International Medical Education

Recent studies have identified various factors influencing how medical students choose medical specialties. An important factor that has been overlooked is learning approach. For Qatar-based medical students aspiring to train overseas, specialty preference often hinges on the relationships between learning approach and career values. Structural equation modelling (SEM) was employed to explore the relationships between learning approach, career values, and specialty preference. Data were collected from two surveys of 108 medical students at Weill Cornell Medicine-Qatar (p-Q): the Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) to assess learning approach and the adapted version of the How Medical Students Choose Questionnaire (HMSCQ) to assess career values and specialty preferences. The results showed significant correlations between learning approach, career values, and specialty preference. Surface learning approach correlated with seeking prestige, imitating role models, and valuing a varied scope of practice while deep learning approach correlated with interest in research and hospital-based careers. Our model accounted for variances in specialty preference to the following degrees: internal medicine (38%), family medicine (25%), neurology (27%), and psychiatry (18%). Medical students in Qatar adopt the learning approach that helps them achieve their career goals and matches their perceptions of medical specialties. Medical educators can foster a deeper learning approach by helping students to clarify their aims for pursuing a medical career, providing early exposure to medical specialties, and fostering a research mindset to enhance intrinsic curiosity. Students interested in physician research careers should be provided opportunities to pursue independent research. Full article

A well-educated midwifery workforce is critical to providing quality health services. However, the quality of midwifery education in Nigeria is identified as a factor contributing to the country’s poor maternal and neonatal health outcomes and inability to meet global development goals. This study aimed to analyse the process used to strengthen the quality of midwifery education with the aim of generating a middle-range model to prepare competent and confident midwifery graduates. The Strauss and Corbin version of the Grounded Theory approach that is underpinned by the Social Constructivism Paradigm was adopted for this qualitative study. Strengthening the quality of midwifery education (SQME) emerged as the model’s core phenomenon. Major concepts, including the midwifery education context, nature of the curriculum, SQME process, pillars, and outcomes, supported the core phenomenon. Strengthening the quality of midwifery education can be achieved over a long time provided the pillars of SQME are deep-rooted to sustain the process of strengthening the quality of midwifery education. The model can be used to strengthen the quality of midwifery education and may be adapted to nursing/allied health programmes in Nigeria and other developing countries. Full article

For feedback to be productive, it relies on the interactions of participants, design elements, and resources. Yet, complexities in clinical education pose challenges for feedback practices in students and teachers, and efforts to improve feedback often ignore the influence of culture and context. A recent sociocultural approach to feedback practices recognized three layers to understand the complexity of productive feedback: the encounter layer, the design layer, and the knowledge layer. This study explores the sociocultural factors that influence productive feedback practices in clinical settings from the clinical teacher–student dyad perspective. A cross-sectional qualitative study in a physiotherapy clerkship involved semi-structured interviews with ten students and eight clinical educators. Convenience sampling was used, and participation was voluntary. Employing thematic analysis from a sociocultural perspective, this study examined feedback practices across the three layers of feedback practices. The analysis yielded different elements along the three layers that enable productive feedback practices in the clinical workplace: (1) the feedback encounter layer: dyadic relationships, mutual trust, continuity of supervision, and dialogue; (2) the feedback design layer: enabled learning opportunities and feedback scaffolding; (3) the knowledge domain layer in the clinical culture: Growing clinical experience and accountability. In the context of undergraduate clinical education, productive feedback practices are shaped by social–cultural factors. Designing feedback practices should consciously integrate these components, such as cultivating relationships, fostering guidance, enhancing feedback agency, and enabling supervised autonomy to promote productive feedback. Full article

Small-group learning is a mainstay of medical education, and group functioning can have a major influence on these learning experiences. Our objective was to explore verbal exchange patterns within small-group learning sessions and examine how different patterns related to tutor involvement, tutor expertise, and participants’ perceptions. A non-participant observer collected group interactivity data using a real-time mobile device-based system. Verbal interaction patterns were visualized and analyzed using social network analysis and correlated with participant survey data and aggregate course grades. There were 46 observations across 30 separate groups. Group interactions clustered into four patterns defined by (1) tutor involvement (high vs. low) and (2) interactivity (high vs. low). Interaction patterns were largely stable for a given group and groups with content expert facilitators were generally less interactive. Students reported objectively fewer interactive groups as more interactive and enjoyable. There were no significant intergroup differences in aggregate course grades. Paradoxically, student perceptions were not aligned with observed interactivity data, and tutor content expertise influenced group interactivity. These findings suggest the need to better manage learner expectations of small-group learning, and to explicitly reflect on and develop skills for effective collaborative learning with both faculty and students. Full article

