International Medical Education doi: 10.3390/ime5030080

Authors: Gisele Massarani Alexandre de Carvalho Gilmar Cardozo de Jesus Ewerton Alexandre Galdeano Marcel Fernando Inácio Cardozo Maria Helena de Sousa Rogerio Leone Buchaim João Paulo Mardegan Issa Vinícius Rodrigues Silva Vinicius Barroso Hirota André Antonio Pelegrine Marcelo Rodrigues da Cunha

Medical residency is a demanding stage of specialty training characterized by extensive clinical exposure, heavy workloads, and ongoing knowledge acquisition. Characterizing residents’ learning-style preferences may help residency programs refine their educational strategies and better address residents’ needs. This study assessed learning-style preferences using the Felder–Soloman Index of Learning Styles in 152 residents from clinical and surgical specialties in a Brazilian medical residency program. In the overall sample, the predominant preferences were sensing (90.79%), visual (73.68%), active (62.50%), and sequential (70.39%). Clinical and surgical residents differed significantly only in the understanding domain: sequential preference was more frequent among clinical than surgical residents (80.0% [95% CI: 68.7–87.9] vs. 63.2% [95% CI: 52.7–72.6]). The limited variation between groups suggests that most residents shared a broadly similar learning profile, although some cognitive-processing preferences may differ according to specialty-related demands. These findings may inform diversified educational strategies that combine visual resources, practical activities, and structured progression across clinical and surgical training contexts.

International Medical Education doi: 10.3390/ime5030079

Authors: Gheorghe Gindrovel Dumitra Linda-Nicoleta Bărbulescu Roxana Surugiu Constantin Kamal Elena Codruța Gheorghe Mirela Radu Carmen-Adriana Dogaru Lucian-Florentin Bărbulescu Virginia-Maria Rădulescu

Background/Objectives: Romania faces a shortage of family physicians, particularly in rural areas. Undergraduate Family Medicine rotations may influence students’ perceptions before residency selection, but the contribution of rural versus urban training settings remains insufficiently documented. This study examined differences between post-rotation perceptions and students’ recalled pre-rotation perceptions, and explored whether these differences varied according to placement setting. Methods: This single-centre study used a single-administration retrospective pretest–posttest observational design. After completing the mandatory one-month Family Medicine rotation, 141 sixth-year medical students completed a questionnaire containing recalled pre-rotation and post-rotation ratings on 12 five-point Likert items. Paired comparisons used Wilcoxon signed-rank tests; multiple-testing corrections were applied within the defined item families. A baseline-adjusted model with robust standard errors examined rural placement. Results: The composite score increased from 3.62 ± 0.84 to 4.10 ± 0.74 (mean change 0.483; W = 602.5; Z = −7.990; p < 0.001; r = 0.673). All 12 paired item comparisons remained significant after Bonferroni correction. No rural–urban item comparison remained significant after correction. In the adjusted model, rural placement was not associated with a statistically significant difference in the post-rotation score (β = 0.197, 95% CI −0.002 to 0.397; p = 0.053). Among the 86 rurally exposed students, the mean willingness to practice rurally was 2.87/5. The apparent association with career intention was not retained when excluding the overlapping career-likelihood item (11-item composite: H = 6.695, p = 0.153). Conclusions: Students reported more favourable perceptions after the rotation than they recalled having before it, but their willingness to practice rurally remained limited. The uncontrolled, retrospective design does not permit causal attribution, and the data do not establish a rural-placement advantage or subsequent specialty choice.

International Medical Education doi: 10.3390/ime5030078

Authors: Sarah Kazemeini Nicholas Staffa Gemma Lagasca Axel Rivas Edward Simanton

Medical schools are increasingly reducing required contact hours and incorporating self-directed learning strategies, yet the impact of these curricular changes on academic performance remains uncertain. This retrospective cohort study compared performance on NBME-based organ system examinations across three consecutive pre-clerkship cohorts at a U.S. allopathic medical school that experienced different levels of required instructional time. Cohorts included 178 students and differed in total required contact hours from 306 to 412 h. Mean MCAT scores did not differ significantly among cohorts (510.4 ± 5.4, 509.6 ± 6.3, and 510.0 ± 4.9; p = 0.74). Significant differences in the proportion of students scoring above the national reference value were observed in the Pulmonology (p = 0.003), Gastroenterology (p = 0.020), and Endocrinology (p = 0.003) blocks; however, these differences did not demonstrate a consistent relationship with contact hour totals. Across cohorts experiencing different contact-hour requirements and concurrent curricular changes, examination performance did not demonstrate a consistent pattern corresponding to the amount of required instructional time. These findings demonstrate that lower contact-hour requirements were not accompanied by consistently poorer short-term standardized outcomes in these cohorts; however, the independent contribution of contact hours cannot be separated from concurrent curricular changes.

International Medical Education doi: 10.3390/ime5030077

Authors: Branko Aleksic Itzel Bustos Villalobos

The story of International Medical Education (IME) began only five years ago with a simple but ambitious vision [...]

International Medical Education doi: 10.3390/ime5030076

Authors: Taylor Fenderbosch Daniel Hargraves Harini Pallerla Megan Rich Shanna D. Stryker

The demand for mental health services is rising, and given the continued shortage of mental health specialists, primary care remains a critical setting for mental health treatment. Training emerging leaders in primary care to integrate interprofessional behavioral health services into care teams can help meet this demand. The Community Primary Care Champions fellowship developed a curriculum for primary care physicians and physician associates to lead primary care teams in addressing mental health within their clinical settings. This mental health curriculum for twenty-four fellows was led by a single faculty member during a part-time year-long fellowship. Seven modules (each 50–110 min long) covered critical topics through a mix of didactic learning, group learning, and a case-based summative independent activity. Evaluation included a pre- and post-assessment of knowledge and confidence, a one-year post-fellowship assessment, and focus groups. Self-assessed knowledge and confidence in key knowledge/skills/behavior improved after the fellowship with large effect sizes, and self-assessed knowledge about the Collaborative Care model for behavioral health integration and confidence in assessing suicide risk persisted one year after the fellowship compared to pre-fellowship. Our mental health curriculum demonstrates increases in self-assessed knowledge and confidence. It can be adapted for other graduate medical education settings to prepare learners to lead primary care transformation.

International Medical Education doi: 10.3390/ime5030075

Authors: Nasser Shubayr Nada Alomairy Hind Shajiri Nouf Almalki Shatha Sabi

Background: Research on emotional intelligence and its associations with authentic leadership, general self-efficacy, and perceived stress among allied health students, particularly radiography students, remains scarce. This study described the levels of these constructs among radiography students during clinical practice, examined their interrelationships, and identified the emotional intelligence facets predicting perceived stress and authentic leadership. Methods: A cross-sectional study was conducted among 135 radiography students enrolled in clinical practice at Jazan University, Saudi Arabia, from March to May 2026 (response rate 61.3%). Data were collected using the Schutte Self-Report Emotional Intelligence Test, Authentic Leadership Questionnaire, General Self-Efficacy Scale, and Perceived Stress Scale. Spearman correlations and hierarchical multiple linear regression were performed. Results: Emotional intelligence was positively correlated with authentic leadership (p < 0.001) and general self-efficacy (p = 0.035) and negatively correlated with perceived stress (p = 0.012). Managing Own Emotions was the strongest negative predictor of perceived stress (β = −0.650, p < 0.001), whereas Managing Others’ Emotions was the strongest predictor of authentic leadership (β = 0.463, p < 0.001). General self-efficacy predicted neither outcome. Female students and those with higher GPAs reported higher emotional intelligence and authentic leadership scores. Conclusions: Specific emotional intelligence facets showed distinct predictive roles, with self-directed emotion regulation predicting lower perceived stress and interpersonal emotion management predicting authentic leadership. These findings support the integration of targeted, facet-specific emotional intelligence training within radiography clinical curricula as a potential approach to support stress management and leadership development.

