International Medical Education doi: 10.3390/ime5020040

Authors: Hongjiao Wang Hadina Habil Noor Aireen Ibrahim

Empathy is fundamental to patient-centered care but frequently diminishes during clinical training. To inform medical education, we conducted a systematic review (PRISMA-2020-compliant) of interventions aimed at augmenting empathy in healthcare learners. We searched the PubMed, EMBASE, PsycINFO, CINAHL, ERIC, and Cochrane CENTRAL databases from the beginning of time until January 2026 for trials and pre- and post-studies that looked at empathy outcomes. Two reviewers evaluated the studies (κ = 0.86) and extracted data regarding participants, intervention format, and outcomes. Our initial search yielded 2056 records. After removing duplicates, 1250 titles and abstracts were screened, resulting in the inclusion of 43 studies from 2010 to 2026. The majority of studies reported improvements in empathy post-intervention, based on both self-report measures and observational assessments. Interventions that included active learning methods like role-playing, standardized patient encounters, narrative medicine, art workshops, and mindfulness led to much better improvements in empathy than passive, lecture-based methods. Long-term, multimodal programs that included communication skills training, reflective exercises, and patient contact were better than classes that only met once. Nonetheless, many studies used different, sometimes untested, empathy measures, and the follow-up period was often short. Our review demonstrates that empathy can be imparted through evidence-based curricular approaches. We advocate for the incorporation of prolonged, experiential empathy training into health professions education, alongside the standardization of outcome assessment. These results make it clear which teaching methods work best and point out areas where more research is needed.

International Medical Education doi: 10.3390/ime5020039

Authors: Philip Vogt Nadine Wolf Sophie Herrmann Sara Volz-Willems Aline Köhler Catherine Bopp Sandra Jordan Sinan Durant Anna Millenaar Tom Schlüter Lisa Zangarini Daria Gheorghe Marie Maingard Aaron Poppleton Fabian Dupont

Background: In-person conferences (IPCs) in family medicine remain central for cross-border collaboration and early-career development. With the rise of digital formats, the motivations of young general practitioners (GPs) to attend or organise IPCs require closer investigation. Methods: Using a modified two-round Delphi design, we surveyed 107 participants and 23 organisers of the 2024 and 2025 EYFDM (European Young Family Doctors’ Movement) Forums. Round one included open and closed questions; round two involved prioritisation tasks. Quantitative data were analysed with non-parametric statistics; qualitative responses were thematically coded. Results: Participants primarily attended in-person conferences for networking (56.1%), workshops, and inspiration, while formal content played a secondary role. Organisers emphasised personal development, citing project management and teamwork as key benefits, though 34.8% reported workload and lack of recognition as major barriers. A strong preference for in-person formats (94.4%) reflected the perceived importance of interpersonal interaction, which online formats could not replicate. Conclusions: The findings highlight IPC as key environments for identity formation, motivation, and sustainable European collaboration in family medicine. Organising offers learning opportunities but demands better structural support. Future conference planning must prioritise in-person interaction, while using hybrid formats as complementary tools. IPCs remain essential for fostering authentic networks and collaboration among young GPs.

International Medical Education doi: 10.3390/ime5020038

Authors: Oksana Babenko

The evolving digital landscape, including artificial intelligence (AI) and its generative forms, is changing how younger generations learn. As students utilize generative AI systems, they cultivate trust in such technology to support their current and long-term learning. The objective of this study was to investigate the relationship between generative AI use among students in health professions and their trust in this technology to support their lifelong learning as future health professionals. This study employed a survey methodology using a cross-sectional study design. The survey included sociodemographic variables and questions regarding students’ generative AI use and their trust in this technology to support their lifelong learning. Descriptive and inferential statistical procedures were used to analyze the data. A total of 558 students representing various health professions responded to the survey. In the regression analysis, after controlling for student’s sex and location variables, greater generative AI use was associated with students’ increased trust in this technology to support their lifelong learning (beta = 0.58, p < 0.001), explaining close to 40% of the total variance. Given the rapidly evolving digital landscape, this finding warrants further study, with implications for training of the future health workforce.

International Medical Education doi: 10.3390/ime5020037

Authors: Thomas Ziegler Nikolaus Poier-Fabian Jan Maximilian Janssen Michael Mayrhofer Paul Martin Zwittag

Background: The complex anatomy of the head and neck region challenges medical students. Cinematic rendering (CR) is an advanced visualization technique that enables three-dimensional (3D) representation of cross-sectional image data and is used in education at the Faculty of Medicine at Johannes Kepler University. Methods: For the first time, CR images were used to illustrate otolaryngology anatomy in medical education. The educational value of this approach was evaluated using a questionnaire assessing six core statements and dichotomous variables, including prior experience with CR and otolaryngology. Results: All six statements showed high levels of agreement based on mean evaluation scores. Evaluation results differed according to participants’ prior experience with CR. A strong correlation was exploratorily observed between prior experience with CR and improved spatial awareness of otolaryngology anatomy (ρ = 0.80, p < 0.05). Additionally, prior experience with CR correlated with improved understanding of complex disease processes (ρ = 0.76, p < 0.05) and enhanced general comprehension of the respective field (ρ = 0.74, p < 0.05). Conclusions: These findings suggest that early integration of CR into otolaryngology education may support students’ perceived spatial understanding and facilitate comprehension of complex disease processes.

International Medical Education doi: 10.3390/ime5020036

Authors: Sin Ting Hui Caitlin L. Gallagher Christine Brutus Sebastian Quintana Manav Jain Sarah Dubois Dominic Burns Ellen S. Smith Kit Ferguson Jack Herbster Brian Quach Sydney Kraez Melany Garcia Adrian C. Lee Anthony M. Payne Douglas McHugh

Learning objectives are a foundational component of undergraduate medical education and are widely assumed to guide students’ studying, planning, and self-assessment. Despite these assumptions, limited empirical work has examined how medical students actually use them in practice. This study examined learning objectives as strategic learning tools by contrasting educator-endorsed strategies identified through a scoping review with student-described practices derived from qualitative focus groups with pre-clerkship medical students. The scoping review identified educator-centered strategies emphasizing proactive planning, self-directed learning, and assessment alignment. Focus group findings revealed that students engaged with objectives selectively and reactively. Most often after learning events for self-testing, gap identification, and content triage; a pattern markedly different from educator assumptions of routine, front-end use. Two novel findings emerged: students’ use was shaped by conditional trust in objective quality and assessment alignment, and a subset of students independently developed technology-enabled adaptations (including AI-generated practice questions and flashcard conversion) not reflected in the existing educator literature. These findings highlight a meaningful gap between prescriptive guidance and student learning realities, and suggest that more learner-aligned approaches to supporting learning objective use are warranted.

International Medical Education doi: 10.3390/ime5020035

Authors: Brenda Ofelia Jay-Jímenez Diego Alberto Martínez-Islas Axel Tonatiuh Marroquin-Aguilar Fernanda Avelino-Vivas Dafne Montserrat Solis-Galván Alexis Arturo Laguna-González Bruno Manuel García-García Eduardo Minaya-Pérez Efren Quiñones-Lara Ismael Martínez-Bonilla Adolfo René Méndez-Cruz Héctor Iván Saldívar-Cerón

Diagnostic disclosure is a complex communication task that requires learners to integrate interpersonal attunement, structured information delivery, and condition-specific reasoning in real time. We conducted a randomized controlled trial comparing conventional diagnostic communication training with the same training supplemented by an AI-supported adaptive virtual patient simulation designed to provide additional deliberate practice and individualized, just-in-time feedback. Eighty undergraduate medical students were randomized 1:1 and completed standardized-patient encounters involving disclosure of a new diagnosis of type 2 diabetes mellitus before and after training. Performance was assessed by blinded physician raters using an adapted Kalamazoo rubric. Among students with complete pre–post data (conventional training, n = 25; AI-supported training, n = 26), both groups showed substantial improvement. Mean gains were numerically larger in the AI-supported group, with small-to-moderate standardized effects across selected communication domains; however, baseline-adjusted group-by-time interactions did not reach conventional thresholds for statistical significance, indicating that any added mean effects beyond conventional training remain uncertain. Exploratory person-level analyses suggested greater heterogeneity of improvement in the AI-supported condition, including a higher density of large gains in higher-order communication components. These findings should therefore be interpreted as exploratory rather than confirmatory. AI-supported adaptive simulation appears feasible as an adjunct to communication training, but adequately powered studies are needed to clarify effect magnitude, mechanisms, and generalizability across training contexts.

International Medical Education doi: 10.3390/ime5020034

Authors: Christian Andrés Verdugo Jonathan Martínez-Líbano

Self-regulated learning (SRL) is a fundamental competence for academic transition and success in higher education, especially in health sciences, where autonomy and learning management are essential. This systematic review analyzed the relationship between SRL, academic performance, and student well-being among undergraduate health sciences students. Following the PRISMA protocol, 39 articles published between 2015 and 2025 on Web of Science, Scopus, and PubMed databases were selected. The consolidated sample consisted of 24,835 participants. The methodological quality of the selected studies was assessed using the Newcastle–Ottawa scale (NOS). A predominantly positive association was found between high levels of SRL and academic performance (GPA) (with correlation coefficients ranging from r = 0.11 to r = 0.55 in the primary studies). Furthermore, evidence from standardized self-report questionnaires in the reviewed literature indicates that several studies report female students showed higher levels of organization and planning, but these findings were not consistently observed across all studies. SRL acts as a key protective factor against stress, anxiety, and academic burnout. However, a “stagnation paradox” was identified: SRL skills do not always evolve linearly, often showing regression or stagnation in advanced clinical years due to the high cognitive load and insufficient support structure in those environments. Regarding sociodemographic variables, female students reported higher levels of planning and responsibility. SRL does not develop spontaneously with academic progress. Therefore, higher-education institutions must implement systematic and intentional pedagogical strategies from the early years of training to foster student well-being and the development of resilient professionals.

International Medical Education doi: 10.3390/ime5010033

Authors: Anna La Palma Giuliana Scarpati Giulia Savarese Ornella Piazza

Teaching empathy remains a challenge in medical education, particularly in anesthesiology, where physicians frequently care for patients at the end of life. Narrative Medicine, centered on communicative competence and patients’ lived experience, offers a framework for cultivating reflective and relational skills. Meanwhile, artificial intelligence (AI) systems can generate expressions of empathy, raising questions about authentic moral engagement. To explore how narrative-based education, combined with AI-generated texts, may stimulate reflection, we implemented an exploratory narrative-based intervention involving 25 anesthesiology residents, supported by three tutors, integrating literature, film, and AI-generated narratives. After an introduction session, participants engaged with excerpts from the book What Are You Going Through and the film The Room Next Door, followed by reflective writing based on five prompts. The same prompts were submitted to ChatGPT (OpenAI, GPT-4o) for comparative analysis, discussed during a debriefing session. Reflective writings were assessed using an adapted REFLECT rubric, alongside qualitative lexical and semantic analyses. Most participants did not reach the highest levels of reflective capacity, while ChatGPT texts achieved higher REFLECT scores, primarily due to linguistic coherence. These findings suggest that empathic competence is neither automatically acquired through medical training nor reducible to verbal fluency. Rather, it requires structured training grounded in meaningful engagement with patients.

International Medical Education doi: 10.3390/ime5010032

Authors: Marie Therese Ettlen Ulrike Keim Claudia F. Plappert

(1) Background: Midwifery students require practical training experience to learn how to perform a medical history. Simulation-based training, such as chatbot exercises using large language models like GPT, provide structured practice but require ongoing evaluation. This study explores German midwifery students’ views on using an AI chatbot simulating a pregnant woman, regarding usability, realism, and educational value. (2) Methods: Twenty-six students participated in a descriptive, quantitative cross-sectional survey, using a literature-based, self-developed questionnaire after interacting with the AI generative chatbot. Data were analyzed via SPSS 30.0, with results shown in a stacked horizontal bar chart. (3) Results: The findings indicate that students experienced no difficulties when interacting with the chatbot. Both the quality and realism of the conversations were evaluated positively. Chatbot training was perceived as helpful in supporting structured medical history interviews and the collection of relevant data but was not considered a substitute for practice with actors or real-life situations. (4) Conclusions: The findings suggest that the medical history chatbot offers midwifery students an innovative, flexible simulation for training. Students responded positively, and it may help develop structured history-taking skills. Further study is needed to determine if repeated chatbot use improves medical history collection skills.

