Search Results (92)

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. Full article

Background: Domain-specific large language models (LLMs) like Ortho GPT have potential advantages over general-purpose models in medical education, offering improved factual accuracy and contextual relevance. This study evaluates the performance of Ortho GPT against general LLMs and senior medical students on validated orthopedic examination questions. Methods: Six LLMs (Ortho GPT 4o, ChatGPT 4o, ChatGPT 3.5, Perplexity AI, DeepSeek-R1, and Llama 3.3-70B) were tested using multiple-choice items from final-year medical student orthopedic exams in German language. Each model answered identical questions under standardized zero-shot conditions; accuracy rates and item-level results were compared using McNemar’s test, Jaccard similarity, and point-biserial correlation with student difficulty ratings. Results: Ortho GPT achieved the highest accuracy across models. McNemar’s tests revealed the significant superiority of Ortho GPT over DeepSeek (p = 2.33 × 10⁻³⁵), Llama 3.3-70B (p = 1.11 × 10⁻³²), and Perplexity (p = 4.01 × 10⁻⁵). Differences between Ortho GPT and ChatGPT 4o were non-significant (p = 0.065), suggesting near-equivalent performance to the strongest general model. No LLM showed correlation with student item difficulty (|r| < 0.07, p > 0.05), indicating that models solved items independently of human-perceived difficulty. Jaccard indices suggested moderate overlap between Ortho GPT and ChatGPT 4o, but distinct response profiles compared with general LLMs. Conclusions: These findings illustrate the superiority of Ortho GPT in orthopedic exam accuracy and context relevance, attributed to its specialized training data. The domain-specific approach enables performance matching or exceeding top general LLMs in orthopedics, emphasizing the importance of domain specialization for reliable, curriculum-aligned support in medical education. Full article

Background/Objective: Worldwide, ~45% of hypertensives remain undiagnosed, and ~26% are adequately controlled. The active involvement of all healthcare professionals in diagnosing hypertension at primary health care units (PHCUs) is linked to better blood pressure (BP) control. There is currently no research examining the potential role of senior medical students in the diagnosis of hypertension. This study aimed to evaluate the contribution of final-year medical students’ active participation in the diagnosis of hypertension. The study also examined the prevalence and control of hypertension among health service users in Greek PHCUs. Methods: This is a cross-sectional convenience sample study. During clinical placement in PHC, sixth-year medical students received systematic training and performed BP measurements, according to the guidelines, in private, well-organized spaces. Adult patients and visitors were enlisted for BP measurements. The BP readings were provided to the participants so they could discuss any concerns about their BP with their physician. Statistical analysis was performed with SPSS. Categorical variables are presented as frequencies. Continuous variables were assessed for normality and, based on their distribution, are expressed as mean ± standard deviation or median (interquartile range). Appropriate tests were performed for the comparisons across groups (chi-square for the categorical variables, and two-sample t-test or Mann–Whitney test for continuous variables). A p-value < 0.05 was considered statistically significant. Results: In the present study, 124 medical students performed BP measurements in 68 PHCUs. BP was measured in 704 individuals, aged 61 (IQR: 48.0–73.0) years old; 58.8% were female, 68.3% of whom were patients. The prevalence of hypertension was 56.7%. The control rate was 44.9% (BP < 140 and 90 mmHg among all hypertensives), and the control rate under treatment was 61.0% (BP < 140 and 90 mmHg among treated hypertensives). The involvement of medical students contributed positively, increasing the diagnosis of hypertension in individuals who might not have their BP measured in routine clinical practice. Ninety-nine newly diagnosed hypertensives were detected. Students identified 220 uncontrolled hypertensives and 112 uncontrolled under-treated patients, who were then referred to the consultant physicians. Conclusions: Students played a critical role in diagnosing hypertension and identifying newly diagnosed hypertensive patients. Embracing interprofessional care in the diagnosis and management of hypertension is essential for achieving better outcomes for our patients. Engaging medical students in BP measurements is a practical and feasible approach to improve hypertension diagnosis and control, taking into consideration the increased workload of PHC physicians. While this action has important medical education implications, the impact on the knowledge level of medical students was not evaluated. Limitations of this study include the assessment of BP in one visit without home BP measurements or a second visit, lack of follow-up of newly diagnosed hypertensives, and the low average number of BP measurements per student. Full article