International Medical Education doi: 10.3390/ime5030074

Authors: Marianne Synnes Emblemsvåg Lindis Kathrine Helberget

Background: Nursing students spend a substantial proportion of their education in clinical practice; hence, the quality of these environments plays a critical role in shaping students’ learning outcomes. While research finds that nursing students often encounter bullying and harassment during clinical placement, the characteristics of positive and high-quality learning situations during these placements are less clearly described in the literature. Methods: A convergent, quantitative-dominant mixed-methods study was conducted between April and June 2024. Quantitative and qualitative data were collected concurrently; statistical analysis described prevalence and associations, while thematic analysis explored students’ experiences and contextualised the quantitative findings. Results: Statistical and thematic analyses indicated that high-quality learning emerged from the interplay of inclusion, mastery and active participation. A gradual transition from observation to independent practice, combined with appropriate challenges and opportunities for reflection, characterised the most effective learning situations. Approximately 50% of the students perceived themselves as victims of bullying or harassment, which impaired learning and prompted some to consider leaving nursing programs. The juxtaposition of positive and negative experiences highlighted team inclusion as the pivotal factor for both enhancing learning and preventing bullying. Conclusions: Being included as part of the team emerged as the main driver of positive clinical learning, whereas feeling isolated from the team was interpreted as bullying or harassment. These results indicated that well-prepared students, empowered supervisors, and inclusive organisational cultures supported by transparent reporting and response systems can provide the foundation for both high-quality learning and the prevention of bullying and harassment in clinical education.

International Medical Education doi: 10.3390/ime5030073

Authors: Buyandelger Batmunkh Munguntuul Enkhbat Tuguldur Gankhuyag Bat-Ulzii Enkh-Amgalan Enkhbold Dogmidsangi Oyungoo Badamdorj

Background: Nursing education has evolved in response to changing social, cultural, political, and healthcare contexts. Although Cultural–Historical Activity Theory (CHAT) has increasingly been applied in medical education research, its application to the historical development of nursing education remains limited. This study examined the historical evolution of Mongolian nursing education through the lens of CHAT to identify patterns of activity system transformation and their implications for contemporary nursing education. Methods: A historical documentary review was conducted using CHAT as the primary analytical framework. Historical evidence was interpreted through Engeström’s activity system model, and transformations across successive historical periods were analyzed by examining changes in the object, mediating tools, institutional rules, community, division of labour, and outcomes of nursing education. Results: The findings demonstrate that the development of Mongolian nursing education was shaped by four complementary analytical dimensions: the Social Determinants of Health (SDOH), Diversity, Equity and Inclusion (DEI), political ideology, and paradigm shifts. These factors collectively influenced the transformation of nursing education activity systems from traditional caregiving practices to a modern, research-oriented, and internationally connected educational system. The analysis further revealed how social reforms, ideological transitions, and educational restructuring generated successive transformations in the organization, objectives, and professional identity of nursing education. Conclusions: This study provides a theoretically grounded historical interpretation of Mongolian nursing education through the lens of CHAT. The findings demonstrate that nursing education evolves through dynamic interactions among social, political, cultural, and educational factors, offering valuable insights for curriculum development, educational reform, and the advancement of nursing education in rapidly changing societies.

International Medical Education doi: 10.3390/ime5030072

Authors: Juan A. Sanchis-Gimeno Juan Jose Valenzuela-Fuenzalida Andreea-Bianca Zuld Mathias Orellana-Donoso Guinevere Granite

Low back pain (LBP) is the leading cause of years lived with disability globally, and a major rehabilitation priority, yet nursing education often does not translate burden evidence into first-contact actions across care settings. This article aimed to develop a nursing education and practice framework that converts global LBP evidence into competencies for assessment, education, medication safety, referral, follow-up and occupational prevention. A focused, Global Burden of Disease-informed narrative review and practice-oriented educational synthesis was conducted. PubMed/MEDLINE, CINAHL, Scopus, Google Scholar, and organisational sources were searched for burden estimates, clinical guidelines, pain education scholarship, nursing occupational health evidence and nurse-led self-management literature. Sources were selected for relevance to nurse-deliverable actions and curriculum assessment; systematic-review methods, meta-analysis and formal risk-of-bias appraisal were not used. Evidence was mapped iteratively to six nursing practice domains: red-flag triage and escalation; functional, psychosocial and contextual assessment; brief therapeutic education; medication safety and low-value-care reduction; follow-up and referral; and occupational prevention. The revised framework adds an explicit evidence-to-competency map, implementation guidance and evaluation indicators for undergraduate education, postgraduate training, continuing professional development, clinical supervision and quality improvement. LBP should be taught as a nursing-sensitive disability and rehabilitation priority, supporting nurses to screen for danger, validate pain, reduce threat, promote graded activity, monitor medicines, coordinate continuity and prevent occupational harm.

International Medical Education doi: 10.3390/ime5030071

Authors: Kelly Peterec Sundes Kazmir David Chartash Uma Padhye Phatak

Feedback is a key component of medical education and is essential for progression throughout medical training. While extensive literature describes best practices for delivering feedback, less is known about the critical role of feedback culture and its impact on feedback practices. This narrative review aims to discuss the evolution of feedback in medicine, the role of feedback culture and its impact on feedback practices, strategies to foster a positive feedback culture, and opportunities and challenges for feedback in the age of artificial intelligence. Relevant articles were identified through database searches and were selected based on relevance to the aims of this review. Our review demonstrates that the literature has shifted to emphasize the importance of broader sociocultural factors in shaping feedback and feedback interactions. Determinants of a positive feedback culture stem from all levels of feedback interactions, including individual learner’s engagement with feedback, interpersonal relationships and strong educational alliances, and institutional level factors that generate a positive culture. These determinants may then be translated into strategies to enhance and sustain a positive feedback culture. The advent of artificial intelligence in medical education has provided opportunities to enhance feedback, although the impact on feedback culture remains unknown. Future research must focus on effective strategies to measure feedback culture which must then be utilized to evaluate the impact of feedback culture on trainee and patient outcomes.