International Medical Education doi: 10.3390/ime5010031

Authors: Thomas Mayers C. Kiong Ho Naoki Maki Testuhiro Maeno

The COVID-19 pandemic caused major disruption to healthcare education worldwide, forcing rapid transitions to online learning, interruptions to clinical placements, and heightened uncertainty that profoundly influenced student experiences. Given that academic motivation is a key determinant of learning quality, persistence, and professional identity, this review sought to consolidate global evidence on how the pandemic affected healthcare students’ motivation to study. A systematic search of peer-reviewed literature was conducted following PRISMA-ScR guidelines, identifying studies across medicine, nursing, and allied health programs that reported on changes in motivation and the factors shaping these trajectories. Extracted data were synthesized narratively, with attention to emerging themes such as stress, anxiety, burnout, resilience, gender differences, and the role of professional identity formation. Findings revealed substantial variability: while many students reported reduced motivation due to social isolation, technological barriers, and limited clinical exposure, others described increased drive linked to professional responsibility, adaptability, and resilience. Evidence also indicated gendered differences in motivational patterns, with female students more likely to report stress-related declines. Overall, the pandemic exposed both vulnerabilities and strengths in healthcare student motivation, pointing to the value of educational strategies that promote motivation, resilience, and professional identity development among future practitioners.

International Medical Education doi: 10.3390/ime5010030

Authors: Annalena Maria Sophie Göttsche Marcus Vollmer Richard Kasch Lyubomir Haralambiev Axel Ekkernkamp Mustafa Sinan Bakir

Introduction: The potential aggravation of the shortage of skilled professionals in surgical specialties presents challenges. The lack of work–life balance and the pressure of training may deter aspiring surgeons. Surgical disciplines still remain predominantly male so that feminization combined with factors such as part-time work and pregnancy-related absence may aggravate workforce shortages. Studies show that the next generation of physicians places more value on work–life balance and seeks a pleasant work environment. This raises the question of whether these developments pose a threat to the future of surgical disciplines or whether generational change may also offer new opportunities. Methodology: This prospective observational study was conducted among a cohort of third-year medical students at a medical university in Germany. A non-validated, self-administered questionnaire was used for data collection. Responses on the Likert scale were dichotomized and the results were statistically analysed using chi-square test and logistic regression. Results: Job expectations differed only marginally across specialties. Students generally rated work–life balance and a pleasant work environment significantly higher than career, income or prestige. Students interested in surgery place significantly less emphasis on work–life balance than non-surgical peers, particularly in orthopedics and trauma surgery (77% vs. 90%, p = 0.025). There was a significant association between interest in surgical specialties and leadership ambitions. Male students were significantly more likely than females to aspire to leadership roles (58.1% vs. 32.7%, p = 0.001) and to choose surgical specialties (46.0% vs. 28.3%, p = 0.018). Female students were not significantly less interested in trauma surgery. Conclusions: Although our data interpretation should be drawn with caution, the increasing feminization of medicine does not appear to exacerbate the shortage of physicians in trauma surgery. In our cohort, we made the indicative suggestion that aspiring surgeons might be willing to trade leisure for career advancement. Specialized curricula could promote identification with the field and develop leadership skills, so that an initial attachment to a specific specialty endures throughout medical studies and results in a corresponding choice of specialty.

International Medical Education doi: 10.3390/ime5010029

Authors: Uma Padhye Phatak Alex Koral Daniel S. Kamin Alan Schwartz Richard Mink Cary Sauer

Entrustable professional activities (EPAs) define key tasks expected of physicians. The entrustment levels that US pediatric gastroenterology (GI) fellowship program directors (FPDs) expect of graduating fellows remain unclear. This study aimed to identify the minimum entrustment levels FPDs expect for graduation and for safe and effective practice. We conducted a secondary analysis of GI data from a national multispecialty cross-sectional survey. FPDs reported the minimum entrustment level for fellows expected for graduation, whether they would graduate a fellow not meeting this level, and the minimum level for practice. A minimum entrustment level was defined as a level where at least 80% of FPDs would not allow a lower rating. Most FPDs did not require level 5 (unsupervised practice) for graduation or for practice. Instead, level 4 (indirect supervision with discussion of complex cases) was the most commonly required minimum for GI EPAs. When adjusted for FPD willingness to graduate fellows even if they did not meet the expected minimum, the level was 3 (direct supervision for complex cases) across all GI-specific EPAs. These findings underscore the potential need for ongoing mentorship, professional development, and continuing medical education after GI fellowship, particularly in the early practice period.

International Medical Education doi: 10.3390/ime5010028

Authors: Vicente Doménech-Briz Vicente Gea-Caballero Elena Chover-Sierra Raúl Juárez-Vela Noelia Navas-Echazarreta Pablo del Pozo-Herce Marta Pardo-Bosch Aurora García-Tejedor Beatriz Sánchez-Hernando Raquel María Martínez-Pascual Antonio Martínez-Sabater

Background: Adequate nutritional knowledge among intensive care nurses is essential for early identification of nutritional risk and prevention of complications in critically ill patients. The questionnaire “Nurses’ perceptions of responsibility, knowledge and documentation focusing on enteral nutrition and nursing practice regarding enteral feeding in the intensive care unit”, developed by Persenius et al., is used internationally, yet no culturally adapted Spanish version has been available. Objectives: This study aimed to translate and culturally adapt Persenius et al.’s questionnaire and evaluate its content for use among Spanish-speaking intensive care unit (ICU) nurses. Materials and methods: A multistep process was conducted, including forward–backward translation, expert review by an expert panel of ICU nurses (N = 26) with at least 2 years of critical care experience, and content validity analysis. Experts rated item relevance and comprehensibility. Item Content Validity Index (I-CVI), Scale CVI, and Aiken’s V were calculated using predefined thresholds. Linguistic clarity/comprehensibility was assessed on a 5-point Likert scale (1–5). To assess the questionnaire’s reliability, Cronbach’s alpha was also analysed in a pilot study (N = 99). Results: The Spanish version retained all 47 original items after minor linguistic adjustments. All items met the minimum content validity threshold; most showed I-CVI values > 0.78 and acceptable Aiken’s V coefficients. The mean comprehensibility score for all items exceeded 4.0, indicating high clarity. No item required significant semantic modification after expert review. Cronbach’s alpha coefficient of 0.85 reflected its reliability. Conclusions: The Spanish version of Persenius et al.’s questionnaire demonstrated adequate content and linguistic validity and internal consistency in a pilot sample of ICU nurses.

International Medical Education doi: 10.3390/ime5010027

Authors: Mohammad Muzaffar Mir Muffarah Hamid Alharthi Jaber Alfaifi Shahzada Khalid Sohail Saba Muzaffar Mir Nadeem Tufail Raina Javed Iqbal Wani Saleem Javaid Wani Shahid Aziz Ayyub Ali Patel Abdullah M. Alshahrani Mohammed Ohaj Elhadi Miskeen Rashid Mir Adnan Jehangir

Artificial intelligence (AI), particularly generative AI, is rapidly reshaping medical education worldwide. While AI-enabled tools offer significant opportunities for personalized learning, feedback automation, and clinical reasoning support, they simultaneously challenge foundational principles of assessment integrity and professional conduct. Traditional assessment models—largely predicated on individual authorship, knowledge recall, and observable performance—are increasingly strained by AI systems capable of generating sophisticated responses, analyses, and clinical narratives. This disruption has prompted urgent reconsideration of what constitutes academic honesty, valid assessment, and professional identity formation in contemporary medical training. This article critically examines the intersection of AI, assessment integrity, and professionalism in medical education from a global perspective, with particular attention to the experiences and emerging lessons from the Gulf Cooperation Council (GCC). The GCC provides a distinctive context characterized by rapid digital transformation, centralized accreditation and licensing systems, high-stakes assessments, and strong sociocultural norms governing professional behavior. These features make the region an instructive case for understanding how medical education systems respond to AI-driven challenges at scale. The article employs a critical narrative and conceptual framework, positioning generative AI as a normative disruptor that necessitates a reevaluation of assessment validity, ethical accountability, and the construction of professional identity. Utilizing worldwide scholarship, policy frameworks, and regional experiences, the analysis underscores that misalignment between assessment design and professional expectations jeopardizes trust, fairness, and public confidence. The essay advocates for a transition from reactive restriction to the principled integration of AI, highlighting the need for assessment redesign, AI literacy matched with professionalism, teacher development, and cohesive governance. These insights are intended to guide educators, institutions, and regulators in maintaining professional standards inside AI-enhanced medical education systems.

International Medical Education doi: 10.3390/ime5010026

Authors: Jose-Manuel Ramos-Rincon Jenna L. Norton Sergio Martin-Benlloch Maria Lopez-Brotons Carlos Fernando Valenzuela

This article adopts a focused comparative perspective on two medical schools to illuminate shared strengths and systemic challenges across educational and regulatory contexts. Undergraduate medical education at the University of New Mexico Health Sciences Center (USA) and the Universidad Miguel Hernández (Spain) is analyzed, highlighting common strengths, including solid biomedical foundations, early clinical exposure, and the growing adoption of competency-based approaches. Despite these assets, both institutions face convergent challenges, including rigid curricula, faculty constraints, and difficulties sustaining student engagement in active learning, exacerbated by rapid digital transformation. The analysis supports recommendations to increase curricular flexibility and personalized instruction, strengthen student-centered and interprofessional learning, optimize educational technology, and reform assessment toward continuous feedback and the demonstration of clinical competence.

International Medical Education doi: 10.3390/ime5010025

Authors: Ángela M. Gómez Javier Fagundo-Rivera Miguel Garrido-Bueno Andrés Castillejo-del-Río

The progressive digitalization of healthcare requires nursing students to develop digital competence to safely access, evaluate, and apply scientific information in clinical practice. This study described nursing students’ perceived digital competence and confidence in using digital resources to support evidence-based clinical decision-making after a structured educational seminar. A descriptive post-intervention, single-group study was conducted with 35 undergraduate nursing students enrolled in a compulsory clinical nursing course. The two-hour seminar covered evidence-based websites and clinical guidelines, biomedical database searching, and use of a wound-management mobile application. Data were collected using an anonymous 12-item Likert-scale questionnaire (Cronbach’s alpha = 0.935). Domain mean scores ranged from 4.19 (SD = 0.83) to 4.51 (SD = 0.67). The highest item mean was for continuous learning (M = 4.63, SD = 0.60) and the lowest was for statistical programs (M = 4.03, SD = 0.95); intellectual property protection was also lower (M = 4.17, SD = 0.89). Spearman correlations showed no significant associations between age and any item after Bonferroni correction (adjusted α = 0.0042; all p > 0.05). These findings describe high perceived digital competence and identify areas for further educational reinforcement.

International Medical Education doi: 10.3390/ime5010024

Authors: Franziska König Doreen Herinek Franziska Matthes Michael Ewers

Health Professions Education research is playing an increasing role in ensuring evidence-based practice in Health Professions Education (HPE). To this end, HPE research uses, among other approaches, comparisons as a method in the sense of Comparative Education Research (CER), which allows to compare programs at different levels of education. To obtain evidence-based results, it needs a methodologically sound approach with transparent and justifiable sampling strategies as well as defined sampling criteria. The aim of this research is to identify sampling criteria used in CER for program comparisons and to draw conclusions about what HPE research can probably learn from that. We conducted a scoping review following the Arksey and O’Malley framework, searching three databases and grey literature for international comparative education studies. Four reviewers selected and analyzed the studies using content analysis. A total of 68 studies were included, and six sampling criteria for international CER were identified: (1) culture, (2) education system, (3) curriculum of an education program, (4) ranking, achievement or performance, (5) state and relevance of research, and (6) opportunities and pragmatic reasons. All these criteria appear to be applicable to education research on HPE programs. The sampling criteria derived can serve as a guide for sample selection in international CER and HPE research, providing impetus to improve the quality of research methodology. This necessitates unrestricted access to data on educational programs and a more profound comprehension of the cultural, political and educational characteristics of the respective country.