Plastic surgery is a diverse speciality relevant to non-plastic doctors, as plastic surgeons frequently collaborate with other specialities and its basic principles are transferable across multiple specialities. Foundation-year (FY) doctors are the most junior doctors in the workforce and may need to apply plastic surgery knowledge and principles during their clinical duties. Despite this, formal plastic surgery education for junior doctors is limited, resulting in an educational gap. This study gains insight into the perceived confidence, knowledge gaps, skills, educational activities and needs related to plastic surgery. This qualitative study uses phenomenology through semi-structured individual interviews with eight FY doctors. Data was analysed using reflexive thematic analysis. This study revealed that plastic surgery features diversely in the work life of FYs, who often manage patients with a lack of knowledge and confidence, influencing patient care and FY wellbeing. FYs primarily acquire knowledge and confidence through experiential learning and individual initiative. A need for curriculum improvements was expressed. FYs are an essential part of the workforce who exhibited educational gaps and a lack of confidence in plastic surgery knowledge. We suggest improved integration of plastic surgery into the FY curriculum for improved FY knowledge and patient care. Full article

(1) Background: There is a need to scale and transform health professional education (HPE) globally to not only improve the quantity but also the quality of health workers. This paper describes the approach undertaken by a Health University in Lao PDR. (2) Approach: The HPE curriculum was designed in an iterative process with key stakeholders from both the institution and government, with external expert advice. (3) Outcomes: The curriculum was successfully developed consisting of nine core modules and one elective module, reflecting both elements seen globally in HPE curricula as well as reflecting local needs. The content and teaching methods were validated and reviewed through piloting with local education leaders. (4) Conclusions: Despite the need to scale HPE globally, there are few examples of how this can be achieved in countries in which large gaps exist in HPE capacity. This paper provides one such example, through recognizing that sustained external partnerships will still be needed for successful future implementation. Full article

Despite the potential benefits of generative artificial intelligence (genAI), concerns about its psychological impact on medical students, especially about job displacement, are apparent. This pilot study, conducted in Jordan during July–August 2024, aimed to examine the specific fears, anxieties, mistrust, and ethical concerns medical students harbor towards genAI. Using a cross-sectional survey design, data were collected from 164 medical students studying in Jordan across various academic years, employing a structured self-administered questionnaire with an internally consistent FAME scale—representing Fear, Anxiety, Mistrust, and Ethics—comprising 12 items, with 3 items for each construct. Exploratory and confirmatory factors analyses were conducted to assess the construct validity of the FAME scale. The results indicated variable levels of anxiety towards genAI among the participating medical students: 34.1% reported no anxiety about genAI‘s role in their future careers (n = 56), while 41.5% were slightly anxious (n = 61), 22.0% were somewhat anxious (n = 36), and 2.4% were extremely anxious (n = 4). Among the FAME constructs, Mistrust was the most agreed upon (mean: 12.35 ± 2.78), followed by the Ethics construct (mean: 10.86 ± 2.90), Fear (mean: 9.49 ± 3.53), and Anxiety (mean: 8.91 ± 3.68). Their sex, academic level, and Grade Point Average (GPA) did not significantly affect the students’ perceptions of genAI. However, there was a notable direct association between the students’ general anxiety about genAI and elevated scores on the Fear, Anxiety, and Ethics constructs of the FAME scale. Prior exposure to genAI and its previous use did not significantly modify the scores on the FAME scale. These findings highlight the critical need for refined educational strategies to address the integration of genAI into medical training. The results demonstrate notable anxiety, fear, mistrust, and ethical concerns among medical students regarding the deployment of genAI in healthcare, indicating the necessity of curriculum modifications that focus specifically on these areas. Interventions should be tailored to increase familiarity and competency with genAI, which would alleviate apprehensions and equip future physicians to engage with this inevitable technology effectively. This study also highlights the importance of incorporating ethical discussions into medical courses to address mistrust and concerns about the human-centered aspects of genAI. In conclusion, this study calls for the proactive evolution of medical education to prepare students for new AI-driven healthcare practices to ensure that physicians are well prepared, confident, and ethically informed in their professional interactions with genAI technologies. Full article

