interest among healthcare students in acquiring knowledge and skills in this area. These findings suggest the need for enhanced educational programs to train healthcare students with the necessary competencies to apply AI/R technologies effectively. Full article

Humor plays a vital role in human well-being and communication and is increasingly recognized as a beneficial resource in healthcare contexts. While prior studies have explored humor in general university populations, limited research has focused on nursing students, who face distinct interpersonal and emotional demands during their training. This pilot study aimed to describe multidimensional sense of humor among first-year nursing students in Spain using the validated Spanish version of the Multidimensional Sense of Humor Scale (MSHS), which includes a three-dimension model: humor competence, humor as a coping mechanism, and social attitudes toward humor. A total of 78 students completed the MSHS questionnaire via an online survey. The overall mean score was 66.8 (SD = 13.1) out of 96, with the highest mean observed in the dimension of humor as a coping mechanism (mean = 22.2, SD = 4.0). Individual item analysis revealed strong agreement with positively worded statements such as “I like a good joke” (mean = 3.36, SD = 0.82) and “Humor is a lousy coping mechanism” (reverse scored; mean = 3.69, SD = 0.67). These findings suggest that humor is a relevant personal and interpersonal resource among future healthcare professionals. Incorporating humor-related competencies in nursing education may support student resilience and enhance patient-centered care. Further research is needed to examine humor’s longitudinal development and its role in clinical practice. Full article

Through semi-structured interviews with attending surgeons, this exploratory qualitative study examined ways in which eleven surgeons create conditions for residents to flourish in the clinical learning environment. We conducted interviews with a purposeful sample of eleven surgical faculty from across the United States. The transcripts were deductively coded using VanderWeele’s (2017) flourishing framework, which includes character and virtue, close social relationships, meaning and purpose, and life satisfaction. Through open coding and thematic analysis, we identified three interrelated themes: (1) acting to promote good through mattering, (2) deriving satisfaction from individualizing teaching, and (3) affirming the worth of residents as humans. Full article

At the Michael G. DeGroote School of Medicine, a significant component of the MD curriculum involves written narrative reflections on topics related to professional identity in medicine, with written feedback provided by their in-person longitudinal facilitators (LFs). However, it remains to be understood how generative artificial intelligence chatbots, such as ChatGPT (GPT-4), augment the feedback process and how MD students perceive feedback provided by ChatGPT versus the feedback provided by their LFs. In this study, 15 MD students provided their written narrative reflections along with the feedback they received from their LFs. Their reflections were input into ChatGPT (GPT-4) to generate instantaneous personalized feedback. MD students rated both modalities of feedback using a Likert-scale survey, in addition to providing open-ended textual responses. Quantitative analysis involved mean comparisons and t-tests, while qualitative responses were coded for themes and representational quotations. The results showed that while the LF-provided feedback was rated slightly higher in six out of eight survey items, these differences were not statistically significant. In contrast, ChatGPT scored significantly higher in helping to identify strengths and areas for improvement, as well as in providing actionable steps for improvement. Criticisms of ChatGPT included a discernible “AI tone” and paraphrasing or misuse of quotations from the reflections. In addition, MD students valued LF feedback for being more personal and reflective of the real, in-person relationships formed with LFs. Overall, findings suggest that although skepticism regarding ChatGPT’s feedback exists amongst MD students, it represents a viable avenue for deepening reflective practice and easing some of the burden on LFs. Full article

To clarify the current status of physical assessment education in Japan, this study analyzed publicly available syllabi from nursing universities. Syllabi from 299 member universities of the Japan Association of Nursing Universities were analyzed, and data on course classification methods, learning content, and practice methods were tabulated. The Body System Approach was the most common classification (used by 244 universities). Implementation rates were high for core systems like the respiratory system (98.0%) and cardiovascular system (95.2%), but lower for others, such as the otolaryngology system (41.5%). The use of simulation was noted in 21.4% of courses, and in 71.0% of syllabi, the role of the patient in practice exercises was not described. A discrepancy exists between the implemented content and the Model Core Curriculum for Nursing Education, which includes a wider range of systems. Furthermore, few syllabi described specific teaching methods, indicating that future curriculum revisions will require re-evaluation to ensure educational quality. Full article

The objective structured clinical examination (OSCE) is a well-established tool for assessing clinical skills, providing reliability, validity, and generalizability for high-stakes examinations. Des Moines University College of Osteopathic Medicine (DMU-COM) adapted the OSCE for formative assessments in undergraduate medical education, focusing on interpersonal aspects in the primary care setting. Students are graded by standardized patients and faculty observers on interpersonal skills, history/physical examination, oral case presentation, and documentation. The purpose of the study is to establish the reliability and to identify sources of variation in the DMU-COM OSCE to aid medical educators in their understanding of the accuracy of clinical skills. We examined student performance data across five OSCE domains. We assessed intra- and inter-OSCE reliability by calculating KR20 values, determined sources of variation by multivariate regression analysis, and described relationships among observed variables through factor analysis. The results indicate that the OSCE captures student performance in three dimensions with low intra-OSCE reliability but acceptable longitudinal inter-OSCE reliability. Variance analysis shows significant measurement error in rubric-graded scores but negligible error in checklist-graded portions. Physical exam scores from patients and faculty showed no correlation, indicating value in having two different observers. We conclude that a series of formative OSCEs is a valid tool for assessing clinical skills in preclinical medical students. However, the low intra-assessment reliability cautions against using a single OSCE for summative clinical skills competency assessments. Full article