International Medical Education doi: 10.3390/ime5010023

Authors: Shalini Virani Parveen Rewri Priya Gupta Dinesh Badyal

The competency-based medical education (CBME) curriculum was introduced recently for undergraduate courses in medical institutions in India. The program needs a paradigm shift in the teaching and assessment methods. Therefore, challenges at the individual as well as organizational level are expected in the initial years of implementation. We used a mixed-method approach through focus group discussions (FGD) and an online survey to assess the perception and attitude of MBBS phase 1 and 2 teachers towards CBME. Themes were generated from FGD, and quantitative data were collected using a structured questionnaire through an online survey. Nearly 80% of the participating faculty perceived that the CBME curriculum was better than traditional teaching methods. Major challenges were either related to a deficiency of curriculum-optimized learning material (85%), material infrastructure (38%), and manpower (46%), or increased documentation (74%), and time constraints (52%). The faculty felt attitudinal change (63%), better acquaintance with the professional environment (60%), improved participation (58%), and the performance of students (38%) were major commendations of CBME. The CBME curriculum is a welcome change in Indian medical teaching institutes, and faculty intend to improve it through feedback mechanisms. The perceived complexities need to be addressed at different levels through collaborative approaches.

International Medical Education doi: 10.3390/ime5010022

Authors: Marcos J. Ramos-Benitez Martha E. García-Osorio Yamixa Delgado

The integration of artificial intelligence (AI), particularly large language models (LLMs), into education, marks a profound shift in how knowledge is accessed, processed, and applied. These tools offer clear advantages—including improved efficiency, immediate support, and high productivity—but it may simultaneously weaken foundational skills. This Perspective examines the dual impact of AI on education, arguing that over-reliance on AI may displace essential cognitive processes that reinforce professional competence. Emerging evidence points to troubling associations between frequent AI use and diminished critical reasoning. We propose a model of critical alliance, in which AI augments but does not replace core intellectual processes. Unlike existing AI competency or digital literacy, this model centers on preserving human cognitive agency, judgment, reflection, and intellectual ownership, as primary educational outcomes. This framework not only emphasizes cognitive independence, but also equitable access, ethical vigilance, and faculty development as cornerstones of AI literacy. Addressing these questions is essential to safeguard both intellectual growth and educational equity in an AI-augmented era. Unlike existing digital literacy or AI competency frameworks, the critical alliance explicitly centers on preserving human cognitive agency and intellectual ownership as educational priorities, particularly in environments increasingly shaped by high-performing generative systems.

International Medical Education doi: 10.3390/ime5010021

Authors: Laurie C. Neely Patrick Pabian Randi Richardson Chloe Artrip Logan Brown Morris Casano Beato

Simulation-based learning experiences (SBLE) are widely used in health professions education to enhance clinical skills, confidence, and decision-making in a safe environment. In Doctor of Physical Therapy (DPT) programs, peer simulation offers a cost-effective alternative to high-fidelity simulation and standardized patients, though its effectiveness across different instructional formats remains underexplored. This study examined the differences in student confidence in outpatient physical therapy between cohorts of students from three educational delivery methods, which included face-to-face (F2F), virtual instruction (VI), and F2F combined with integrated clinical experiences (F2F + ICE), prior to their first clinical experience. Using a three-group comparative design, 107 students across three academic years (2019, 2020, and 2022) completed pre- and post-course surveys assessing confidence in four domains and interest in outpatient care. A two-way ANCOVA, controlling baseline interest, revealed significant differences in confidence across all cohorts between pre- and post-course assessment time periods (p < 0.001), with no significant differences between cohorts under the various delivery formats at post-course assessment. While the F2F + ICE group demonstrated higher baseline confidence, this difference was not found post-course. Findings suggest that peer simulation effectively improves perceived confidence in outpatient physical therapy regardless of delivery mode. These results support the integration of SBLE in DPT curricula to prepare students for clinical practice and highlight the need for further research across multiple programs.

International Medical Education doi: 10.3390/ime5010020

Authors: Adrian C. Lee Cathleen Li Anne Yan Reuben R. Reyes Sharon Kung Shawnae B. Remulla Alan C. Chai Megan M. Tran Julianne M. Hall

While the distribution of those underrepresented in medicine (URiM) varies across US medical specialties, it remains unclear whether residency website diversity messaging influences these patterns by specialty and geographic region. This study investigates residency diversity messaging from different specialties and assesses factors that influence URiM recruitment. The 2024 AAMC Report on Residents identified the three specialties with the highest and lowest URiM representation (Integrated Thoracic Surgery, Otolaryngology, Interventional Radiology, Public Health and General Preventive Medicine, Obstetrics and Gynecology (OBGYN), and Family Medicine). Using FREIDA™, all residency programs were reviewed between December 2024 and March 2025. Websites received diversity indicator scores based on the presence of a nondiscrimination statement, a diversity and inclusion message, a program-specific diversity section, a general diversity section, an appointed diversity leadership position(s) or committee(s), URiM rotations or fellowship opportunities, and diversity initiatives. Diversity scores only differed significantly between OBGYN and Family Medicine (p = 0.003). Significant regional differences include South–Midwest (p = 0.014), South–Northeast (p = 0.030), West–Northeast (p = 0.044), and West–South (p < 0.001). Multivariate analysis showed no relationship between diversity criteria and URiM representation, suggesting current messaging that emphasizes diversity may not be associated with URiM resident proportions. Programs in the South had lower diversity scores, indicating geography may influence URiM representation more than website content.

International Medical Education doi: 10.3390/ime5010019

Authors: Sana Loubbairi Laila Lahlou Yassmine El Moussaoui Abdelkader Amechghal Hicham Nassik

Background: This study evaluated the impact of high-fidelity simulation versus simulation with standardized patients on the development of reflective practice among medical students. Methods: A randomized controlled trial design with both pre- and post-simulation assessments was adopted. Thirty-two final-year medical students were randomly assigned to two groups (Group 1: high-fidelity simulation (n = 16); Group 2: simulation with standardized patients (n = 16)). Each group participated in six sessions over the course of two months, including six identical scenarios for both groups. The Groningen Reflection Ability Scale (GRAS) was used to assess the participants’ reflection skills before and after the simulation. Data were analyzed using descriptive statistics, paired t-tests for within-group changes, and independent t-tests for between-group comparisons. Results: Reflection scores improved significantly from pre- to post-simulation across the combined sample (p < 0.05). Within-group analyses demonstrated statistically significant improvements in self-reflection (31.3 ± 7.11 vs. 36.8 ± 5.34; p < 0.001), empathic reflection (19.1 ± 4.68 vs. 20.6 ± 4.51; p = 0.020), and reflective communication (23.1 ± 5.11 vs. 25.5 ± 4.35; p < 0.001). Additionally, between-group comparison revealed that the high-fidelity simulation group attained a significantly higher total reflection ability score compared with the standardized patient group (91.8 ± 7.70 vs. 74.0 ± 11.55; p <0.001). Conclusions: Simulation practice, whether high-fidelity or with standardized patients, helps to improve students’ reflection. However, high-fidelity simulation was proven to be more effective than simulation with standardized patients. This study reinforces the use of simulation as a tool for developing reflective practice skills in medical training.

International Medical Education doi: 10.3390/ime5010018

Authors: Amélie Blanchet Garneau Cheryl Ward Patrick Lavoie Jennifer Petiquay-Dufresne Marilou Bélisle Diane Smylie Céline Nepton

Racism within healthcare systems remains a critical barrier to equitable care for Indigenous Peoples. Despite calls from the Truth and Reconciliation Commission of Canada to integrate anti-racist frameworks into health education, implementation remains limited. Understanding how educators integrate Indigenous-specific anti-racist pedagogy is essential for developing effective and sustainable teaching approaches. This study aimed to identify the pedagogical principles that educators implement when teaching Indigenous-specific anti-racism in health professionals’ education programs. Using biographical narrative methodology, we conducted 17 in-depth interviews between September 2023 and March 2024 with educators who met three criteria: (1) teaching in Canadian health professional programs, (2) explicit commitment to anti-racist approaches, and (3) focus on Indigenous health content. Analysis was validated through race-based focus groups (n = 8), individual follow-up interviews (n = 4), and written feedback (n = 5). Thematic analysis identified six interconnected pedagogical principles specifically designed for Indigenous-specific anti-racist education, grounded in educators’ lived experiences: (1) centering and privileging Indigenous knowledge, worldviews, and strategies; (2) adopting a relational approach to teaching and learning; (3) contextualizing content in relation to colonialism; (4) supporting transformational learning leading to action; (5) embracing discomfort and addressing resistance; and (6) incorporating accountability mechanisms. These principles collectively create safe and transformative learning environments that challenge systemic racism in healthcare education. Implementing Indigenous-specific anti-racist pedagogy requires a holistic, systemic approach that centers Indigenous knowledge, fosters relational learning, and embeds accountability. These principles provide a framework for educators and institutions committed to decolonizing health education and advancing health equity for Indigenous Peoples.

International Medical Education doi: 10.3390/ime5010017

Authors: Eva García Carpintero-Blas Ana Sanz-Cortés Pablo Del Pozo-Herce Marta Rodríguez-García Maria Del Carmen Hernández-Cediel Elena Chover-Sierra Antonio Martínez-Sabater Regina Ruiz De Viñaspre-Hernández Raúl Juárez-Vela Alberto Tovar-Reinoso

Background: Communication with patients and families at the end of life is key to quality care, allowing for informed decisions and emotional support. This study explores the experience of nursing students in clinical simulations, analyzing their emotions, perceptions of the family role, the impact on their communication skills, and their reflection on the role of nursing in these contexts. Methods: This study was conducted at the Faculty of Health Sciences of UNIE University, Spain, with 44 first-year students enrolled in the Fundamentals of Psychology in Health Sciences course. Data were collected through focus groups and reflective narratives with open-ended questions between January and February 2025. Following data collection, transcripts were generated and subjected to a thematic analysis following the COREQ checklist. Results: Five thematic blocks and their categories were identified: (T1) Family as a pillar of care; (T2) Relationship with the family; (T3) Communication as a therapeutic tool; (T4) Emerging emotions; (T5) Learning through simulation. Conclusions: The family is a fundamental pillar at the end of life, providing emotional and practical support to the patient and the care team. Communication is key to building trust and facilitating acceptance of the process. Students experience diverse emotions that reflect the complexity of the accompaniment. Simulation at the end of life allows nursing students to develop communication skills, reflect on their professional role, and manage complex emotions.

International Medical Education doi: 10.3390/ime5010016

Authors: Gillian Maudsley

Educators’ epistemological experience of facilitating medical students’ active learning is under-researched, especially concerning non-biomedical learning in integrated curricula. Longitudinal, qualitative research on problem-based learning (PBL) tutors’ long-term insights is rare. Therefore, this study explores the following question: How do tutors conceptualise knowledge and knowing, particularly non-biomedical, after substantial experience in an integrated, problem-based medical curriculum and how does that relate to the student perspective? In a mixed-method study (pragmatism paradigm), sixteen years after semi-structured interviews with inaugural PBL tutors, follow-up interviews with the remaining ten revisited their replies about the population health knowledge theme. Via e-questionnaire, two years later, 9/10 tutors discussed student comments about their own knowledge base from four historical surveys (two student-cohorts, Years 1 and 5). Those surveys also provided a backdrop of comments on the public health knowledge theme, including threshold concepts and reducing health inequalities, plus Moore’s Cognitive Complexity Index (CCI). Each survey found mean CCI in Perry position 3–4 transition (multiplicity-to-relativism). Uncertainty or concern, especially about feared basic science gaps, prevailed across CCI scores. Public health knowledge appeared ‘worthy’ but unappealing for students’ professional identity, but tutors now appreciated its ‘ways of knowing’ and were more reflective, flexible, and accommodating about their own and students’ knowledge. Persistent challenges were student uncertainty or concern about knowledge gaps, particularly basic science, and conflict between knowledge types, for which staff and student epistemological support should be explicitly anticipated. Further research should explore staff–student epistemologies about other types of knowledge.