International Medical Education doi: 10.3390/ime5030070

Authors: Jason R. Thrift

Background: The global shortage of qualified nursing faculty continues to challenge schools of nursing by limiting program capacity and contributing to difficulties in recruiting and retaining new educators. Although mentoring has been widely recognized as an effective strategy for supporting novice faculty, comparatively little attention has been devoted to coaching as an intentional approach for facilitating the transition from clinical practice to academia. Aim: To describe the development of the Coach–Player Relationship Framework, a conceptual coaching framework designed to support the successful transition, confidence, and retention of new nursing faculty in higher education. Methodology: The Coach–Player Relationship Framework was developed through a conceptual model development process informed by a structured literature synthesis, the Growing Together mentoring framework, and reflective analysis of a shared faculty coaching experience involving two nursing educators teaching multiple sections of an undergraduate nursing course. Literature, theory, and practical experience were integrated to construct a coaching framework that translates mentoring principles into an operational faculty development strategy. Results: The resulting framework identifies three foundational elements—clear expectations, willingness to serve, and balance—that underpin successful coaching relationships between experienced and novice faculty. These principles are operationalized through the Coach–Player Model, which illustrates how reciprocal coaching interactions evolve across the Field of Play, Sidelines, End Zones, and Red Zones to foster instructional confidence, collaborative learning, and progressive professional independence. Conclusions: The Coach–Player Relationship Framework extends existing mentoring theory by providing a coaching-oriented approach to faculty transition into higher education. The framework offers nursing programs a practical strategy for onboarding novice educators while promoting collaboration, reflective practice, instructional confidence, and faculty retention. Future empirical investigation is needed to evaluate the framework across diverse educational settings and determine its effectiveness in improving faculty development outcomes.

International Medical Education doi: 10.3390/ime5030069

Authors: Osamah M. Abdulaal

Objectives: The aim of this study was to investigate radiography students’ perceptions of the usefulness of hands-on 3D-printed models for supporting their understanding of key image quality concepts in magnetic resonance imaging (MRI). Students’ views on the perceived contribution of these models to their learning experience, confidence, and independent learning were also evaluated. Methods: This questionnaire-based study included 79 students. Three 3D-printed MRI model sets were designed and fabricated for use in hands-on teaching sessions. Following the sessions, participants completed a seven-item questionnaire divided into two sections. The first section assessed students’ perceptions of the teaching value of each model set, whereas the second section assessed students’ perceived learning benefits. Likert-scale responses were summarized descriptively, and the internal consistency of the seven-item questionnaire was assessed using Cronbach’s alpha. Results: In terms of the perceived teaching value of the models, the highest proportion of “strongly agree” responses were observed for pixel–voxel dimensionality and voxel geometry model sets, with 58 (73.4%) and 55 (69.6%), respectively. Regarding students’ perceived learning benefits, students strongly agreed that the 3D-printed MRI models supported their confidence, independent learning, and learning experience in understanding MRI image-quality concepts, with 49 (62%), 47 (59.5%), and 46 (58.2%), respectively. The seven-item questionnaire demonstrated good internal consistency (Cronbach’s α = 0.896, 95% CI [0.835, 0.957]). Conclusion: Radiography students expressed strong favorable views regarding the hands-on use of 3D-printed models and perceived them as helpful tools for visualizing core MRI image quality concepts.

International Medical Education doi: 10.3390/ime5030068

Authors: Simranjeet S. Sran Carson Flamm Kevin Nies Latricia Lombardi Pavan Zaveri Ioannis Koutroulis

Recruitment and admission of highly qualified applicants to Doctor of Medicine (MD) programs are vital components of many academic institutions. We aimed to develop a structured curriculum to facilitate consistent and mission-aligned review of applicants within our MD admissions program. Across the 2023–2024 admissions cycle, we utilized Kern’s Six-Step Approach to Curriculum Development to design and implement a simulation-based curriculum to enable mission-aligned applicant evaluation, beginning with the interview process. The training targeted faculty interviewers and admissions committee members responsible for reviewing a diverse applicant pool that includes many non-traditional candidates. Our training was completed by 32 interprofessional medical school faculty, of whom 28 submitted both pre- and post-training rubrics, and 24 completed a retrospective post-then-pre survey. On a 4-point Likert scale, comfort applying competency-based interviewing (CBI) within the mission-aligned review framework increased from 3.0 to 3.8 (p < 0.0001, 95% CI 0.44–0.97), and ease of use for the new rubric was rated 3.4 compared to 3.0 for the prior rubric (p = 0.0215). Concordance with ideal scoring improved from 68% to 73% (p = 0.0287), corresponding to a mean increase from 6.11 to 6.54 of 9 competencies correctly assessed. Identification of weak competencies increased from 14% to 27% (p = 0.0287). Faculty rated the overall quality of the training as 3.7/4 (SD 0.5). These findings, based on a small sample from a single institution, suggest that simulation-based faculty development may improve interviewer comfort, rubric usability, and the process measure of scoring consistency in a simulated MD admissions setting.

International Medical Education doi: 10.3390/ime5030067

Authors: Alejandro Bruna-Mejias Loreto Paez-Alliendes Valentina Perez-Lira Diego Santander-Chavez Mathis Miranda-Schoen Rodrigo Vega-Salces Macarena Rodriguez-Luengo Diego Luengo Juan Jose Valenzuela-Fuenzalida María P. Moya Gustavo Oyanedel Gloria Cifuentes-Suazo Julio Figueroa-Puig Mathias Orellana-Donoso Juan Jose Cabezas-Salgado Cristopher Blackwood-Espinoza Juan Sanchis-Gimeno

Drawing-centred and drawing-associated visual-representation strategies are used in anatomy and histology education, but the literature spans learner-generated drawing, guided drawing, screencasts, multisensory approaches, and model-based visual abstraction. This systematic evidence map examined their use and conducted an exploratory quantitative synthesis of objective learning outcomes among health science students. The review was prospectively registered in PROSPERO (CRD420261360533) and reported according to PRISMA 2020. Searches finalized in April 2026 covered PubMed, Scopus, Web of Science Core Collection, CINAHL, and MEDLINE via Ovid, with backward and forward citation searching. After deduplication and supplementary searching, 1129 records were screened, 181 full-text reports were assessed, and 100 unique studies were included in the evidence map. Fifty-one studies were preliminary quantitative candidates. Six independent contrasts met the numerical meta-analysis criteria; however, only four were sufficiently aligned with drawing-centred learning to form the primary quantitative subset. Random-effects meta-analysis using Hedges g, REML estimation, and Hartung–Knapp confidence intervals yielded a positive but statistically uncertain primary estimate (g = 0.18, 95% CI −0.27 to 0.64; I2 = 50.1%; τ2 = 0.037; prediction interval −0.85 to 1.22). The broader six-contrast model was also positive but uncertain (g = 0.29, 95% CI −0.08 to 0.67). Certainty of evidence was very low. These analyses are exploratory rather than confirmatory because few conceptually comparable studies were available.

International Medical Education doi: 10.3390/ime5030066

Authors: Daian-Ionel Popa Codrina Mihaela Levai Florina Buleu Sonia Burtic Marius Militaru Iulius Juganaru Melania Lavinia Bratu

Background and Objectives: Generative artificial intelligence (AI) chatbots have entered medical education faster than guidance for their responsible use. Although a rapidly expanding 2024–2026 literature has examined generative AI adoption, attitudes, and AI literacy among healthcare students, comparatively little is known about which specific tools medical students prefer or whether reliance on them carries measurable cognitive risks. We characterized adoption patterns, tool preferences, perceived benefits, and determinants of cognitive overdependence among medical students. Methods: A single-center cross-sectional survey was administered to 141 medical students across preclinical and clinical years at a single institution. A 28-item instrument captured usage patterns, perceived learning benefit, output trust, verification behavior, and AI overdependence risk. Analyses included t-tests, ANOVA, chi-square tests, Pearson correlations, and hierarchical regression. Results: Unless otherwise specified, values are reported as group mean scores on 1–5 Likert agreement scales or as percentages of respondents. ChatGPT was the primary tool for 69.5% of respondents, followed by Claude (12.1%). Daily users reported greater perceived learning benefit than infrequent users (4.14 vs. 3.36; p < 0.001). Clinical students verified AI outputs more often than preclinical students (3.69 vs. 3.21; p < 0.001), while preclinical students showed higher reliance (p = 0.002); verification moderated overdependence risk across academic years (interaction p = 0.041). AI familiarity (β = 0.31) and verification habit (β = −0.22) were the strongest predictors of integration acceptance (R2 = 0.34). Conclusions: Reliance and verification habits diverge by training stage; curricula should pair AI literacy with explicit verification training to mitigate overdependence. As a single-center, self-report study, these findings require multi-center confirmation; nonetheless, to our knowledge, this is among the first studies to jointly profile students’ tool-specific reliability perceptions and to identify verification behavior as a moderator that buffers familiarity-driven overdependence.