The integration of sociology into medical education is essential for cultivating a nuanced understanding of the complex interplay between social determinants and health outcomes. This national cross-sectional survey utilized a qualitative, descriptive research approach to examine the inclusion of sociology as a course in the undergraduate curricula of medical schools in Greek higher education. Data collection and analysis were conducted through a comprehensive review of the syllabi from all seven medical schools in Greece. The analysis revealed that none of the seven undergraduate medical curricula include sociology as a discrete course. Social medicine is offered as a discrete course in three out of the seven programs, whereas sociological concepts are present in the majority of the medical curricula (six out of seven). A significant gap in the integration of sociology as a discrete course within Greek medical graduate education is revealed. To better equip future medical doctors with sociological lenses towards medical practice, a more comprehensive integration of sociology into medical training is recommended. Full article

Advances in artificial intelligence (AI) in the medical sector necessitate the development of AI literacy among future physicians. This article explores the pioneering efforts of the AI in Medicine Association (AIM) at Brigham Young University, which offers a framework for undergraduate pre-medical students to gain hands-on experience, receive principled education, explore ethical considerations, and learn appraisal of AI models. By supplementing formal, university-organized pre-medical education with a student-led, faculty-supported introduction to AI through an extracurricular academic association, AIM alleviates apprehensions regarding AI in medicine early and empowers students preparing for medical school to navigate the evolving landscape of AI in healthcare responsibly. Full article

Through the pivot to emergency remote teaching during the pandemic, most universities have managed to become ‘digital’, at least in the delivery of educational programmes and business operations. And yet, the purposeful design and use of technology for education is far from the reality of such a pivot and remains difficult to achieve. While most universities outline some level of digital transformation as part of their innovation narrative and strategies, there is only a limited number of universities that adopt the culture of co-creation. This paper illustrates a bottom-up approach to the co-creation of a new digital and medical education strategy in a London-based Russell Group university to bring on change that is fit for purpose. The findings include the key insights, specifically, the five key values of what the community believed to be crucial—(i) broadening access to education, (ii) flexibility, efficiency and convenience, (iii) authentic learning, (iv) business proposition, and (v) pastoral care; and the eight areas of opportunities and challenges—(i) human relationships, (ii) co-creation, (iii) digital engagement, (iv) digital pedagogy, (v) digital literacy, (vi) edtech and IT infrastructure, (vii) support, and (viii) digital assessment and feedback. This paper also outlines the strategic project plans that were generated and since implemented as a result of the co-creation process. The limitations and future directions of this study are also noted. Full article

(1) The purpose of this project was to create and collect validity evidence for a lifestyle medicine objective structured clinical examination (OSCE) station to assess medical students’ performance related to lifestyle medicine competencies. (2) We developed a lifestyle medicine case/station with an associated observation checklist and rubric. We piloted the checklist and rubric in one lifestyle medicine OSCE station, securing triplicate scores of each student’s performance. For analysis, generalizability (G) theory was utilized for observation checklist data and interclass correlation coefficients (ICC) for patient encounter notes (PENs). (3) One hundred and fifteen third-year medical students completed the lifestyle medicine OSCE station in the Internal and Family Medicine Clerkship. The generalizability coefficient and Phi-coefficient based on the number of encounters (P = 115), facet 1 (nfacet1 = 10 assessment tool checklist items), and facet 2 (nfacet2 = two performance ratings in the live examination) were 0.71 and 0.69, respectively. The average interclass correlation coefficient (ICC) measure for PEN was 0.79 (CI = 0.69–0.85). (4) For this OSCE station, the G-coefficient provides positive indicators for the validity of the observation checklist items. Similarly, the ICC result provides validity evidence for the usefulness of the PEN rubric for capturing lifestyle medicine knowledge reflected in students’ PEN notes. Full article