International Medical Education doi: 10.3390/ime5010015

Authors: Michelle Helen Cruickshank Heather Gadalla Ewaoluwa Akomolafe Natasha Johnson Patricia Farrugia

Background: Many Canadian medical schools have introduced equity-focused admissions pathways for Black and Indigenous applicants, yet little is known about how current medical students perceive these policies. Understanding these perceptions is critical to ensuring equity initiatives are effective and well-supported. Methods: We conducted a cross-sectional survey of 95 undergraduate medical students at McMaster University. The survey included Likert-scale, multiple-choice, and open-ended questions assessing attitudes toward Black and Indigenous facilitated admissions pathways. Educational background was categorized by the number of humanities/social science courses taken prior to medical school. Quantitative data were summarized descriptively; qualitative responses were thematically analyzed. Results: Most students supported diversity in medicine and agreed that equity pathways address barriers faced by Black and Indigenous applicants. However, fewer than half felt informed about the purpose of these pathways. Responses highlighted concerns about transparency, fairness, and the possibility that pathways may disproportionately benefit higher-socioeconomic-status applicants. Subgroup trends did not show consistent support among students with greater exposure to humanities/social sciences; some expressed stronger skepticism regarding fairness. Qualitative themes emphasized the need for clearer communication, recognition of socioeconomic barriers, and expansion of equity initiatives. Interpretation: Students broadly valued equity-focused admissions but questioned their implementation and transparency. Concerns about socioeconomic privilege and unclear standards indicate a need for better institutional communication and more inclusive eligibility criteria. Equity pathways should be paired with structured education and clear messaging to foster trust, improve understanding, and align admissions policies with the social accountability mandate of medical education.

International Medical Education doi: 10.3390/ime5010014

Authors: Constanze Dietzsch Johanna Klutmann Helene Junge Sandra Jordan Sophie Sun Aaron Poppleton Fabian Dupont

(1) Background: The evolving demands of general practice have increased stress, workload, and fatigue among patients and doctors. In 2022, the European Young Family Doctors Movement (EYFDM) identified wellbeing as a key competency for future GPs. This study primarily explored the perspectives of early-career GPs on integrating wellbeing in general practice training. (2) Methods: A concurrent mixed-methods approach combined a quantitative survey with a town hall discussion at the EYFDM workshop during WONCA Europe 2023 in Brussels. The meeting included brainstorming, subgroup discussions, and synthesis of findings. Subgroup discussions among young GPs and GP trainees were recorded, analyzed using content analysis, and validated through two rounds of stakeholder consultation. (3) Results: Participants advocated for mandatory wellbeing-focused timeslots during training with flexible, self-selected learning activities. Proposals included a toolbox with individual, group, and supervised options. A cultural shift towards prioritizing wellbeing as part of professional development was unanimously supported. Senior GP involvement was seen as crucial for driving this change, alongside wellbeing training for coaches and role models. (4) Conclusions: GP trainees across Europe emphasize the need for greater focus on wellbeing in training, supported by a generational cultural shift. Voluntary, diverse learning activities (toolbox) and role-modeling activities with experienced GPs may support wellbeing to be embedded as a core competency in general practice.

International Medical Education doi: 10.3390/ime5010013

Authors: Esteban Zavaleta-Monestel José Miguel Chaverri-Fernández Angie Ortiz-Ureña Luis Esteban Hernández-Soto Jeaustin Mora-Jiménez Andrea Chaves-Arroyo Lissette Rodríguez-Yebra Melissa Martínez-Domínguez Natalia Bastos-Soto Sebastián Arguedas-Chacón

Background: Artificial intelligence (AI) is reshaping health sciences education worldwide, yet regional data from Latin America remain scarce. Understanding students’ AI literacy and perceptions is essential for developing informed curricular strategies. Methods: A cross-sectional online survey was conducted among 270 students from four Costa Rican universities across five health sciences programs. Descriptive and inferential analyses (ANOVA, Chi-square) examined AI knowledge, usage frequency, and perceptions of ethical integration in academic contexts. Results: Over 80% of respondents reported moderate or higher AI knowledge and frequent use of tools such as ChatGPT, mostly for academic support tasks. However, more than 90% had not received formal institutional training, and ethical awareness—particularly regarding misinformation and bias—was limited. Conclusions: Students demonstrate active engagement with AI despite minimal curricular exposure. These findings emphasize the need for structured AI training, faculty development, and equitable access policies aligned with global digital ethics frameworks to ensure responsible adoption within Costa Rican health sciences education.

International Medical Education doi: 10.3390/ime5010012

Authors: Heather Wolfe Allison Schneider Carolyn Davis

The use of interpreter services is an important component of medical care. It is critical for medical students to practice this during training. It is known that simulation and role play provide important opportunities for students to practice skills. This scoping review maps the experience that medical students around the world have practicing with interpreter services in a simulated environment. We searched within three major databases (PubMed, ERIC, and SCOPUS) using a wide range of search terms for publications from the past 15 years. This scoping review was conducted according to PRISMA-ScR guidelines. Of the 1341 studies initially obtained from search terms, 22 were ultimately found to meet inclusion criteria. There is variability in curricula offered including when in medical school, what other specialties are involved, and how the education is conveyed. Most publications lacked longitudinal follow-up and assessment of learner competence was limited. Review articles, a prevalence study, and proof of concept studies also serve to demonstrate the breadth of publications on this subject. This is an area of important consideration within medical education today. Many studies highlight the relative scarcity of formal programs as well as a lack of consistency. Where programs do exist, the importance of including simulation is highlighted.

International Medical Education doi: 10.3390/ime5010011

Authors: Kaori Yamada Yoko Inaguma Sayuri Nakamura Masatsugu Ohtsuki Hitomi Kataoka Atsuhiko Ota

This pre–post study aimed to determine whether interprofessional education (IPE) combining online and in-person instruction enhanced medical students’ empathy. The IPE program was conducted during the academic years 2022 and 2023 for medical (n = 240) and other healthcare students. Subjects discussed a case scenario involving a patient with chronic myeloid leukemia, sharing their ideas within their team and with other teams. The medical students’ empathy was assessed before and after the IPE program using the Japanese version of the Jefferson Scale of Empathy for Health Professions Students (JSE-HPS). Medical students provided written responses to the question, “What do you think is necessary for the care of patients with cancer, besides medical skills and knowledge?” Empathy-related terms were identified using frequency and co-occurrence analyses. The frequencies before and after the IPE were compared. The median JSE-HPS score rose from 98.0 to 114.0 (p < 0.001, Wilcoxon signed-rank test). The frequency of words categorized as demonstrating empathy increased from 37.9% to 52.9% after the IPE (p < 0.01, chi-square test). Our hybrid IPE program enhanced medical students’ empathy, which was supported by both quantitative and qualitative methods.

International Medical Education doi: 10.3390/ime5010010

Authors: Zhiling Qu Chengcheng Wang Yaqi Duan Junhong Guo Rumeng Yang Huiling Yu Xi Wang Zitian Huo

Background: Pathology education requires innovative experimental teaching approaches to enhance clinical competency. This study evaluated the integration of special staining techniques into pathology curricula to improve diagnostic confidence and practical skills. Methods: The reform involved 227 medical students, incorporating acid-fast, PAS, GMS, Congo red, and other special stains into laboratory sessions. Diagnostic confidence was surveyed, and theoretical and practical exam scores were compared with 180 students from a previous grade. Statistical analysis was performed using GraphPad Prism 7.0. Results: Practical exam scores significantly improved (86.0 ± 17.2 vs. 82.2 ± 18.9, p < 0.001), while theoretical scores remained unchanged. Diagnostic confidence strongly correlated with morphological recognition, particularly for acid-fast and fungal stains. Student feedback noted challenges such as staining artifacts. Conclusion: Integrating special staining enhances practical skills and diagnostic confidence, effectively bridging basic and clinical training. Expanding such modules is recommended to advance competency-based medical education.

International Medical Education doi: 10.3390/ime5010009

Authors: Masatoshi Miyamura Goro Fujiki Yumiko Kanzaki Kosuke Tsuda Hironaka Asano Hideaki Morita Masaaki Hoshiga

Background: Recent advances in artificial intelligence (AI) have produced ChatGPT-4o, a multimodal large language model (LLM) capable of processing both text and image inputs. Although ChatGPT has demonstrated usefulness in medical examinations, few studies have evaluated its image analysis performance. Methods: This study compared GPT-4o and GPT-4 using public questions from the 116th–118th Japanese National Medical Licensing Examinations (JNMLE), each consisting of 400 questions. Both models answered in Japanese using simple prompts, including screenshots for image-based questions. Accuracy was analyzed across essential, general, and clinical questions, with statistical comparisons by chi-square tests. Results: GPT-4o consistently outperformed GPT-4, achieving passing scores in all three examinations. In the 118th JNMLE, GPT-4o scored 457 points versus 425 for GPT-4. GPT-4o demonstrated higher accuracy for image-based questions in the 117th and 116th exams, though the difference in the 118th was not significant. For text-based questions, GPT-4o showed superior medical knowledge, clinical reasoning, and ethical response behavior, notably avoiding prohibited options. Conclusion: Overall, GPT-4o exceeded GPT-4 in both text and image domains, suggesting strong potential as a diagnostic aid and educational resource. Its balanced performance across modalities highlights its promise for integration into future medical education and clinical decision support.

International Medical Education doi: 10.3390/ime5010008

Authors: Reem M. Alhossaini Anthony Richard Cox Sarah Katie Pontefract

Script Concordance Tests (SCTs) assess clinical reasoning under uncertainty. While construction guidelines exist, the feasibility of collaborative development approaches and educators’ real-time experiences remain underreported. This feasibility study explores how medical educators construct SCTs collaboratively and their perceptions of the process. Four UK-based medical educators developed SCTs for prescribing in older adults during a three-hour workshop involving observation with a think-aloud approach, followed by a post-workshop focus group. Data were analysed using Braun and Clarke’s thematic analysis, Tuckman’s group development informed observation analysis, and an inductive approach for the focus group. Educators created seven vignettes (30 items) in 127 min, averaging 18 min per vignette. Observation revealed small-team role specification (lead, scribe, challenger) and three themes: content development, quality checks, and team dynamics. The team progressed rapidly through Tuckman’s stages, spending most of the time in the performing stage. Focus group analysis revealed four themes: design features, perceived utility, group dynamics and best-practice recommendations. This study demonstrates the feasibility of collaborative SCT development through structured teamwork. Educators perceived SCTs as practical, as valuing effective team dynamics and clear role distribution. Findings can provide practical insights for institutions implementing SCT development, emphasising practice sessions and appropriately sized collaborative teams.

International Medical Education doi: 10.3390/ime5010007

Authors: Alison Prosper Alice Broutin Sylvie Lê Chiara Cecchin-Albertoni Paul Monsarrat Charlotte Thomas Sara Laurencin Sarah Cousty Bénédicte Gendron Florent Destruhaut Franck Diemer Matthieu Minty Marie-Cécile Valéra Julien Delrieu Thibault Canceill Vincent Blasco-Baque Mathieu Marty

Traditional assessment methods in dental education, such as written tests and multiple-choice questions, primarily measure theoretical knowledge but inadequately evaluate clinical and interpersonal competencies. The Objective Structured Clinical Examination (OSCE), recognized globally for its validity and reliability, addresses these limitations and is widely adopted in medical curricula; however, its implementation in dental education remains poorly undocumented. This study explored perceptions of OSCE compared to traditional formats within the Clinical and Therapeutic Synthesis Certificate (CTSC) at Toulouse Faculty of Health during its first OSCE-based session in January 2019. Eighty-four fifth-year students and eight faculty assessors completed a validated questionnaire assessing fairness, educational value, and stress levels. Results indicated that OSCE was perceived as covering diverse clinical skills (86%) and offering authentic scenarios (83%). Despite being stressful (76%), OSCE was considered the fairest (60% vs. MCQ 31%, WT 41%; p < 0.001) and most educational (77% vs. MCQ 17%, WT 31%). Eighty-three percent of students recommended its broader use, while assessors unanimously endorsed its fairness and utility. Both groups highlighted its formative potential. These findings support OSCE’s integration into French dental curricula to strengthen competency-based assessment and enhance clinical skill evaluation.