Background/Objectives: Interprofessional training wards (ITWs) are effective in fostering interprofessional collaboration during undergraduate medical training. Ensuring safety is particularly crucial for vulnerable patient groups. We developed a safety concept for the pediatric cardiology ITW, enabling nursing trainees and final-year medical students to independently care for children with congenital heart defects (CHDs). This study aims to evaluate whether our safety concept allows the inclusion of patients with CHDs in the care provided by our ITW. It also seeks to evaluate patient feedback, including their perception of safety, and to investigate whether there is a correlation between the input and the severity of the heart defect. Methods: From 2020 to 2023, 16 ITW blocks were evaluated, each lasting 3–4 weeks. The three-stage safety concept includes patient selection, emergency prevention and emergency training. CHD severity in treated patients was recorded, and experiences were assessed via parent/patient questionnaires. Results: Between August 2020 and November 2023, 183 patients with mild (n = 52), moderate (n = 28), and severe (n = 103) CHDs were treated. The severity of CHDs was generally higher compared to other pediatric cardiology wards in Germany. There was no significant difference between the severity of CHDs of the patient treated by the ITW and those treated on the regular ward. Of 140 completed questionnaires, 99% of respondents would recommend the program. Overall impressions ranged from “very good” (81%) to “good” (19%), with a high sense of safety reported. Positive free-text comments highlighted the team’s competence and friendliness. Conclusions: The safety concept enabled the successful treatment of patients across all CHD severities, providing a transferable model for safe, interprofessional care in ITWs. Full article

Acid-base analysis is a high-load diagnostic skill that many medical students struggle to master when taught using traditional text-based flowcharts. This multi-institution mixed-methods study evaluated a novel visual mnemonic algorithm that integrated Medimon characters, symbolic imagery, and pop-culture references into the standard acid-base diagnostic framework. First-year medical students (n = 273) at six distributed WWAMI campuses attended an identical lecture on acid-base physiology. Students at five control campuses received the original text-based algorithm, while students at one experimental campus received the Medimon algorithm in addition. Achievement was measured with a unit exam (nine focal items, day 7) and a final exam (four focal items, day 11). A Differences-in-Differences approach compared performance on focal items versus baseline items across sites. Students at the experimental campus showed no significant advantage on the unit exam (DiD = +1.2%, g = 0.12) but demonstrated a larger, but still non-significant, medium-to-large effect on the final exam (DiD = +11.0%, g = 0.85). At the experimental site, 39 students completed the Situational Interest Survey for Multimedia (SIS-M), revealing significantly higher triggered, maintained-feeling, maintained-value, and overall situational interest scores for the Medimon algorithm (all p < 0.001). Thematic analysis of open-ended responses identified four themes: enhanced clarity, improved memorability, increased engagement, and barriers to interpretation. Collectively, the findings suggest that embedding visual mnemonics and serious-game characters into diagnostic algorithms can enhance learner interest and may improve long-term retention in preclinical medical education. Full article

Background: Direct clinical training on real patients is essential in dental education. However, the declining patient inflow increasingly challenges this objective. This cross-sectional study aimed to assess patients’ experiences and preferences to derive recommendations for improving patient recruitment. Material and Methods: Over a period of one year, patients treated by students in the courses and final examinations at the dental school of conservative dentistry were questioned using a specially designed questionnaire and reviewed using their medical records. They were asked about their complete treatment process, and patient files were used to record socio-demographic as well as economic and appointment-specific data. Results: We analysed 297 patients (142 women, 47.8%; 155 men, 52.2%) treated by undergraduates across two semesters (four courses) and two final examinations. Median age was 57.0 years (IQR 46–67; mean 55.2, SD 15.2; range 14–85) with no sex-based difference (p > 0.05). Arrival was predominantly by car (72.7%, n = 216); median one-way distance was 20.5 km (IQR 11.2–32.1); and 58.4% were employed, while 41.6% were not employed (33.7% retired, 7.9% unemployed). The leading reason for course attendance was “satisfaction with previous treatments” (65.32%). Information sources were reported by 290/297 (98%); the most common was already being a course patient (143, 48.1%). Most patients attended one appointment (109, 36.7%). Median travel cost per appointment (including parking) was €17.0 (typically €10.0–€23.5). Of 285 respondents, 93.68% answered “Yes” to satisfaction with student treatment. Conclusions: Important steps include enhancing parking facilities, optimizing recall systems and appointment accessibility, and strengthening relationships with regular patients to encourage word-of-mouth referrals. The main focus is to maintain high clinical quality, ensure affordability, and further reduce patient copayments where possible. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