International Medical Education doi: 10.3390/ime5030065

Authors: Tim Murphy Ginger Vaughn Rob E. Carpenter Benjamin McKinney Rochell McWhorter

Artificial intelligence (AI), treated in this study as an umbrella term for AI-enabled clinical and educational technologies rather than as a single platform, is reshaping medical education, including how diagnostic skills, treatment planning, and patient care are taught. This study examines AI integration in medical education through the perceptions and readiness of clinical educators. Guided by the Unified Theory of Acceptance and Use of Technology, the study explores factors influencing AI adoption in medical training, including performance expectancy, effort expectancy, social influence, and facilitating conditions. In this exploratory study, semi-structured interviews were conducted with 15 clinical educators in the south-central United States who supervise third-year medical students. Findings suggested six recurring themes: the technological learning curve, the need for hands-on learning, institutional support, mentorship, preservation of human elements, and generational differences in comfort with AI. While some AI-enabled applications may support adaptive and personalized learning, educators expressed concerns about maintaining empathy, patient interaction, and human-centered care. The findings suggest that effective AI integration may require strategic institutional support, ongoing training, and pedagogical change. This study provides insight into developing AI-ready medical education models that balance technical competence with humanistic values.

International Medical Education doi: 10.3390/ime5030064

Authors: Kathleen L. Mulligan Elina Kurkurina Alexander M. Mass Brendan L. Rooney Shaila Gopal Jessica Riley Rahul Anand

Wasteful care is a prevalent, costly problem in the United States. Medical schools are addressing this by teaching about value-based care. However, students still struggle with the application of this concept. We hypothesized that this struggle may be due to students’ uncertainty about how to define value-based care. In this article, we evaluated a novel, interactive, value-based care session for first-year medical students and assessed students’ abilities to define value-based care pre- and post-session. Our curricular session introduced first-year medical students to value-based care principles and included both a lecture and small-group role-play exercise focused on value-based decision-making. Students completed pre- and post-session surveys that assessed how they defined value-based care, from which we identified 11 unique themes. Following the session, students provided more complete definitions. Early instruction using peer-led sessions, application through role-play, and assessment through open-ended responses were associated with improved student ability to conceptualize and define value-based care. Improved definitional clarity may allow students to better apply value-based principles to their clinical practice. However, further research is needed to assess how the ability to conceptualize this concept translates to clinical application.

International Medical Education doi: 10.3390/ime5030063

Authors: Karthik Adapa Lisa Vizer Viola Goodacre Elizabeth Kwong Jennifer Bissram Emily Kertcher Nadia Charguia Lukasz Mazur

Burnout among internal medicine (IM) and internal medicine–pediatrics (Med–Peds) residents is at epidemic levels, yet few studies use systems-based methods to identify the specific work-system factors that drive it. Guided by the National Academy of Medicine (NAM) systems model of clinician burnout, we conducted a five-phase sequential mixed-methods study—survey, focus groups, contextual inquiry, affinity modeling and validation, and impact–effort prioritization—among 119 IM and Med–Peds residents at one academic medical center. Burnout (two-item Maslach Burnout Inventory [MBI]), resilience (two-item Connor–Davidson Resilience Scale), and 21 NAM-derived work-system factors were assessed, along with analyses report means, standard deviations (SD), 95% confidence intervals (CIs), and internal-consistency reliability. Among 36 respondents (30% response rate), 55.6% screened positive for burnout (95% CI 39.6–70.5%); mean emotional exhaustion was 3.78 (SD 1.12), and depersonalization was 3.17 (SD 1.38). The 21-item severity scale showed good reliability (Cronbach’s α = 0.85). The highest-severity factors were interruptions/distractions, excessive workload, time pressure, and work-life integration. Focus groups (n = 30), contextual inquiries (n = 14, ~80 observation hours), and validation sessions (n = 8) yielded 167 breakdowns and 11 priorities. An impact–effort analysis (n = 19) identified clinic workflows and in-basket workload as high-impact/lower-effort priorities. This participatory, systems-based method yields contextually grounded, prioritized targets for reducing resident burnout that survey data alone would not surface.

International Medical Education doi: 10.3390/ime5030062

Authors: Polykarpos Gkasiavelis Ioanna V. Papathanasiou Maria Malliarou Anna Mavroforou

Since the 1960s, Bioethics, Law and Deontology have become increasingly integrated into healthcare education in response to the growing ethical, legal and professional complexity of clinical practice. This national cross-sectional comparative study aimed to investigate the presence and structural characteristics of Bioethics, Law and Deontology teaching in Greek undergraduate Medical, Dental and Nursing curricula. Online study guides and syllabi for the academic year 2024–2025 from all Greek public Medical (n = 7), Dental (n = 2) and Nursing (n = 9) Departments were systematically reviewed. Data regarding course presence, type, semester allocation, European Credit Transfer and Accumulation (ECTS) credits and teaching hours were extracted and analyzed using descriptive and comparative statistics. Courses related to Bioethics, Law and Deontology were identified in 17 of 18 Departments (94.4%). The mean teaching hours per Department were 37.4, with Nursing Departments demonstrating higher teaching loads. However, 50% of Departments reported fewer teaching hours than the minimum proposed by the UNESCO Bioethics Core Curriculum. Considerable heterogeneity was observed regarding course structure and curricular integration. These findings suggest the need for greater curricular harmonization and strengthened Bioethics, Law and Deontology education in Greek undergraduate healthcare training.

International Medical Education doi: 10.3390/ime5030061

Authors: Ilham Refki Mohamed Benfatah Abdelghafour Marfak Elmadani Saad Abderraouf Hilali Ibtissam Youlyouz-Marfak

Background: Clinical reasoning is a core midwifery competency, yet adopting standardized NANDA–NIC–NOC frameworks remains challenging due to perceived abstraction. Objective: To explore the effectiveness of a pedagogical intervention combining collaborative learning, artistic mediation, and AI to enhance midwives’ clinical reasoning. Methods: A convergent parallel mixed-methods study with 40 practicing midwives at Hassan I Hospital, Morocco, involving a structured workshop with a learning game, symbolic tree creation, and AI-facilitated reflection. Inductive thematic analysis was applied to qualitative data, complemented by descriptive pre/post rubric scores assessed by two independent raters. Results: Four themes emerged: (1) improved structuring of clinical reasoning; (2) deeper conceptual appropriation of the NANDA–NIC–NOC framework; (3) enhanced reflexivity and metacognition via AI; (4) high engagement and pedagogical acceptability. Conclusions: Integrating collaborative gaming, artistic mediation, and AI showed high pedagogical acceptability and supported immediate structuring of clinical reasoning in midwifery, offering a promising and feasible model for initial and continuing training in resource-limited settings. Longitudinal studies are needed to confirm long-term clinical impact. Clinical reasoning; NANDA–NIC–NOC; artificial intelligence; simulation-based learning; collaborative learning; educational innovation.