International Medical Education doi: 10.3390/ime5010006

Authors: Muhammad Kamran Rasheed Fay Alonayzan Nouf Alresheedi Reema I. Aljasir Ibrahim S. Alhomoud Alian A. Alrasheedy

The integration of artificial intelligence (AI) tools, such as the chat generative pre-trained transformer (ChatGPT), into health professions education is rapidly accelerating, creating new opportunities for personalized learning and clinical preparation. These tools have demonstrated the potential to enhance learning efficiency and critical thinking. However, concerns regarding reliability, academic integrity, and potential overreliance highlight the need to better understand how healthcare students adopt and perceive these technologies in order to guide their effective and responsible integration into educational frameworks. This nationwide, cross-sectional, survey-based study was conducted between February and April 2024 among undergraduate students enrolled in medical, pharmacy, nursing, dental, and allied health programs in Saudi Arabia. An online questionnaire collected data on ChatGPT usage patterns, satisfaction, perceived benefits and risks, and attitudes toward integrating them into the curricula. Among 1044 participants, the prevalence of ChatGPT use was 69.25% (n = 723). Students primarily utilized the tool for content summarization, assignment preparation, and exam-related study. Key motivators included time efficiency and convenience, with improved learning efficiency and reduced study stress identified as major benefits. Conversely, major challenges included subscription costs and difficulties in formulating effective prompts. Furthermore, concerns regarding overreliance and academic misconduct were frequently reported. In conclusion, the adoption of generative AI tools such as ChatGPT among healthcare students in Saudi Arabia was high, driven by its perceived ability to enhance learning efficiency and personalization. To maximize its benefits and minimize risks, institutions should establish clear policies, provide faculty oversight, and integrate AI literacy into the education of health professionals.

International Medical Education doi: 10.3390/ime5010005

Authors: Vincenzo Andretta Raffaele Antonio Elia Maria Colangelo Ivan Rubbi Emanuela Santoro Giovanni Boccia Marco Cascella Valentina Cerrone

Background: Gamification is an innovative pedagogical strategy for improving learning outcomes, motivation, engagement, and knowledge retention. Nevertheless, evidence on the effectiveness of gamification remains heterogeneous. Methods: A systematic review was conducted. Searches were performed across PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Google Scholar, and grey literature (2010–2025). Eligible studies included quantitative, qualitative, and mixed-methods research involving undergraduate nursing students exposed to gamification interventions. Data extraction and quality assessment were independently performed using RoB-2, ROBINS-I, and JBI tools. Narrative synthesis was adopted due to the heterogeneity of interventions and outcome measures. Results: A total of 48 studies were included. Gamification strategies varied widely and included interactive quizzes, gamified flipped classroom models, serious games with explicit game elements, escape rooms, digital badges, and audience-response systems. For learning outcomes, most studies reported improvements in knowledge or performance, particularly when gamification included immediate feedback and repeated practice. While the knowledge retention was evaluated less frequently (12%), it was generally maintained or improved up to 2–4 weeks and across semester assessments. Strong positive trends of motivation and engagement were found across most studies, especially with competitive quizzes, missions, and narrative-based activities. Self-efficacy and satisfaction frequently improved, particularly in gamified simulations and team-based activities. Risk of bias was variable, with many quasi-experimental and descriptive studies limiting causal inference. Evidence certainty ranged from low to moderate according to GRADE criteria. Conclusions: Gamification is a promising educational approach in undergraduate nursing programs. Effects on long-term retention and practical skills remain less clear due to methodological variability and limited follow-up data. Future research focused on standardized outcome measures and longer follow-up intervals is required to consolidate evidence and guide educational policy. Protocol registered on PROSPERO (CRD420251117719).

International Medical Education doi: 10.3390/ime5010004

Authors: Chaoyan Dong Elizabeth Wen Yu Lee Clement C. Yan Vaikunthan Rajaratnam

(1) Background: Interprofessional supervision is an emerging approach in health professions education that strengthens collaborative practice competencies while maintaining profession-specific expertise. Understanding current evidence regarding supervision models, outcomes, and implementation factors is crucial for advancing this field. (2) Methods: This narrative review analyzed 28 studies, including quantitative, qualitative, mixed-methods studies, and systematic reviews. Studies were analyzed for supervision models, outcome measures, evidence of effectiveness, and implementation factors. (3) Results: Six categories of interprofessional supervision models were identified: clinical practice-based, group supervision, competency-based training, skills training, case-based learning, and mentorship/coaching. Across models, interprofessional supervision consistently enhanced collaborative competencies, professional development, clinical skills, and organizational outcomes. Organizational support, structured curricula, interprofessional leadership, and individual readiness facilitated implementation success. Barriers included limited resources, professional silos, and challenges in curriculum integration. (4) Conclusions: Interprofessional supervision shows consistently positive outcomes across diverse models and settings, though more rigorous research designs and standardized outcome measures are needed. Successful implementation requires systematic attention to multiple factors at multiple levels, from organizational support to individual readiness. Interprofessional supervision is positioned for significant advancement through the application of implementation science frameworks and continued research on optimal model characteristics and implementation strategies.

International Medical Education doi: 10.3390/ime5010003

Authors: Mario Pagano Angelo Parello Francesco Litta Angelo Alessandro Marra Paola Campennì Claudia Varrella Cesare Caruso Carlo Ratto

Background: Simulation-based laparoscopic training increasingly relies on portable, low-cost platforms that support home-based practice, but detailed descriptions of reproducible, do-it-yourself (DIY) trainers and their educational potential remain limited. Methods: We updated a low-budget laparoscopic simulator constructed from an inexpensive plastic container, wood components, a low-cost webcam, and plywood task pads modeled on Fundamentals of Laparoscopic Surgery (FLS) exercises. We then conducted informal qualitative usability testing in which 10 residents and 5 fellows from general surgery, gynecology, and urology used the simulator at home for one week and completed an eight-item feedback form plus free-text comments on assembly, ergonomics, realism, and educational value. Results: All participants successfully assembled and used the simulator; most described set-up as easy or intuitive, reported adequate image quality and lighting, and considered the platform useful for practicing depth perception, bimanual coordination, and cutting and suturing tasks. Feedback emphasized low cost, portability, and cross-specialty applicability, with only minor suggestions such as adjustable camera height or increased base weight. Conclusions: This DIY laparoscopic simulator could be assembled and used in a home-based setting, and trainees reported favorable usability and perceived educational value. More structured validation studies addressing face, content, and construct validity are needed to define its potential role within contemporary surgical curricula.

International Medical Education doi: 10.3390/ime5010002

Authors: Oyuntugs Byambasukh Usukhbayar Munkhbayar Munkhbaatar Dagvasumberel Khangai Enkhtugs Oyungoo Badamdorj Khandmaa Sukhbaatar Damdindorj Boldbaatar Batbaatar Gunchin Enkhtur Yadamsuren

This paper examines the 14-year journey of the Mongolian National University of Medical Sciences (MNUMS) in achieving and sustaining international accreditation for its undergraduate medical program. Beginning in 2010, MNUMS undertook a series of institutional reforms that culminated in full accreditation in 2016 and re-accreditation in 2024 by an international agency recognized by the European Network for Quality Assurance in Higher Education (ENQA). Drawing on institutional self-assessment reports, evaluator feedback, and stakeholder consultations, this case study explores how the accreditation process functioned as a catalyst for educational reform and quality enhancement. The findings reveal major transformations in curriculum design, assessment systems, and institutional governance. MNUMS adopted the European Credit Transfer and Accumulation System (ECTS), introduced outcome-based education and Entrustable Professional Activities (EPAs), expanded its Clinical Skills Center, and implemented a compulsory undergraduate research project. Additionally, the creation of an integrated Bachelor–Master pathway and strengthened international partnerships further advanced the university’s alignment with global medical education standards. This case illustrates how international accreditation can drive systemic improvement in medical education within developing-country contexts. The MNUMS experience highlights the value of sustained institutional commitment, responsiveness to external evaluation, and the strategic use of accreditation as a framework for continuous innovation and global integration.

International Medical Education doi: 10.3390/ime5010001

Authors: Eliza Sherman-Daniels Ljiljana Vasovic Rajan Dewar

The Multiple Mini-Interview (MMI) model is a commonly used interviewing technique at the undergraduate medical education (UME) level for medical school admissions. In this interview, candidates discuss a scenario with their interviewer. While many undergraduate medical institutions have adopted the MMI form of interviewing, it is rarely used in graduate medical education (GME/residency) interviews; no other pathology programs currently employ MMI. We share our experience with the use of MMI for Pathology GME interviews in 2023–2024. 50 interviews for the pathology residency program at Westchester Medical Center (WMC) were performed for the 2023–2024 season and included in this study (100%), with two scenarios on different interview dates. Candidates were scored from 1–5 based on five criteria. Including data from both scenarios, candidates performed well, with average scores above 4 for all categories. We found that most candidates received high scores in the MMI portion; however, the bottom ranked candidates performed very poorly in the MMIs. Traditional faculty scores varied significantly from MMI scores (p < 0.01). MMI scores were high overall and had less discriminatory value during this initial reiteration. Broader MMI implementation may provide more insights for its utilization in pathology resident selection.

International Medical Education doi: 10.3390/ime4040055

Authors: Holly Olson Melodee Deutsch Chad Kawakami Alison Miyasaki Sheri Tokumaru Joanne R. Loos Susan Steinemann Lee Buenconsejo-Lum Kamal Masaki Lorrie C. K. Wong

Background: Patient safety through root cause analyses and action planning (RCA2) is often taught in healthcare system-specific formats, in ways that are not applicable to interprofessional teams. The purpose of this article is to describe and evaluate an interprofessional RCA2 simulation conducted via videoconferencing, where attendees used cause mapping to identify root causes. Methods: Educators from medicine, nursing, and pharmacy schools developed the curriculum. Sessions included residents from graduate medical education programs, senior nursing students, and pharmacy residents. Facilitators provided brief didactics, and the simulation reviewed a safety event, root cause analysis, development of action plans, and a formal debrief session. Google Suite tools were used to create a cause map and action plan. Participants completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), facilitators conducted after-action reviews, and survey responses were used for quality improvement. Results: Most participants found this simulation helpful. There were significant improvements in self-perception of skills in the six ICCAS domains. Participants also noted that learning RCA would be helpful in their future practice. Conclusions: This patient safety simulation in an interprofessional team environment helped participants develop teamwork and an understanding of the RCA2 process. Participants learned to ask clarifying questions and voice concerns, which is essential when identifying root causes. This process serves as a guide for teaching these skills. Future iterations can implement this simulation-based RCA and adapt it for other, diverse populations.

International Medical Education doi: 10.3390/ime4040054

Authors: Leenah Abojaib Aashvi Patel Beatrice T. B. Preti

In oncology, traditional H&P templates centered on a single chief complaint often fail to address the longitudinal care needs and emotional complexities of cancer patients, leaving learners unprepared for sensitive conversations such as breaking bad news or discussing treatment goals. To address this, we conducted a literature review of specialty-focused H&P tools in child psychiatry and gynecology and, drawing on our experiences as two first-year medical students in an outpatient oncology clinic, developed an oncology H&P template to guide novice clinicians. The guide incorporates structured prompts for rapport-building; detailed oncologic and family cancer history; functional independence assessments; treatment goals; emotional wellbeing; support networks; and responding to emotion. After initial pilot testing by the two developers under supervisor guidance, the template was distributed to five then ten additional students and disseminated via the ASCO online forum and Twitter. Feedback from ten oncologists and oncology trainees highlighted the template’s value in gathering review of systems, past treatment details, functional status, and cancer history. Our findings suggest that this oncology-tailored tool enhances interview flow, promotes comprehensive data collection, and supports empathetic patient engagement. Integration into routine oncology training is planned, with future adaptations for specific oncological subspecialties and potential use in other medical specialties.

International Medical Education doi: 10.3390/ime4040053

Authors: Ray Samuriwo

Midwives and nurses are integral to the quality and safety of patient care. However, there is a limited amount of critical discussion and debate about the use of interviews to recruit people to study for these professions. There are some reports of people who are marginalised, minoritised, or racialised, being denied the opportunity to study for a degree in these professions, despite meeting the requisite entry requirements. Therefore, this commentary analyses the contemporary narrative and discussion relating to the role of interviews in recruiting student midwives and nurses. This critical analysis uses the UK as a case study and promulgates an alternative approach that could result in a more diverse workforce and enhance patient safety. It is hoped that the critical analytical approach taken in this paper will inspire those involved in recruitment to midwifery and nursing to consider the efficacy, utility, and equity of recruitment interviews and their impact on who is or is not afforded the opportunity to pursue a career in these professions.