Student-centered active learning (SCAL) shifts the focus from the teacher to the student. Implementing SCAL requires the development of new forms of assessment beyond memorization and comprehension. This paper aims to demonstrate the effectiveness of SCAL by analyzing student performance at different cognitive levels. In flipped classrooms, students completed tasks with varying cognitive demands. The tests measured knowledge (level 1), comprehension (level 2), application (level 3) and analysis (level 4). This approach to assessment assesses not only the acquisition of content, but also skills that are critical to a health science student’s future career. The results of expository learning were compared with student-centered collaborative learning in the Anatomy and Embryology I course over three academic years. Student opinions were collected through 326 anonymous Wooclap^® (Version: 2019101500) surveys. No differences in performance were found for low-cognitive-level questions. However, SCAL significantly improved performance on higher-cognitive-level questions that required problem solving and application of knowledge. Despite the benefits of SCAL, it requires more effort from both teachers and students. The current assessment system at Universidad Complutense, which measures teaching quality primarily in terms of student satisfaction, tends to penalize efforts to innovate. Many students are attracted to passive learning techniques because they provide a clear and structured path to success. This approach, which focuses on memorizing information for exams, provides a sense of security. Teachers need to have a strong belief in the effectiveness of SCAL methods to persist in their implementation. Full article

Clinical academics experience dual workplaces, namely the clinical and the research environment. However, working in two workplaces leads to difficulties in forming an integrated identity, affecting a person’s work environment and well-being. The aim was to explore how clinical academics experience the psychosocial work environment and their suggestions for improving and changing work well-being. A multicenter qualitative approach with group interviews inspired by participatory action design was used. A purposeful criterion sampling strategy was used, selecting researchers affiliated with the university’s research network (n = 12). Data were analyzed by thematic analysis and the consolidated criteria for reporting qualitative research was applied. The main finding, ‘lack of integration of research in clinical practice’, revealed how clinical academics balanced between the two practices, how their need for belonging in both work environments was established by fellowship, and how motivational factors and role models could be enhanced through a joint commitment of responsibility in research units and clinical practice. This study provides a contemporary understanding of the challenges that mainly Ph.D. students encounter and what solutions they would offer. This study adds to knowledge on well-being in psychological work and provides solutions on how clinical academic Ph.D. students can achieve the integration of research in clinical practice. Full article

Introduction: In this narrative review, we identified concepts related to the process of transforming a psychiatry curriculum for New Zealand medical students. Method: A literature search was performed on four databases (Embase, Medline, PsycInfo, and Scopus) for articles related to curriculum development in psychiatry, including relevant aspects of culture and technology. Results: Ninety-three articles met the inclusion criteria. Three main themes were identified: the needs of learners; curriculum frameworks that optimise learning; and the role of technology. The key features of an effective psychiatry curriculum are the extent to which it integrates with other disciplines, develops key competencies, supports authentic learning, and promotes cultural safety. Conclusions: Transforming curricula is an iterative process that prioritises learners’ needs, establishes psychiatry within the teaching context, integrates learning evidence, and responds to the changing demands of society. The findings from this review apply to medical curricula more generally: a well-integrated specialist curriculum, in this case psychiatry, enables medical students to build essential competencies and depends upon effective collaboration with stakeholders, attention to cultural safety, and incorporating technology into the teaching context. Full article

Background: Clinical reasoning (CR) is fundamental in medical education. However, the Italian curriculum has not incorporated a structured CR format yet. Therefore, we introduced the Clinical Case Discussions (CCD), to medical students attending the University of Bologna as a tool for developing CR abilities. CCDs are a case-based peer-teaching format, simulating the diagnostic process using published patient cases. Methods: Students of all clinical years of the University of Bologna Medical School were invited to voluntarily participate in a two-day CCD training program. They completed pre- and post-training questionnaires assessing their expectations before and impressions after the training and comparing learning outcomes to their usual classes. Results: Twenty-one students participated in this pilot program. Before the training, more than half of the participants expressed either interest or a strong interest in all proposed learning objectives. Afterward, 84.6% of the students stated that the training much exceeded (63.5%) or exceeded (23.1%) their expectations considering its utility for their future medical activities. A total of 92.3% strongly agreed (84.6%) or agreed (7.7%) to have improved their CR. Conclusions: Although this pilot program had some intrinsic limitations, the students’ positive feedback on this CCD format (combining the benefits of case-based learning and peer teaching) encourages further research on its potential role in the Italian curriculum. Full article