International Medical Education doi: 10.3390/ime5030060

Authors: Catherine A. MacNary Dimitrios E. Bakatsias Gianna M. Ungaro Krisha S. Shah Ada Liu Tresor-Ange G. Oertel Homaira M. Azim

Early clinical exposure (ECE) has been associated with increased confidence, professionalism, and career exploration in undergraduate medical education. Student-run free clinics (SRFCs), such as the Health Outreach Project (HOP) at Drexel University College of Medicine, provide opportunities for preclinical students to engage in patient care and community outreach. This qualitative study explored medical students’ perceptions of participation in HOP. Fourteen third- and fourth-year medical students with prior HOP experience participated in four semi-structured focus groups conducted virtually over Zoom. Data were analyzed using an inductive thematic analysis approach. Four major themes emerged: (1) early clinical exposure and clinical skills development, (2) community engagement and patient-centered perspectives, (3) professional identity formation and career exploration, and (4) opportunities, limitations, and emotional challenges of outreach work. Participants described HOP as an important source of authentic clinical exposure that increased confidence in patient interactions and broadened awareness of social determinants of health and underserved populations. Students also reflected on the influence of HOP on professional identity formation, career interests, and perspectives on patient-centered care, while acknowledging frustrations related to systemic barriers and limited resources. These findings suggest that students perceive SRFCs as valuable experiential learning environments that support clinical preparedness and professional development early in medical training.

International Medical Education doi: 10.3390/ime5030059

Authors: Isshak Mrabet Deraoui Bernard Laubscher

Standardized Letters of Recommendation (SLORs) were introduced in the United States and Canada to address limitations of narrative letters in residency selection by improving objectivity, comparability, and reliability. This review evaluates their structure, performance, and broader adoption across regions. This narrative review synthesizes the literature published between 1995 and 2025, including survey-based studies, a systematic review, and specialty-specific analyses. Key domains examined include SLOR structure, predictive validity, score inflation, interrater reliability, correlation with objective metrics, and potential bias. SLORs are widely used across multiple North American specialties but remain rare in Europe, with limited implementation such as in Swiss pediatrics. The summative ranking component consistently shows the strongest association with match outcomes, whereas other domains demonstrate limited discriminatory value due to ceiling effects and score inflation. Interrater reliability remains suboptimal, and correlations with objective metrics such as USMLE scores are weak. Although major demographic biases are not evident, local applicants and those with distinctions tend to receive more favorable evaluations. SLORs represent an improvement over narrative letters but require refinement. Enhancing rating scales, strengthening rater training, and developing more detailed structured assessments may improve their reliability and utility as evaluation tools.

International Medical Education doi: 10.3390/ime5030058

Authors: Oksana Babenko Polina Morilova Lia M. Daniels

Introduction: Traditional instruments for measuring lifelong learning of health professionals fail to capture digital-age learning, creating a critical measurement disconnect. To address this gap, we developed a 16-item Self-Pursuits, Aspirations, and Knowledge Endeavors in the Digital Era (SPArKED) instrument. Methods: To gather validity evidence for SPArKED, a cross-sectional survey was deployed to health professional students (n = 558). The survey questionnaire included: SPArKED, Jefferson scale of lifelong learning for students in health professions, basic psychological needs satisfaction scale, and human–computer trust scale assessing students’ trust in generative technology to support lifelong learning. Exploratory factor analysis (EFA) and correlation analysis were performed. Results: The EFA of the SPArKED revealed a three-component structure: networked learning, i-learning (individual mastery), and AI-powered learning, together explaining 55% of the total variance. The SPArKED demonstrated good internal consistency (α = 0.86) and convergent validity with the Jefferson scale of lifelong learning (r = 0.75). The correlations between SPArKED and psychological needs satisfaction scores were moderately high: autonomy (r = 0.50), competence (r = 0.48), and relatedness (r = 0.51). SPArKED had a higher correlation with students’ trust in generative technology to support lifelong learning than the Jefferson scale (r = 0.52 and r = 0.32, respectively). Conclusions: Compared to the Jefferson scale, the SPArKED instrument appears to better capture digital-age learning behaviors among students in health professions. By assessing these evolving behaviors in learners, education programs can better guide future health practitioners in developing desired lifelong learning competencies and digital literacies. Future research should gather validity evidence for SPArKED across diverse learner samples and educational stages, informing a critical re-assessment of established instruments in the rapidly evolving learning landscape.

International Medical Education doi: 10.3390/ime5030057

Authors: Joshua Oladele Owolabi

Inner Triangle Outer Diamond (ITOD) Framework, presented and published in 2025, informed and guided the introduction of Artificial Intelligence (AI) ethics education into a Medical Humanities course for medical students. Central to the ITOD Framework is the premise that education takes place in an ecosystem, with outcomes shaped by the dynamic interplay and interactions among multiple components. In planning and designing the instruction, the ITOD’s inner triangle helped connect pedagogy (team-based learning), curriculum (AI in Medical Humanities), and assessment (reflective practice). The outer diamond’s elements were also considered to ensure proper alignment of the educational intervention with programme requirements, with special emphasis on resources, policies, instructional design, curricular structure, standard practices, including the educational ecosystem dynamics, and alignment of outcomes with overall programme objectives. Very importantly, the ITOD also aided in calibrating an effective response to external conceptual factors such as technological and cultural advances, and professional advancements. A pre- and post-intervention survey design was adopted to evaluate the impact of the educational intervention (n = 113 pre-session; n = 103 post-session). Results showed significant positive shifts in self-reported AI understanding, increased support for formal AI integration into the curriculum, and enhanced confidence in critically engaging with AI outputs (94.1% reporting ‘yes’ or ‘somewhat’ post-session). Following the educational intervention and the feedback received from the learners, it is accurate to state that the ITOD was a reliable framework for introducing technology-related topics, specifically Artificial Intelligence ethics education, into Medical Humanities within an undergraduate medical programme. The approach is hereby presented in this work and recommended to educators, academic leaders, and other stakeholders.

International Medical Education doi: 10.3390/ime5020056

Authors: Angelina Van Dyne Nicole P. Mirabadi Federica Klaus Lisa T. Eyler

Background: Empathy, compassion, self-compassion, and resilience are essential to medical practice and education. While some evidence shows that these traits may decline during medical school, few studies have examined all these capacities in the same cohorts or trends within an academic year. This study examines first-year longitudinal findings on cohort and within-year changes in these constructs among medical students. Methods: 98 students (58.2% female; Mage = 26.34 (2.86); 37.8% White; MS1 25.5%, MS2 25.5%, MS3 20.4%, MS4 26.5%) from a large US school participated in at least one wave of an online survey distributed 4 times during the 2023–2024 academic year. Validated measures assessed empathy (IRI), compassion (SCBCS), self-compassion (Neff SCS), and resilience (CD-RISC-10). Linear mixed models analyzed between-cohort differences over time with gender and race/ethnicity as covariates. Results: Compared to MS4 students, MS2 and MS3 students had significantly lower cognitive empathy and self-compassion, with marginally lower compassion and higher resilience (p = 0.06). Women reported higher compassion toward others but lower self-compassion and resilience than men. Conclusions: Lower empathy and compassion were observed as early as the second year of medical school, suggesting erosion factors, such as academic pressure and standardized testing, may impact trainees earlier than previously reported.