International Medical Education doi: 10.3390/ime4040052

Authors: Veena Prasad Adriana Dyurich Woodson Scott Jones Jon A. Courand

Graduate Medical Education trainees’ wellness has become an important topic in academic medicine. The Accreditation Council for Graduate Medical Education (ACGME) requires oversight, education, and resources, understanding that medical training happens within a complex environment. Patients, personal and psychosocial issues, overlays, administrative demands, and intense oversight at various levels add additional elements of complexity and stress. The demographics of medicine are changing, with a greater proportion of women, minorities, and international medical graduates entering training with different needs and greater expectations. GME trainees constitute a population with unique needs that demand an adaptable and broad approach toward wellbeing and training success. The University of Texas Health San Antonio (UTHSA) created the Wellness Home, a comprehensive and adaptable model inspired by those used in primary care, where support is offered to trainees and training programs. It addresses issues beyond mental health management by including interventions such as coaching, access to medical services, or financial literacy. We present here a detailed description of the program and a rationale for developing this holistic approach in other institutions. Case studies are used to illustrate the complex needs of trainees and the innovative approaches used in their support. Usage data is presented as additional evidence that this model is increasingly and successfully being used.

International Medical Education doi: 10.3390/ime4040051

Authors: Fani Alevrogianni Anna Korompeli Christos Triantafyllou Theodoros Katsoulas Panagiotis Koulouvaris Pavlos Myrianthefs

Cardiopulmonary resuscitation (CPR) is a vital skill for healthcare professionals, crucial in life-saving situations. More than 80% of cardiac arrest cases occur out of hospital. As the demand for competent CPR practitioners grows, the effectiveness of training methods becomes increasingly important, especially for undergraduate students preparing to enter the healthcare field. The primary objective of our study is to investigate the effectiveness of simulation-based teaching methods and by integrating innovative technologies, such as the OMNI2 simulator, to enhance practitioners’ performance and to improve the precision and objectivity of CPR instruction. A cohort of 144 undergraduate students from the Nursing School Department of the National Kapodistrian University of Athens participated in an 8 h Basic Life Support Seminar. It consisted of a 5 h theoretical instruction followed by 3 h of practical training using the OMNI2 simulator. Each student was tasked to identify cardiac arrest and to perform two cycles of CPR according to the 2021 guidelines. Metrics, including total session time, cycles performed, compression-to-ventilation ratio, compression depth, compressions and ventilations per minute, full recoil, peak inspiratory pressure, and ventilation duration, were measured and compared against the simulator’s preset targets. Statistically significant differences (p < 0.05) were observed for all outcomes. In conclusion, while simulation-based teaching has conventionally been proven effective for CPR proficiency, real-time data collected in this study reveal a disparity between anticipated and actual performance. Our research underscores the necessity of refining instructional methods to enhance skill acquisition, potentially leading to improved patient outcomes in the future.

International Medical Education doi: 10.3390/ime4040050

Authors: Effie Simou

The rapid integration of artificial intelligence (AI) into healthcare has reshaped medical education and clinical practice. While technological innovation is vital, soft skills are essential for preserving trust, ethical accountability, and humanistic care. This study explores the evolving role of soft skills in medical education in the AI era by examining definitional challenges, pedagogical strategies, and the integration of AI-related literacy. A narrative review methodology synthesized evidence across seven thematic domains, focusing on curricular integration, pedagogical strategies, and assessment approaches in medical education within AI-enabled learning environments. The findings demonstrated that soft skills improve patient adherence, satisfaction, safety, and trust; strengthen physicians’ professional identity, collaboration, and resilience; and enhance system-level outcomes, such as resilience, safety, and public trust. Experiential, reflective, and competency-based pedagogies remain the most effective instructional strategies, while AI-supported tools, including virtual patients, adaptive simulations, large language models (LLMs), and Retrieval-Augmented Generation systems (RAG), offer complementary benefits by enhancing doctor-patient communication, providing real-time personalized feedback, and strengthening clinical reasoning. Soft skills function as an interconnected and synergistic ecosystem that is reinforced by cognitive, affective, humanistic, and ethical mechanisms. Integrating these competencies with AI literacy promotes theoretical clarity, supports programmatic assessment, and fosters responsible innovation, ensuring that technological advancement enhances rather than diminishes the humanistic foundations of medicine.

International Medical Education doi: 10.3390/ime4040049

Authors: Arianna B. Morton Zunaira Naeem Allison Goldberg Alexis Peedin Joanna Chan

Residents preparing for pathology board exams frequently use multiple-choice questions (MCQs) from question banks (QBs) like PathDojo and PathPrimer, which can be costly. ChatGPT, a free tool, has been used to generate MCQs for other tests like the SAT. This study compared the quality of pathology MCQs created by ChatGPT versus commercially available study questions for the American Board of Pathology’s (ABPath) certifying exams. A rubric adapted from the National Board of Medical Examiners’ (NBME) question writing guide was validated by two pathologists using commercially available pathology board exam questions. This rubric was then used to evaluate MCQs from commercially available pathology board study books as well as MCQs created by ChatGPT. The results compared the percentage of criteria met between ChatGPT and control MCQs using chi-square analysis with significance set at <0.05. While ChatGPT MCQs were less likely to be accurate compared to commercially available MCQs in four criteria (the best answer choice (82.5% vs. 100%), reflection of current practice (84.6% vs. 100%), error-free explanation (87.9% vs. 100%), and explanation reflecting current practice (87.9% vs. 100%)), the complexity of the ChatGPT-generated questions was higher (78.5% vs. 47.2%). At this time, ChatGPT-generated MCQs should not be used in the same way as commercially available study guides, however there is potential for learned language models (LLM)s to create quality study materials and exam questions with careful monitoring

International Medical Education doi: 10.3390/ime4040048

Authors: Nadine Wolf Philip Vogt Sinan Durant Sara Volz-Willems Johannes Jäger Fabian Dupont

(1) Podcasts are increasingly used in undergraduate medical education. They differ from traditional learning activities and may influence exam performance. Podcasts also offer insights into learning behaviour and perceptions of family medicine (FM). Despite their frequent use in medical education, it remains unclear how they can best be integrated into competency-based curricula and motivate students to study for FM. This study examines the impact of a medical podcast on learning behaviour and academic performance at Saarland University (UdS). (2) This exploratory mixed-methods study analyzed podcast-related learning behaviour and exam relevance among year-five medical students at UdS in the winter semester 2024/25. Demographic, quantitative, and qualitative data were collected via an online questionnaire (Google Forms®) in January 2025. Data were descriptively and analytically evaluated and linked to exam results. Qualitative data were analyzed using Kuckartz’s content analysis. (3) Of 123 eligible students, 92 participated. Most listened to episodes in full. Podcasts were seen as low-threshold means to access study content, but they were often not perceived as a separate learning activity. Listening to podcasts did not directly influence exam performance but helped connecting theory with clinical relevance and increased motivation for FM. (4) Podcasts are popular for exploring clinical practice and complex topics. Their didactic value lies in contextual learning and career orientation, rather than improving exam performance.

International Medical Education doi: 10.3390/ime4040047

Authors: Punithalingam Youhasan Hayathu Mohamed Fathima Jameelathun Nazeefa

Contemporary medical education is shifting from traditional, teacher-centred anatomy instruction toward interactive, student-centred, and clinically integrated approaches. The Jigsaw Method aligns with this shift by fostering collective competence, which is vital for effective clinical practice. This study aimed to introduce the jigsaw model to medical students and explore its perceived effectiveness in teaching anatomy. A phenomenological qualitative design was employed to explore the experiences of second-year medical students (n = 120) at the Faculty of Health-Care Sciences, Eastern University, Sri Lanka. Open-ended questions were used to elicit students’ reflections on the effectiveness of jigsaw learning. Thematic analysis was conducted using NVivo software (ver.14). Students reported generally favourable perceptions of the jigsaw method. Four major themes emerged: two described the positive impact of the approach—enhanced understanding through peer learning and improved interpersonal and communication skills; the remaining themes addressed challenges in implementation and suggestions for refinement. Participants appreciated the structured collaboration and positive interdependence fostered by the method. Moreover, students viewed the jigsaw technique as well-aligned with student-centred learning principles. The jigsaw method was perceived as an effective cooperative learning strategy that enhanced engagement, promoted active participation, and fostered teamwork in anatomy education. These findings support the integration of structured peer-based approaches into medical curricula to enrich students’ learning experiences.

International Medical Education doi: 10.3390/ime4040046

Authors: Suet Voon Yu Gerlese S. Åkerlind

Previous research has shown that medical practitioners’ conceptions of their profession play a significant role in their practice. This study extends that research by investigating ways in which different conceptions of ‘being a doctor’ may act to expand or limit the potential for future development as a doctor. Based on previous research that identified different conceptions of ‘being a doctor’ and ‘developing as a doctor’, a chi-square test of association between the two sets of conceptions was undertaken and a statistically significant association found. More and less complex conceptions of being a doctor were associated with more and less complex conceptions of developing as a doctor, respectively. This raises the likelihood that conceptions of being a doctor that develop early in one’s career may act to limit the potential for future development. Consequently, the paper recommends that different conceptions of medical practice be addressed as part of medical education. To help with this, the paper describes an innovative educational design based on the ‘variation theory of learning’ proposed within a phenomenographic epistemology. The educational design is specifically intended to help trainees become aware of elements of practice and development that they have not previously discerned.

International Medical Education doi: 10.3390/ime4040045

Authors: Amy Dievendorf Phyllis Raynor Beverly Baliko Abbas Tavakoli

Depressive disorders are common mental health conditions that are often undiagnosed or undertreated. Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs) are educated in the management of acute and critically ill patients but are often uncomfortable identifying and treating mental health conditions. Telehealth instruction is useful in mental healthcare and is required as part of the AGACNP’s efficient patient care competencies. This article reports findings from a mental health-focused telehealth instructional activity integrated into an existing AGACNP curriculum. This instructional activity was designed to introduce students to telehealth delivery and build AGACNP competencies using telehealth technology to assess patients with depressive mood symptoms. A two-part instructional scenario included didactic course preparation and an experiential activity involving a virtual encounter with a standardized patient (SP). Student feedback on the telehealth experience was generally positive. However, they felt uncomfortable with the mental health component of the scenario, providing an opportunity for improved preparation of mental health screening and treatment.

International Medical Education doi: 10.3390/ime4040044

Authors: Øyvind Lockertsen Kjell Kjærvik

Simulation is widely used in healthcare, with VR simulation replacing physical scenarios with virtual ones. Participants observe based on predefined learning objectives and reflect on them during debriefing sessions. De-escalation is recommended as the first-line response to potential aggression in mental healthcare. Staff in secure mental health units frequently face aggression, and training may enhance de-escalation skills. The study aimed to explore staff experiences with VR simulation as a supplement to physical simulation for de-escalation and examine differences between those with and without prior physical simulation experience. The study involved 58 frontline staff in a Norwegian high security secure mental health department. Twelve simulations were conducted, followed by a post-simulation questionnaire. Data was analyzed using thematic analysis and appropriate statistical analyses. Departmental and data protection approvals were obtained, and participation was based on informed consent. Two themes emerged: (1) enhances situational understanding, and (2) lack of training for action readiness. Participants rated the simulation highly on most questions and perceived VR simulation as a valuable supplement to physical simulation. Those without prior simulation experience were more satisfied with the VR scenario (mean difference = 0.421, 2-sided 95%CI = 0.036–0.807, t = 2.188, p = 0.033), learned more from the VR simulation (mean difference = 0.725, 2-sided 95%CI = 0.045–1.406, t = 2.136, p = 0.037), experienced VR scenario which was more applicable to clinical work (mean difference = 0.645, 2-sided 95% CI = 0.161–1.128, t = 2.674, p = 0.010), and reflected that the VR simulation increased their experienced safety (mean difference = 1.133. 95%CI = 0.478–1.788, t = 3.468, p = 0.001). Greater benefits were yielded from the VR simulation for those without prior simulation experience than those with previous experience. Further studies are recommended.