Background: Emergency medicine in Japan traditionally emphasizes critically ill patients, but recent trends show an increase in minor illness cases influenced by social factors. This study assessed integrating community nurse (CN) training into an emergency medicine elective to evaluate its effect on students’ self-achievement and communication skills. Methods: Medical students rotating in the emergency department participated. Those choosing the CN training spent one week in the community, while others remained hospital-based. Surveys evaluated self-achievement of Shimane University emergency medicine objectives and communication skills per the Model Core Curriculum. Analyses used t-tests. Results: Of 35 students, 21 (60%) completed surveys. Satisfaction levels did not differ significantly between CN and non-CN groups (4.0 ± 0.70 vs. 4.5 ± 0.63, p = 0.15). Regression analysis indicated satisfaction correlated only with online practice availability. No significant differences emerged for goals or communication items (all p > 0.05), although CN participants tended to rate higher on patient proximity, communication, and social engagement. Discussion: CN training maintained overall satisfaction and slightly enhanced communication and social aspects, aligning with shifts toward psychosocial care in emergency medicine. Conclusions: Integrating CN practice did not significantly impact emergency medicine knowledge or skill satisfaction but showed a trend toward improved communication and social purpose satisfaction. Larger-scale studies are needed for validation. Full article

Medical education is inherently demanding, requiring students to balance intense academic workload, clinical training, and emotional resilience. High levels of stress and burnout among medical students have been associated with decreased empathy, poorer academic performance, and increased risk of mental health problems. This cross-sectional, correlational study examined the relationships between emotional intelligence (EI), perceived stress, and burnout among undergraduate medical students at the Alexandria Faculty of Medicine. Participants completed self-report questionnaires: the Mind Tools Emotional Intelligence Test, the Perceived Stress Scale, and the Maslach Burnout Inventory. Descriptive statistics, bivariate correlations, and multivariate regression models were used for analysis. Among the 264 participants (88% response rate), the majority (73.4%) demonstrated average EI with no statistically significant differences across gender and academic year. Higher perceived stress was strongly correlated with emotional exhaustion and depersonalization, and it was also inversely correlated with personal accomplishment. Regression analysis indicated that gender, academic year, and academic grade were not independent predictors of stress or burnout (R² = 0.054). Approximately 30.3% of the students met the criteria for burnout. These findings highlight the complex interplay between emotional functioning and burnout, and they also suggest that interventions targeting emotional regulation and resilience may be beneficial in reducing stress and promoting well-being among medical students. Full article

Background: Undergraduate research is vital for developing critical thinking and academic identity in medical students, yet traditional models often fail to overcome institutional and personal barriers. Peer-led approaches may offer more accessible, supportive environments that promote deeper engagement and leadership in research. Methods: This study evaluated medical students’ experiences in a peer-led research initiative from 2022 to 2024. Students were then invited to complete a qualitative questionnaire reflecting on their perceptions towards research, development in research skills, confidence, and academic identity. Results: Code saturation was achieved after 9 responses (N = 15). Participants reported intrinsic interest, peer encouragement, and opportunities to publish as motivating factors. The peer-led model made research feel more approachable, fostering technical growth and academic confidence. Peer mentorship and a gradual learning structure were especially valued. While challenges such as workload and team dynamics emerged, students reported growth in resilience and self-reflection. Conclusions: Peer-led research initiatives can effectively support academic identity formation by integrating motivation, support, and skill development. Despite obstacles, students gained competence and confidence. Full article

The COVID-19 pandemic disrupted medical education as the shift from face-to-face to remote teaching raised concerns about learning outcomes and well-being. However, while established schools’ adaptations have been widely studied, the challenges faced by new institutions in the pandemic’s aftermath remain underexplored. This research provides a valuable case study examining the motivations and concerns of faculty and students at a newly established medical school in the Philippines during its inaugural academic year. Employing a mixed-methods design, data were obtained via validated Likert-based questionnaires assessing motivation and survey questions eliciting concerns. Descriptive and inferential approaches were utilized to analyze data. Results show that faculty motivations were primarily intrinsic, whereas students were driven by a mix of intrinsic and extrinsic factors. Subgroup analyses revealed no difference in motivational profiles across demographic characteristics. Faculty were primarily concerned with their readiness for academic roles, use of modern teaching technologies, and ensuring effective student learning. Students’ concerns focused on training quality, institutional capacity, and the uncertainties of being the pioneer batch. Despite the pioneer cohort’s small size, this study highlighted the importance of understanding faculty and student motivations and concerns, already shaped by post-pandemic realities, to provide targeted support for new medical programs in the evolving post-pandemic landscape. Full article

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