International Medical Education doi: 10.3390/ime5020055

Authors: Khadija Aboukad Mohamed Amine Baba Hicham Nassik

Purpose: To evaluate the effectiveness of serious games, including virtual reality-based interventions, in improving clinical skills acquisition among undergraduate and postgraduate health science students. Methods: This systematic review was prospectively registered in PROSPERO (CRD42024589035) and conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and ScienceDirect were searched from inception to 31 August 2025. Eligible studies examined serious games, simulation-based platforms, or immersive and non-immersive virtual reality interventions designed to support clinical skills development. Outcomes were classified using a predefined hierarchical framework aligned with Miller’s pyramid, distinguishing performance-based clinical competence, clinical reasoning, and secondary educational outcomes. Owing to substantial heterogeneity in interventions, comparators, and assessment methods, a narrative synthesis was performed. Results: Thirteen studies involving 892 participants were included. Serious games and virtual reality-based interventions were associated with generally favorable outcomes for knowledge acquisition, self-efficacy, motivation, satisfaction, and anxiety reduction. Improvements in clinical reasoning were reported in several studies, and some studies demonstrated benefits in performance-based clinical competence, particularly in simulation and virtual reality settings. However, findings for objective performance-based outcomes were mixed, with some studies reporting no statistically significant between-group differences. Heterogeneity in outcome definitions and limited reporting of standardized effect sizes reduced cross-study comparability. Conclusions: Serious games, including virtual reality-based interventions, may serve as complementary, scenario-based learning strategies in health sciences education. The most consistent effects were observed for cognitive and learner-centered outcomes, whereas evidence for objective gains in performance-based clinical competence remains variable. Further high-quality studies using standardized outcome frameworks, validated performance-based assessments, effect sizes, confidence intervals, and longer follow-up are needed.

International Medical Education doi: 10.3390/ime5020054

Authors: Edie L. Sperling Abigail Leff Hayden Manninen Natalie Walzer

Although one of the most common coping strategies for medical students is seeking interpersonal support, evidence shows that they often experience social isolation and low levels of emotional support and belonging, putting them at risk for increased stress and depression. In this exploratory systematic review and meta-analysis, we completed a comprehensive literature search including multiple databases to identify interventions used to increase belonging-oriented psychosocial outcomes among medical students. N = 5 articles (k = 7) were eligible for inclusion. Meta-analysis with the random effects model suggests that belonging-oriented psychosocial interventions may have a small, positive effect on improving feelings of belonging, g = 0.25, 95% CI [0.01–0.50], 95% PI [−0.52–1.02], p = 0.045. However, heterogeneity was substantial (Q = 9.92, p of Q = 0.04, I2 = 59.69%, T = 0.21, T2 = 0.04), and risk of bias was substantial. Subgroup analysis was precluded by the low number of primary studies. Further investigation into belonging-oriented psychosocial support among medical students would be beneficial to determine if these interventions are effective, and if so, ideal intervention types, modalities, facilitators, and durations.

International Medical Education doi: 10.3390/ime5020053

Authors: Elvira Rodriguez-Flores Eli Efrain Gomez-Ramirez Maria Valentina Toral-Murillo Melissa Ramirez-Villafaña Fernanda Medina-Vinelli Karime Nereida Valdez-Toral Liliana Alvarado Ruiz Maricela Casas Castañeda Jesus Jonathan Garcia-Galindo

The integration of non-immersive digital technologies into anatomy education has expanded substantially; however, their relationship with students’ academic motivation remains underexplored. This study examined the association between two non-immersive instructional modalities (Sectra® Table and Complete Anatomy®) and academic motivation among medical students, framed within Keller’s ARCS model. An analytical cross-sectional quasi-experimental design was utilized with 109 participants, whose group allocation was determined by existing curricular organization (LMC13: Sectra® Table; LMC23: Complete Anatomy®). Academic motivation was assessed using the Reduced Instructional Materials Motivation Survey (RIMMS), which evaluates attention, relevance, confidence, and satisfaction. Due to non-normal data distribution and variance heterogeneity, group differences were analyzed using permutation multivariate analysis of variance (PERMANOVA). The analysis revealed significant differences between instructional groups (R2 = 0.17, p = 0.001). Students in the Complete Anatomy® group reported higher motivational scores across domains, with the largest difference observed in confidence (R2 = 0.10). Although effect sizes were modest, the findings indicate that differences in accessibility and opportunities for autonomous interaction are related to variations in motivational engagement in technology-enhanced anatomy learning contexts. These results highlight the importance of considering motivational constructs when comparing instructional design approaches. Future longitudinal and controlled studies are needed to further examine these associations and their potential educational implications.

International Medical Education doi: 10.3390/ime5020052

Authors: Tina Seidel Christian Kosel Ricardo Böheim Martin Gartmeier Pascal O. Berberat

Physicians routinely operate in environments that require the rapid processing of complex and dynamic visual information to diagnose patient conditions, communicate effectively, and make informed decisions. Despite the central role of visual attention in clinical practice, these processes are rarely conceptualized or systematically measured in medical education research. In other professional domains, such abilities are described as professional vision (PV)—the situated capacity to selectively attend to relevant cues and interpret them considering domain-specific knowledge. Although the term professional vision foregrounds visual attention, we use it here to cover the multimodal clinical perception in which visual cues are typically embedded—predominantly visual, but in many tasks also auditory and verbal—with visual attention as the analytic anchor. This paper introduces a cognitive process model of professional vision for medical education (PV-CP) that specifies the perceptual and cognitive subprocesses underlying how physicians perceive and interpret clinically relevant information. Building on this model, we propose a theory-driven framework for the measurement of professional vision using multimodal indicators. Central to our argument is the assumption that professional vision represents a latent, temporally unfolding construct that cannot be validly captured through single behavioral metrics or outcome measures. Instead, robust measurement requires the coordinated analysis of gaze-based indicators of visual attention and cognitive indicators of reasoning, each reflecting distinct subprocesses of professional vision. By systematically linking families of indicators to specific subprocesses and clarifying their respective inferential strengths and limitations, the PV-CP model advances a process-oriented approach to studying professional vision in medical education. The framework provides a conceptual basis for integrating multimodal data sources and supports more precise interpretations of gaze and reasoning data in expertise research. In doing so, the model contributes to the theoretical refinement of professional vision and offers a structured foundation for future empirical research and the design of learning environments aimed at fostering clinically relevant perceptual–cognitive skills.

International Medical Education doi: 10.3390/ime5020051

Authors: Shayma Aljedaani Intessar Sultan Shereen El-Tarhouny

Proficiency in history-taking is foundational to safe clinical practice, yet traditional teaching methods offer infrequent opportunities for deliberate practice. This study evaluated whether an AI-powered virtual patient chatbot with a custom knowledge base could improve history-taking competence among fifth-year medical students during general medicine rotations. A mixed-method, quasi-experimental, non-equivalent control group design was used. The experimental group (N ≈ 157) engaged with four custom knowledge-based chatbot scenarios, while a control cohort (N ≈ 156) followed traditional training within the same curriculum. Assessment was performed using a validated Objective Structured Clinical Examination across two standardized cases, and user perceptions were gathered using an adapted Technology Acceptance Model survey from 105 students, with qualitative feedback from 32 trained students in a focus group. Compared to the control group, the experimental group demonstrated significant improvements in direct assessments (79.2% vs. 74.8%, p = 0.002) and indirect assessments (81.2% vs. 79%, p = 0.026). Participants reported a high user-perception score (80%) across usefulness, ease, attitude, and behavior. Focus group findings highlighted the chatbot’s value as a safe, flexible, feedback-rich tool. The chatbot-based training improved students’ performance and satisfaction and should serve as a supplementary aid rather than a substitute for real patient interactions.