International Medical Education doi: 10.3390/ime4040043

Authors: Chao Tian Tang Lucas Jun Hao Lim Haoming Tang Gaytri Gupta Isabelle Chiao Han Sung Chaoyan Dong

Background: Empathy and perspective-taking are, respectively, associated with improved healthcare and educational outcomes. However, numerous studies show that medical students are experiencing a significant decline in self-reported empathy. We aim to examine the impact of empathy and perspective-taking on medical student satisfaction and performance. Methods: Qualitative evidence synthesis was performed using a meta-ethnography approach. Six electronic bibliographic databases were searched for papers published during 2000–2021, including those exploring empathy or perspective-taking in medical education concerning medical student satisfaction and performance and involving medical students. The Critical Appraisal Skills Programme was used to appraise the quality of each included paper critically. Results: In total, 851 articles were identified, and 15 studies were included. Six third-order constructs were synthesized and integrated via a “Bow-Tie” model. This included blending humanism in clinical skills with personal experiences, vicarious learning, challenging pre-conceived notions, curricular and pedagogical inculcation, collective expressions of empathy with secure catharsis, and multi-stakeholder perspectives and involvement. Conclusion: This Bow-Tie model provides a novel framework that integrates the contextual factors to better understand the roles of empathy and perspective-taking in medical education. This aids the planning of interventions, such as in the medical humanities to achieve the desired outcomes.

International Medical Education doi: 10.3390/ime4040042

Authors: Samantha Wong Bradson Serikawa Meliza Roman Nicole Hada Jannet Lee-Jayaram Benjamin W. Berg

Manikin-based simulation is widely used in undergraduate medical education to develop clinical reasoning and communication skills. The Borich Needs Assessment Model has been applied in fields such as nursing and global health to identify gaps between perceived importance and performance, but it has not been used to evaluate simulation-based learning in undergraduate medical education. We applied the Borich model to assess student perceptions of competencies developed in an established simulation curriculum and to inform future simulation curriculum development. A cross-sectional survey was administered to first-, second-, and fourth-year medical students at the University of Hawaii John A. Burns School of Medicine. Students rated eight SNAP competencies for importance, self-reported performance, and perceived influence of simulation. Weighted discrepancy scores were calculated using the Borich model. Faculty completed a parallel survey to compare competency prioritization. Among 164 student respondents, all competencies were rated as highly important. The greatest performance and influence gaps were reported for “Apply knowledge covered in the unit or rotation to simulation cases” (MWDS = 1.37 and 1.61, respectively). Priorities varied by student year, and agreement between faculty and student rankings was limited. The findings highlight a perceived gap between simulation curriculum and knowledge application. The Borich model effectively identified performance gaps and can support targeted simulation curriculum refinement.

International Medical Education doi: 10.3390/ime4040041

Authors: Ovuokerie Addoh Alyssa Axelrod Caroline Gormley Sarah Mahasin Brionn Tonkin Alexander Senk Erica Seidel

People with disabilities (PWDs) face unique challenges in accessing equitable medical care, due in part to physicians’ limited training in disability-related competencies. This study explored a novel approach to bridging this gap by integrating selected videos and reflective essays into medical education. Third- and fourth-year medical students watched four videos depicting diverse experiences of PWDs and submitted reflective essays, resulting in the analysis of 90 essays by six investigators. Through thematic analysis, 50 concept codes were distilled into six key themes: recovery process, student insight, adjustment to disability, patient-doctor relationship, social model of disability, and support systems. The reflections revealed a growing awareness among students of the need to individualize care and address systemic barriers, though some medicalized views of disability were noted. These findings underscore the potential of video-based education to enhance disability competence in medical training by fostering critical reflection and empathy. However, to maximize impact, educators should prioritize diverse portrayals of disability and challenge sensationalized or “overcoming” narratives common in such media. Overall, this study demonstrates that widely available media can be a valuable, scalable tool for advancing disability education in medical curricula.

International Medical Education doi: 10.3390/ime4040040

Authors: Dorottya Cserző

International medical graduates (IMGs) make up a significant proportion of general practitioners (GPs) in high-income countries such as the United Kingdom (UK), the United States of America (USA), Australia, and Canada. This paper compares views about IMGs with their own views in relation to the timing of GP placements in GP specialty training programs in the UK. It presents an inductive thematic analysis of focus groups with GP specialty trainers and trainees (149 participants across 32 focus groups), examining opinions about the ideal timing of GP placements. Trainers and home graduates argued that for home graduates, the ideal sequence depends on the trainee’s previous experience. They also suggested that IMGs should start in a hospital placement to develop familiarity with the healthcare system. In contrast, most IMGs expressed a preference for starting in a GP placement, so that they can gain an understanding of the requirements of their specialty as early as possible. There is a contrast between what IMGs said about themselves and the views shared by trainers and home graduates. This highlights the need to involve IMGs in the design of support programs targeted towards them. Recommendations include tailoring training to account for individual career paths and providing training about the healthcare system before the start of the first placement. This could improve the efficiency of GP training programs at a time of extreme pressure on healthcare systems and training providers.

International Medical Education doi: 10.3390/ime4040039

Authors: Urmi Sheth Margret Lo Jeffrey McCarthy Navjeet Baath Nicole Last Eddie Guo Sandra Monteiro Matthew Sibbald

Access to practice opportunities for history-taking in undergraduate medical education can be resource-limited. Large language models are a potential avenue to address this. This study sought to characterize changes in learner self-reported confidence with history-taking before and after a simulation with an LLM-based patient and understand learner experience with and the acceptability of virtual LLM-based patients. This was a multi-method study conducted at McMaster University. Simulations were facilitated with the OSCEai tool. Data was collected through surveys with a Likert scale and open-ended questions and semi-structured interviews. A total of 24 participants generated 93 survey responses and 17 interviews. Overall, participants reported a 14.6% increase in comfort with history-taking. Strengths included its flexibility, accessibility, detailed feedback, and ability to provide a judgement-free space to practice. Limitations included its lower fidelity compared to standardized patients and at times repetitive and less clinically relevant feedback as compared to preceptors. It was overall viewed best as a supplement rather than a replacement for standardized patients. In conclusion, LLM-based virtual patients were feasible and valued as an adjunct tool. They can support scalable, personalized practice. Future work is needed to understand objective metrics of improvement and to design curricular strategies for integration.

International Medical Education doi: 10.3390/ime4040038

Authors: Adam P. Forrest Kyung Min Kirsten Lee Kevin O’Shaughnessy Jimit Gandhi Jacinta L. Johnson

Pharmacy and nursing professions collaborate closely in healthcare settings. Effective interprofessional practice is now widely recognised as essential for achieving optimal patient care outcomes. Little has been published on nursing-pharmacy Interprofessional learning (IPL) in a simulated environment in Australian contexts. This study aimed to evaluate whether an IPL activity improved participants’ communication confidence, role understanding, clinical knowledge, and preparedness for hospital placement, while also assessing student satisfaction and identifying areas for improvement. A pedagogically structured teaching and learning model was developed, involving a high-fidelity on-campus simulated hospital ward, supplemented with a virtual online environment to immerse nursing and pharmacy students in a realistic clinical environment to achieve deep learning in preparation for safe practice. An online anonymous survey was conducted to evaluate participants’ experience and preparedness following the simulation. 280 students participated and 52 completed the evaluation. Most students reported that the experience boosted their confidence in communicating with other healthcare professionals (82%), increased clinical/therapeutic knowledge (86%), gave them a better understanding of the roles of nurses/pharmacists within the hospital setting (88%) and left them feeling better prepared for hospital placement (85%). Student free-text responses from the evaluation survey further supported the expansion of the IPL sessions in the future. IPL involving nursing and pharmacy students in a simulated hospital builds confidence in communicating and increases self-reported preparedness for placement.

International Medical Education doi: 10.3390/ime4040037

Authors: Madile Mmoloke Martine Vorster Christmal Dela Christmals

Professional nurses assume clinical mentoring roles for pharmacy students in Primary healthcare (PHC) settings in South Africa due to the chronic shortage of pharmacists in these settings. This study sought to describe the experiences, challenges and needs of professional nurses mentoring pharmacy students within the primary healthcare settings of South Africa. A descriptive qualitative study design was employed and 35 semi-structured, individual interviews in 18 primary healthcare settings were conducted. Data was analyzed using thematic content analysis. While some professional nurses are supportive of mentoring pharmacy students during healthcare delivery, others believe it increases workload and slows down healthcare delivery. The professional nurses enjoyed mentoring pharmacy students but indicated a lack of confidence due to non-preparation and not being involved during the planning or preparation for the pharmacy students’ clinical placement visits. They needed short courses to train them to perform better in mentoring pharmacy students in PHC settings. To facilitate the successful implementation of interprofessional mentoring of pharmacy students, deeper collaboration between the university and the professional nurses in primary healthcare facilities is needed to improve interprofessional mentoring of students in primary healthcare settings. Universities must provide clear information, guidance, and feedback on students’ clinical placements, while professional nurses require in-service training on interprofessional mentoring and recognition from universities for their educational contributions.

International Medical Education doi: 10.3390/ime4030036

Authors: Nikhita Kathuria-Prakash Anthony Bejjani

Patient education is a crucial component of a physician’s responsibility, and effective patient education can improve patient health outcomes and satisfaction. However, there is currently no formalized training for residents to develop and practice these skills at our large, academic internal medicine residency program. We created a virtual, case-based, interactive session for all residents to practice patient education skills and receive real-time feedback. Residents were given three scenarios: heart failure (HF), breast cancer (BC), and chronic kidney disease (CKD), and role-played as the physician, patient, and observer. The intervention was studied with single-group, pre-post intervention surveys. The session was virtual due to restrictions related to the COVID-19 pandemic. Mean Likert scale scores were compared by paired Wilcoxon rank-sign tests. The sessions were attended by 177 residents; 95 completed both pre- and post-session surveys (53.6%). Participants felt significantly more comfortable teaching patients about HF, BC, and CKD pathophysiology and treatments after the session (HF: pre-median = 4, post-median = 4, p = 0.0032; BC: pre-median = 2, post-median = 4, p < 0.0001; CKD: pre-median = 3, post-median = 4, p = 0.0016). There was a trend towards a significant increase in belief that teaching patients about common diseases should be integrated into the residency curriculum, but this did not reach statistical significance (pre-median = 4, post-median: 5, p = 0.0548). A targeted session for residents to practice patient education improved resident comfort with explaining three common diseases. These data suggest that the session was effective in a virtual format, demonstrating feasibility to be adapted in the increasingly online realm of patient encounters.

International Medical Education doi: 10.3390/ime4030035

Authors: Pelagia Soultatou Charalambos Economou

Sociology provides essential insights into the social and cultural determinants of health and is critical to holistic nursing education. However, its integration into Greek undergraduate nursing curricula remains underexplored. This study employed a qualitative content analysis of the curricula from the eight public university nursing departments in Greece to examine the inclusion of sociology-related courses. Findings show that seven out of eight curricula (87.5%) include dedicated sociology courses, indicating a strong incorporation of sociological content. Compared to medical curricula in Greece, where sociology is largely absent, nursing education demonstrates greater engagement with sociological frameworks. The results support the need for curriculum harmonization across institutions and more robust interdisciplinary collaboration and interprofessional care. Standardizing the inclusion of sociology in healthcare education can strengthen interprofessional collaboration between doctors and nurses to address health inequities and improve patient-centered care.

International Medical Education doi: 10.3390/ime4030034

Authors: Nieves Martín-Alguacil Luis Avedillo Rubén A. Mota-Blanco Mercedes Marañón-Almendros Miguel Gallego-Agúndez

Artificial intelligence is transforming higher education, particularly in flipped classroom settings, in which students learn independently prior to class and collaborate during in-person sessions. This study examines the role of ChatGPT as a virtual peer in a veterinary anatomy course centered on cardiovascular and respiratory systems. Over two academic years (2023–2025), 297 first-year veterinary students worked in small groups to explore anatomy through structured prompts in English and Spanish using ChatGPT versions 3.5 and 4. Activities involved analyzing AI output, evaluating anatomical accuracy, and suggesting alternative names for vascular variations. Learning outcomes were assessed using Bloom’s Taxonomy-based questions, and student perceptions were captured via online surveys. Progressive performance improvement was noted across three instructional phases, particularly in higher-level cognitive tasks (Bloom level 4). Responses to English prompts were more accurate than those to Spanish prompts. While students appreciated ChatGPT’s role in reinforcing knowledge and sparking discussion, they also flagged inaccuracies and emphasized the need for critical evaluation. Peer collaboration was found to be more influential than chatbot input. Conclusions: ChatGPT can enrich flipped anatomy instruction when paired with structured guidance. It supports content review, fosters group learning and promotes reflective thinking. However, developing digital literacy and ensuring expert oversight are essential to maximizing the educational value of AI.