Over the last decade, initiatives like the Choosing Wisely campaign have promoted the practice of evidence-based, cost-conscious care. However, education surrounding value in medicine has been largely restricted to graduate-level medical education or post-clerkship undergraduate medical education. Here, we present a mixed-methods study evaluating pre-clerkship medical student engagement with and response to new value-based curricular initiatives to assess whether high-value care (HVC) can be introduced successfully earlier in training. Initiatives were introduced into the pre-clerkship clinical curriculum without major alterations to the established curricular structure. These comprised an annual event devoted to self-reflecting on HVC observed in prior and current clinical experiences and subsequent small-group facilitated discussion. Engagement with and response to these initiatives were analyzed for two whole-class cohorts using an abductive, progressive focusing approach complementing quantitative survey data. Baseline familiarity with HVC and post-event response to the annual event was higher and more positive, respectively, among responders from the Class of 2025 compared with those from the Class of 2024. Analysis of reflection essays revealed the emergence of five primary themes differentiating the two class years: (1) understanding HVC, (2) addressing barriers to HVC, (3) medical waste and underserved communities, (4) patient–physician relationship and value, and (5) self-reflection. Evaluation of thematic patterns in light of survey response data suggests that early clinical exposure combined with intentional self-reflection could promote engagement with HVC topics in a way that shapes students’ foundational understanding of the practice of medicine. Full article

Immunology is an important component of the medical curriculum. It provides a foundation for understanding the cellular and molecular processes by which the body protects itself from external substances and the immunological responses that contribute to the development of many illnesses. The inclusion of immunology in an osteopathic medical curriculum is essential to understanding the body’s defense systems as well as the alignment of osteopathic concepts with immunology. By encompassing innate and adaptive immunity, immunology reflects the interconnectedness of the body’s systems and the foundation for self-regulation inherent in osteopathy. A problem facing medical educators is determining how to facilitate students’ learning of immunological concepts in a way that will help them retain and apply the material throughout their clinical years and beyond. This paper aims to provide an immunology education framework designed to effectively integrate immunology topics across the preclinical courses of an osteopathic medical curriculum. Drawing insights from an extensive review of the literature and current medical curricula, we propose an integrative curriculum model that broadly incorporates fundamental concepts of immunology across multiple disciplines and systems-based courses horizontally as well as vertically over the preclinical years using clinical presentations and laboratory findings and further connecting them to osteopathic principles. This integrative curriculum will augment medical students’ understanding of immunology, making them better able to connect core concepts with clinical applications and enhance their application of immunological concepts in osteopathic patient care in alignment with the NBOME guidelines. Using the proposed integrative medical curriculum may better prepare medical students for providing holistic medical care and guidance to their future patients. Full article

Child abuse affects millions of children globally. Comprehensive training is essential to promote its recognition and trigger appropriate responses to prevent missed opportunities for intervention. We describe a child abuse and child protection training programme for University of Ghana Medical School students and the cross-sectional survey of student assessment at the end. The programme comprised a lectures, dissertations, community surveys, case reports, public health advocacy topics, and poster designs. These were carried out as part of regular coursework in community health, using individual and group—methods. It culminated in a one-day whole-class seminar after their final examinations with completion and analyses of self-administered student assessment questionnaires. The seminar comprised nineteen 10-min oral presentations, twelve poster presentations on community surveys and dissertations, nine educative posters, three leaflets and a question-and-answer session. The training involved 208 students, and 126 completed the questionnaires. The majority of the students had good knowledge (80–100%). They correctly identified the types (91%), risk factors (87%), and gained clarity in selected areas. Added benefits were awards, a book of abstracts and summaries, policy brief and continuous professional development points for doctors. This training programme exemplifies the establishment of medical education in the context of the needs of the population to—be served. Full article

Entrustable Professional Activities-based (EPAs-based) assessments gained much interest among clinical educators, especially after the AAMC publication in 2014. In 2016, a standardized tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM), was developed at a national conference. Since 2018, the modified NCAT-EM has been used at Central Michigan University School of Medicine at shift ends, midway through clerkships, and upon completion of the clerkship. This empirical study analyzed student performance progression in order to enhance school assessment practices and inform future action plans. Descriptive and inferential statistics were calculated. During the 2021–2022 academic year, 89 faculty and residents assessed 97 students on 238 submission days. The students generally received multiple sets of daily shift feedback. Two domains, note writing and practice-based learning, showed significant differences between the mid-clerkship formative and summative scoring. Professionalism issues were evident with this cohort of students. The study provides some validity evidence regarding student performance and progression within the context. The NCAT-EM provides values and benefits as evidenced by the substantial volume of assessor feedback during its fourth year of implementation. This study provides directions for future action plans for faculty training, promising continuous improvement in emergency medicine assessment practices. Full article