International Medical Education doi: 10.3390/ime5020050

Authors: Shereen El Tarhouny Shayma Aljedaani Rania Alkhadragy Tayseer Mansour

This study explored faculty perceptions of using Facial Recognition Technology (FRT) for tracking medical student attendance at a private Saudi medical college. Using a mixed-methods approach, researchers surveyed 112 faculty members and conducted focus groups with 26 participants. The findings revealed a balanced but divided perspective. While a slight majority (51.8%) showed good acceptance, a significant minority (48.2%) did not. Faculty rated the technology highly for its perceived ease of use (85.7%) and effectiveness (75%). However, significant privacy concerns were a major issue for over half of the respondents (55.3%). Qualitative data highlighted key themes, including initial staff reactions to FR technology, the need for better staff communication and training, the balance between efficiency and technical challenges, and deep-seated ethical and privacy concerns related to surveillance. The study concludes that, while faculty see the potential benefits of FRT, successful implementation depends on addressing their legitimate concerns. To succeed, institutions must develop comprehensive strategies that include transparent privacy policies, reliable technology, and robust training for staff. Prioritizing stakeholder engagement and creating culturally sensitive implementation plans are crucial for balancing the benefits of FRT with privacy and ethical considerations.

International Medical Education doi: 10.3390/ime5020049

Authors: Beatrisa Volel Irina Smilyk Seyedamirhossein Hosseini Natalia Kireeva Dmitry Zakondyrin Sergey Dydykin Yuriy Vasil’ev

Introduction: Simulation-based training is a key component of surgical education; however, existing models, such as dry-laboratory and virtual reality simulators, have limitations in terms of realism and accessibility. The use of human cadaveric material is also challenging because of its high cost and limited availability. Objectives: To evaluate the effectiveness of biological models based on large animal cadaveric material, specifically cattle and pigs, for practicing head and neck surgical skills. Materials and Methods: The study included 100 third- and fourth-year students, who were divided into a study group and a comparison group, with 50 participants in each group. The study group practiced surgical skills using animal cadaveric material: a porcine mandible for bone graft harvesting and a bovine head for resection craniotomy. The comparison group practiced using 3D-printed models. The results were assessed using an anonymous 8-item Likert-scale questionnaire, followed by statistical analysis using the Mann–Whitney U test. Results: In the study group, statistically significant increases were observed in satisfaction with participation, fulfillment of expectations, perceived subjective acquisition of manual skills, and overall satisfaction with the training process (p < 0.001; median scores: 38.0 and 34.0, respectively). The greatest differences were observed in satisfaction with participation, where 54% of participants rated it as “Excellent” compared with 6% in the comparison group, and in perceived subjective acquisition of manual skills, reported by 80% of participants in the study group compared with 24% in the comparison group. Conclusions. The use of cadaveric specimens from large animals is associated with higher satisfaction and represents an accessible alternative for practicing basic and commonly performed head and neck surgical procedures that do not require fine dissection of neurovascular bundles. This model provides a high degree of tactile realism and anatomical context and is subjectively preferred over non-anthropomorphic simulators.

International Medical Education doi: 10.3390/ime5020048

Authors: Ravi Maharaj Maritza Fernandes Devindra Ramnarine Shastri Motilal Bidyadhar Sa

Purpose: In 2024, the University of the West Indies transitioned from discipline-specific final examinations to a unified medical exit examination. This study evaluates the feasibility and psychometric performance of this unified format, focusing on written item discrimination and the comparability of multiple Objective Structured Clinical Examination (OSCE) circuits. Methods: A retrospective analysis of de-identified results from all candidates sitting the unified examination at the St Augustine Campus in May/June 2025 was conducted. The assessment comprised a 320-item single best answer paper and a 17-station OSCE delivered concurrently across seven circuits. Inter-circuit differences were tested with one-way analysis of variance (ANOVA). Reliability was estimated using Cronbach’s alpha and Generalizability Theory (G- and phi coefficients). Decision-study modelling estimated the number of OSCE stations required for high-stakes reliability. Pearson’s correlation assessed the relationship between written and OSCE performance. Results: Scores from 157 candidates were analysed. Of 320 MCQs, 163 (50.9%) demonstrated acceptable discrimination with a point-biserial correlation coefficient (PBSC ≥ 0.20) and 26 (8.1%) showed negative discrimination, indicating the need for post-examination item review. Although 16 of 18 OSCE stations showed statistically significant inter-circuit differences, these variances were substantially attenuated upon aggregation; total OSCE scores showed only minor but statistically significant difference in total OSCE scores between circuits. Overall OSCE reliability was moderate (Cronbach’s alpha 0.72; G-coefficient 0.72; phi coefficient 0.69). Decision-study modelling indicated that approximately 20 stations would be required to achieve reliability suitable for high-stakes decisions. Written and OSCE scores correlated positively (r = 0.70, p < 0.001). Conclusions: A unified final exit examination is feasible and psychometrically defensible in large cohorts, but requires adequate OSCE station sampling to support high-stakes decisions.

International Medical Education doi: 10.3390/ime5020047

Authors: Wanjiku Githere Hawarit Jemal Mohammed Eilidh O’Brien Andrea Ouyang Anamika Sengupta Jyotsna Pandey

Increasing use of intrauterine devices (IUDs) makes effective pain management essential for high-quality care. However, gaps between patient and clinician pain perceptions, along with limited training in managing IUD-related acute pain, contribute to barriers in IUD use and patient–provider mistrust. This narrative review aims at (1) summarizing current IUD-related pain management, (2) evaluating the emphasis on pain education and management, including IUD insertion pain, in medical education, and (3) examining how gaps in pain education and management may affect clinicians’ preparedness to manage patients’ IUD-related pain. Relevant literature was identified through keyword searches across major databases and national organizations. Studies on IUD pain management approaches and pain education in undergraduate medical education (UME), graduate medical education (GME), and residency programs were included. The results section outlines the current IUD insertion pain-management options available and their limitations, alongside evidence of insufficient emphasis on pain education and its management in medical school and residency training. In conclusion, the study indicates that, although all pain-management approaches reduce perceived IUD-related pain, significant gaps in national guidelines, clinician–patient pain-perception non-alignment, and pain-education across UME and GME may be contributary to inconsistent clinical practices. A multi-pronged approach that includes strengthening pain-education throughout medical training could be one way to reduce these disparities by improving clinicians’ competence to manage pain effectively.