International Medical Education doi: 10.3390/ime4030033

Authors: Catherine Bopp Aline Salzmann Sinan Durant Melanie Caspar Sara Volz-Willems Johannes Jäger Fabian Dupont

(1) Background: Medical education is moving from a cognition-based to a competency-based model in Germany. Traditional learning activities (LAs) are questioned. Some stakeholders criticise traditional LAs for not facilitating deep learning or operational competency transfer required in practical contexts. This qualitative study aims to take a closer look at the role of lectures in competency-based medical education from a student’s point of view. (2) Methods: Three semi-structured group interviews were held with students from the family medicine curriculum in the summer semester of 2021. Questions focused on the three lectures in this family medicine curriculum and on students’ experiences with lectures in general. One additional expert interview was held with one of the lecturers. The video-recorded interviews were transcribed verbatim and analysed using content analysis. (3) Results: Interview participants highlighted entertainment, the provision of a social and physical learning environment, and the completion of knowledge from books and educational websites as important roles of lectures. Lectures on demand were used by interviewees for time- and space-independent repetition. Lecturer-dependent qualitative differences between lectures were identified by interviewees. Important differences were the extent of interaction, as well as the enthusiasm and preparation of the lecturer. (4) Conclusions: Even though literature suggests that lectures may be a less effective learning activity, under certain circumstances, several aspects make them an essential element of modern curriculum development. By raising interest in a subject, providing a space for discussion and social interaction, interactive lectures appear to be a helpful link between knowledge acquisition and practical training of competencies.

International Medical Education doi: 10.3390/ime4030032

Authors: Samiksha Prasad Kate J.F. Carnevale

Recognizing and understanding the nuances of mental health and how issues can present at various levels of healthcare for both patients and the interprofessional (IP) healthcare team can be crucial for the success and well-being of team members, as well as for achieving positive patient outcomes. Learners from various allied healthcare disciplines participated in a Case-Based Learning-Sequential Disclosure Activity (CBL-SDA) to address navigating appropriate approaches to fostering wellness in the clinical encounter and within healthcare teams from a multidisciplinary perspective. The CBL-SDA was delivered to a cohort of allied health students (N = 90) using a 4-step process during an interprofessional education (IPE) event of (i) Orientation, (ii) Sequential Disclosure, (iii) IPE Forum, (iv) Wrap-up. Pre- and post-activity surveys were voluntarily collected to gauge participants’ perceptions of the content and delivery method, with a response rate of 90% (N = 81). Overall, participants reported gaining confidence in their understanding of wellness, in identifying and providing support for a person struggling with wellness, in having tools to promote wellness, and also rated their own wellness higher, following the one-hour training session. It can be concluded that IPE activities highlighting wellness and mental health are beneficial and necessary in allied health care training.

International Medical Education doi: 10.3390/ime4030031

Authors: Maxime Baril Lilly Groszman Khalifa Alhojailan Anthony Albers

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.

International Medical Education doi: 10.3390/ime4030030

Authors: Ngoc Bao Dang Quang Ngoc Phan Nam Hoang Tran

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.

International Medical Education doi: 10.3390/ime4030029

Authors: Pablo Fernández-León Javier Fagundo-Rivera Miguel Garrido-Bueno Rocío Romero-Castillo

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.

International Medical Education doi: 10.3390/ime4030028

Authors: Randi Stanulis Luke Beauchamp John Pestenariu Scot Stanulis Linda Qu Rachel Gerth Alicia Knickerbocker Jordan Knepper

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.

International Medical Education doi: 10.3390/ime4030027

Authors: Nabil Haider Leo Morjaria Urmi Sheth Nujud Al-Jabouri Matthew Sibbald

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.

International Medical Education doi: 10.3390/ime4030026

Authors: Yuma Ota Emiko Matsuo Sumire Shinjo Yasuyo Kasahara Ayako Nishimura

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.

International Medical Education doi: 10.3390/ime4030025

Authors: Martin Schmidt Sarah Parrott Maurice Blodgett

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.

International Medical Education doi: 10.3390/ime4030024

Authors: Yoshiaki Iwashita Haruka Saigusa Moe Fusayama Hiroshi Miyamoto Rie Sato Nobuhiro Kodani Noriaki Yamada Tetsuya Makiishi Akiko Yata

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.

International Medical Education doi: 10.3390/ime4020023

Authors: Marwa Schumann Hossam M. Ghorab Azza Baraka

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.

International Medical Education doi: 10.3390/ime4020022

Authors: Andrea Cuschieri Sarah Cuschieri

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.

International Medical Education doi: 10.3390/ime4020021

Authors: Eugene John Balmores Generaldo Maylem

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.

International Medical Education doi: 10.3390/ime4020020

Authors: Aysha M. Nijamudeen Harish K. Thampy

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.

International Medical Education doi: 10.3390/ime4020019

Authors: Kelsi Chan Holly Olson Melissa Natavio Paris N. Stowers

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.

International Medical Education doi: 10.3390/ime4020018

Authors: Sonya Moore Sia Kazantzis

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.

International Medical Education doi: 10.3390/ime4020017

Authors: Meghan E. Quinn Lauren A. Maggio Duane R. Bidwell LaKesha N. Anderson

(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.

International Medical Education doi: 10.3390/ime4020016

Authors: Anson Y. Lee Jonathan Hu Helaine J. Kwong Dee-Ann Carpenter

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.

International Medical Education doi: 10.3390/ime4020015

Authors: Angela Caldwell Cerelia Donald Gabrielle Simcoe Lillia Thumma Amber R. Green Alison J. Patev Kristina B. Hood Madison M. Marcus Caitlin E. Martin

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.

International Medical Education doi: 10.3390/ime4020014

Authors: Kyle Sporn Rahul Kumar Phani Paladugu Joshua Ong Tejas Sekhar Swapna Vaja Tamer Hage Ethan Waisberg Chirag Gowda Ram Jagadeesan Nasif Zaman Alireza Tavakkoli

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.

International Medical Education doi: 10.3390/ime4020013

Authors: Branko Aleksic Itzel Bustos Villalobos Tetsuya Yagi Norbert Skokauskas

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.

International Medical Education doi: 10.3390/ime4020012

Authors: Johanna Klutmann Constanze Dietzsch Philip Vogt Nadine Wolf Melanie Caspar Sara Volz-Willems Johannes Jäger Fabian Dupont

(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.

International Medical Education doi: 10.3390/ime4020011

Authors: Chaoyan Dong Derrick Chen Wee Aw Deanna Wai Ching Lee Siew Ching Low Clement C. Yan

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.

International Medical Education doi: 10.3390/ime4020010

Authors: Masooma Kazmi Stacey Wong Perrilynn Conklin David Cohen Andrew Wackett Wei-Hsin Lu

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.

International Medical Education doi: 10.3390/ime4020009

Authors: Shastri Motilal Patrick Harnarayan Andrea Garbutt Vrunda Sakharkar Morton Frankson Subir Gupta Maisha Emmanuel

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.

International Medical Education doi: 10.3390/ime4020008

Authors: Heather Hall John Feest Sydney Zarate Martin S. Forde

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.

International Medical Education doi: 10.3390/ime4020007

Authors: Amar Kohli Russell Schuh Margaret McDonald Ana Arita David Michael Elnicki

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.

International Medical Education doi: 10.3390/ime4020006

Authors: Odunayo Kolawole Omolade John Stephenson

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.

International Medical Education doi: 10.3390/ime4020005

Authors: E. Pollio Laila Abbas Waqas Haque James Wagner Carol North David Pollio

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.

International Medical Education doi: 10.3390/ime4010004

Authors: Andrea Schlicker Jan P. Ehlers

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.

International Medical Education doi: 10.3390/ime4010003

Authors: Rahul Pandit Rens L. Essers Helena J. M. Pennings

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.

International Medical Education doi: 10.3390/ime4010002

Authors: Denise Castro Siddharth Mishra Benjamin Y. M. Kwan Muhammad Umer Nasir Alan Daneman Donald Soboleski

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.

International Medical Education doi: 10.3390/ime4010001

Authors: Mohamad Nasser Elsouri Victor Cox Vinayak Jain Ming-Jung Ho

International medical graduates (IMGs) account for 25% of the physician workforce in the United States, yet little is known about their professional identity formation (PIF). This qualitative study explores the process of PIF in IMG residents with special attention to how they integrate their intersectional marginalized personal identities. Method: Using a social constructivist approach, the researchers conducted semi-structured individual interviews with 15 IMG resident physicians in the United States. The authors analyzed the data using a constant comparison approach and identified themes by consensus. Results: Participants described their PIF journey beginning before starting residencies in the US. Their PIF was challenging due to structural barriers associated with their immigrant status. Furthermore, participants reported more difficulties with PIF if they did not look white. When their pre-existing professional and personal identities clashed with the American professional norm, the residents suppressed or compartmentalized these pre-existing identities. However, participants also reported that their diverse personal identities could be assets to the provision of care for diverse patient populations. Conclusions: This study reveals the identity tension experienced by IMGs in their PIF journey and the different strategies they employed to navigate the conflicts with American professional norms. This study suggests reimagining PIF frameworks to cultivate a more diverse physician workforce.

International Medical Education doi: 10.3390/ime3040038

Authors: Daseul Kwon Takeshi Kondo Noriyuki Takahashi Hideki Takami Hiroshi Nishigori Branko Aleksic Itzel Bustos-Villalobos Tetsuya Yagi Norbert Skokauskas

Purpose: Mental health care is limited worldwide, especially for children and adolescents. Moreover, there are barriers to using mental health services for children and adolescents, including a shortage of standardized training programs and the subsequent workforce. To solve this problem, Japan adopted problem-based learning (PBL) to enhance standardized medical education about child and adolescent psychiatry (CAP). This preliminary study aimed to evaluate online CAP studies at Nagoya University (NU), Japan, with a focus on PBL materials. Design and methods: A descriptive cross-sectional preliminary study was carried out at NU with a questionnaire developed under the Trondheim–Nagoya (TroNA) project by NU and the Norwegian University of Science and Technology (NTNU). The questionnaire, measuring students’ perceptions and understanding of the PBL curriculum and PBL in the CAP, consisted of 15 questions answered on a three-point Likert scale. To compare the PBL CAP delivered online (2021) with the established PBL CAP carried out in person (2019) at NU, an identical questionnaire was used both in 2019 and 2021. Results: The majority of medical students in both in-person (82.5%) and online (91.2%) classes agreed that PBL helped them develop clinical problem-solving skills. In addition, 53.6% of the students in the in-person class and 75.8% of the students in the online class thought PBL enhanced their understanding of CAP. In terms of specific case scenarios, the majority of students in the in-person class (59.8%) and online class (74.7%) agreed that the PBL case helped them understand the importance of a multidisciplinary approach in CAP. Conclusions: Most of the NU medical students were generally satisfied with CAP’s online PBL curriculum. The online PBL CAP curriculum with specific case scenarios can provide medical students with suitable educational means. This preliminary study can to a certain extent provide information relevant for the development of online PBL education in CAP patients and for planning to attract more future doctors to CAP.

International Medical Education doi: 10.3390/ime3040037

Authors: Venkat Rao Vishnumolakala Adam H. Larson Sheila S. Qureshi Abdulrahman Al-Abdulmalek Abdulaziz Al-Thani

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 (WCM-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.

International Medical Education doi: 10.3390/ime3040036

Authors: Waleola B. Ige Winnie B. Ngcobo

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.

International Medical Education doi: 10.3390/ime3040035

Authors: Javiera Fuentes-Cimma Dominique Sluijsmans Javiera Ortega-Bastidas Ignacio Villagran Arnoldo Riquelme-Perez Sylvia Heeneman

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.

International Medical Education doi: 10.3390/ime3040034

Authors: Jennifer M. Walton Anna E. Oswald

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.