International Medical Education doi: 10.3390/ime5020046

Authors: Nino Shiukashvili Gvantsa Vardosanidze Ketevan Shengelaia Lika Khorbaladze Davit Nikolaishvili Mariam Rochikashvili Nino Tevzadze Archil Undilashvili Eka Ekaladze

Background: Empathy is a critical component of patient-centered care, influencing clinical outcomes, patient satisfaction, and adherence. Despite its recognized importance, empathy often declines during medical training, particularly in clinical years. Traditional teaching methods, such as reflective writing or self-assessment scales, often fail to promote sustained behavioral change. This study evaluated a structured, skills-focused empathy training program integrated into the third-year medical curriculum, designed to improve observable communication behaviors through actor-led simulation and multi-rater feedback. Methods: This single-group pre-post study evaluated a four-week mandatory intervention embedded within the clinical communication curriculum. Students were assessed before and after the intervention using a 19-item checklist covering five domains of empathy-related communication. Pre-post changes were analyzed using paired-sample t-tests and Cohen’s dz. Results: Thirty-two third-year medical students (mean age 21.25 years, 53% female) participated in the study. Post-intervention scores were significantly higher than baseline scores for the overall empathy-related communication score and across all five domains (all p ≤ 0.001). The overall mean score increased from 7.5 (SD 1.43) to 9.2 (SD 1.14), with a mean difference of 1.7 points (95% CI 1.12 to 2.28; p < 0.001), corresponding to a large paired-sample effect size (Cohen’s dz = 1.03). The largest domain-level gains were observed in verbal and non-verbal communication. Conclusions: This curriculum-embedded, actor-led empathy training intervention was associated with short-term improvement in observed empathy-related communication behaviors among third-year medical students. These findings support the feasibility of behaviorally grounded empathy training within undergraduate medical education, while highlighting the need for controlled and longitudinal studies to assess durability and transferability.

International Medical Education doi: 10.3390/ime5020045

Authors: Manal El Amrani Mohamed Amine Baba Hicham Nassik

Background: The increasing complexity of healthcare systems and the emphasis placed on patient safety have highlighted the crucial role of non-technical skills (NTS). Simulation-based training (SBT) has been widely adopted to acquire these skills. Objective: To evaluate the impact of simulation on the development of non-technical skills in health sciences students. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251066518). MEDLINE, Scopus, and Web of Science were searched from their inception to July 2025. Results: Twelve studies met the inclusion criteria. Most used quasi-experimental, before-and-after study designs and relied primarily on self-reported measures. The majority of results were classified at Kirkpatrick level 2a (attitude changes). Three studies reached level 2b, demonstrating improvements in objectively observed teamwork and communication behaviors. MERSQI scores ranged from 6.5 to 17, indicating variable methodological quality. No studies assessed transfer to clinical practice (level 3) or patient-level outcomes (level 4). Conclusions: Simulation-based training appears effective in improving self-reported non-technical skills and, to a lesser extent, objectively observed teamwork behaviors among health sciences students. However, the predominance of lower-level outcomes and methodological heterogeneity limit the strength of the evidence. Rigorous longitudinal studies evaluating higher-level outcomes are needed.

International Medical Education doi: 10.3390/ime5020044

Authors: Desiree’ Sant Andrea Cuschieri Sarah Cuschieri

Obesity is a global epidemic, posing intricate health dilemmas with wide-reaching ramifications. Despite its rising prevalence, obesity often receives inadequate attention in medical training, which is hypothesized to influence obesity management. The study aimed to evaluate medical students’ readiness in addressing obesity, which is especially relevant in a country with significant high obesity rates. A cross-sectional pilot study was carried out by disseminating a mixed-methods anonymous questionnaire among pre-clinical and clinical students studying at the University of Malta. Quantitative data was analyzed through descriptive and inferential statistical analysis, while qualitative responses were subject to thematic assessment. One hundred and eighty-nine students were recruited, and the majority expressed dissatisfaction with curricular education on obesity, especially clinical students who reported a perceived lack of essential theoretical and practical skills (82.65%, 95% CI [73.69–89.56]). Less pre-clinical students perceived receiving sufficient education on obesity and obesity management students (33.3% and 43.33%, respectively) compared to their clinical counterparts (67.68% and 53.54% respectively), which highlights a potential curriculum gap. Qualitative analysis revealed discontent with teaching methods and demonstrated the need for a more holistic approach to obesity education. This study highlights an urgent need to integrate holistic and comprehensive obesity education within the medical education curriculum that addresses both theoretical understanding and practical skills.

International Medical Education doi: 10.3390/ime5020043

Authors: Nadine Wolf Philip Vogt Sandra Jordan Stuart Holmes Kerry Greenan Nick Mamo Nele Michels Aaron Poppleton Fabian Dupont

Background: Professional identity formation (PIF) and wellbeing are increasingly being recognised in postgraduate Family Medicine (FM) education. Role models are central to both, yet traditional learning activities often struggle to implement them effectively. Podcasts offer a flexible medium that may support these goals. This study examines the potential of postgraduate medical education (PGME) podcasts, such as the European Young Family Doctor’s Movement (EYFDM) podcast, to promote PIF and wellbeing. Methods: This mixed-methods study analyses podcast use, role modelling effects, and PIF among young general practitioners (GPs). In 2024, 57 participants, including students, FM trainees, and specialists, completed an online questionnaire with quantitative and qualitative items. Descriptive and analytical statistics were combined with qualitative content analysis (Kuckartz). Sentiment analysis was conducted using artificial intelligence, and triangulation enhanced credibility. Results: Within the trainees and specialists of the study population, most participants (70%; 32/46 SPs) reported regularly using podcasts for PGME, and particularly young female GPs in Western Europe. In our study population, 90% (27/30 SPs) agreed that the podcasts broadened their perspective on professional opportunities in FM. Many participants reported reflections on potential career pathways and PIF. Exposure to role models significantly increased motivation to work in FM (χ2 (1) = 10.7, p < 0.001). Conclusions: Podcasts may help address gaps in affective competency training, including wellbeing and PIF, while integrating easily into busy routines. Findings suggest a positive influence on career attitudes, with role modelling supporting PIF and motivation in FM.

International Medical Education doi: 10.3390/ime5020042

Authors: Rahul Pandit

The Special Issue “New Advancements in Medical Education” was intended to create a compilation of ideas on how medical education is preparing to keep up with a changing world [...]

International Medical Education doi: 10.3390/ime5020041

Authors: Deanna Wai Ching Lee Chong Yau Ong Marcus Chua Ang Zhe Chaoyan Dong

Background: Variability in procedural exposure among internal medicine junior doctors may result in inconsistent preparedness for essential bedside procedures. Simulation-based education grounded in mastery learning has been proposed to standardise skill acquisition, but less is known about how such training is integrated into clinical practice. Methods: We conducted a theory-informed mixed-methods evaluation of a mastery-oriented procedural simulation workshop. The quantitative component used pre–post assessments, including a multiple-choice knowledge test and self-reported measures of perceived knowledge, skill, and confidence using a 5-point Likert scale. Participants were required to achieve predefined competency benchmarks based on ACGME-aligned procedural checklists. The qualitative component, conducted two years later, involved semi-structured interviews exploring how participants integrated workshop learning into clinical practice. Results: Thirty-eight participants completed paired pre–post assessments. Knowledge scores and self-reported perceived knowledge, skill, and confidence improved significantly across all procedures (p < 0.01), with large effect sizes. Ten participants participated in follow-up interviews. Thematic analysis identified four themes: (1) standardization of procedural practice, (2) activation of prior knowledge, (3) hands-on experience and skill development, and (4) relevance to clinical practice. Conclusions: A mastery-oriented simulation workshop was associated with improvements in knowledge and perceived procedural readiness. Structured simulation may influence how junior doctors approach procedural learning in clinical practice.

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.