Background/Objectives: Septoplasty is a commonly performed surgical procedure aimed at correcting nasal septal deviations, to improve nasal airflow and respiratory function. Traditional approaches to septal correction rely on either direct visualization or endoscopic guidance. Recently, a novel technology known as exoscopy has been introduced into surgical practice. Exoscopy is an “advanced magnification system” that provides an enlarged, three-dimensional view of the operating field. In this article, we present our experience with exoscope-assisted septoplasty, developed over the last two years, and compare it with our extensive experience using the endoscopic approach. Methods: Our case series includes 26 patients, predominantly males and young adults, who underwent exoscope-assisted septoplasty. We discuss the primary advantages of this technique and, most importantly, provide an analysis of its learning curve. The cohort of patients treated using the exoscopic approach was compared with a control group of 26 patients who underwent endoscope-guided septoplasty, randomly selected from our broader clinical database. Finally, we present a representative surgical case that details all phases of the exoscope-assisted procedure. Results: Our surgical experience has demonstrated that exoscopy is a safe and effective tool for performing septoplasty. Moreover, the learning curve associated with this technique exhibits a rapid and progressive improvement. Notably, exoscopy provides a substantial educational benefit for trainees and medical students, as it enables them to share the same visual perspective as the lead surgeon. Conclusions: Although further studies are required to validate this approach, we believe that exoscopy represents a promising advancement for a wide range of head and neck procedures, and certainly for septoplasty. Full article

Background: Medical education is considered one of the most academically and emotionally demanding training programs. Throughout their education, medical students are exposed to various factors that can lead to psychological distress, depression, and anxiety. The aim of this longitudinal study was to examine the changes in psychological distress, depression, anxiety levels and internet addiction among medical students throughout their six-year education and to identify the contributing factors. Methods: The study cohort consisted of 282 students who enrolled in the medical faculty in the 2017–2018 academic year. A questionnaire including sociodemographic characteristics, the General Health Questionnaire-12 (GHQ-12), Beck Depression Inventory (BDI), State–Trait Anxiety Inventory (STAI), and Young Internet Addiction Test (IAT) was administered to the students during the first week of their education. The same questionnaire was readministered at the end of the third and sixth years. Friedman’s variance analysis was used to compare measurement data across the three time points, while Cochran’s Q Test was employed for categorical variables. Results: The median scores of the GHQ-12, BDI, S-Anxiety, and IAT significantly increased from the first to the sixth year (p < 0.05). The prevalence of depressive symptoms, S-Anxiety, and risky internet use significantly increased from the first to the final year, particularly between the third and sixth years. According to logistic regression analysis based on sixth-year data, students whose fathers were university graduates, who had been diagnosed with COVID-19, and who were dissatisfied with their social lives were found to be at increased risk for psychological distress and depression. Students with high parental expectations were found to be at risk of depression and S-anxiety. Those dissatisfied with their occupational choice were at risk for both psychological distress and S-anxiety. Conclusions: It was found that the mental health of medical students deteriorated during their education, especially during the clinical years. Given that these students will be responsible for protecting and improving public health in the future, it is essential to prioritize their own mental well-being. Interventions aimed at preserving the mental health of medical students should be planned. Full article

Background: The effective use of electronic health records (EHRs) is an essential clinical skill, but medical schools have traditionally provided limited systematic teaching on the topic. Inefficient use of EHRs results in delays in diagnosis, fragmented care, and clinician burnout. This study investigates the impact on medical students’ confidence, efficiency, and proficiency in extracting clinically pertinent information from patient records following an organised EHR teaching programme. Methods: This observational cohort involved 60 final-year medical students from three London medical schools. Participants received a structured three-phase intervention involving an introductory workshop, case-based hands-on practice, and guided reflection on EHR navigation habits. Pre- and post-intervention testing involved mixed-method surveys, simulated case tasks, and faculty-assessed data retrieval exercises to measure changes in students’ confidence, efficiency, and ability to synthesise patient information. Quantitative data were analysed using paired t-tests, while qualitative reflections were theme-analysed to identify shifts in clinical reasoning. Results: All 60 students successfully finished the intervention and assessments. Pre-intervention, only 28% students reported feeling confident in using EHRs effectively, with a confidence rating of 3.0. Post-intervention, 87% reported confidence with a rating of 4.5 (p < 0.01). Efficiency in the recovery of critical patient information improved from 3.2 to 4.6 (p < 0.01). Students also demonstrated enhanced awareness regarding system-related issues, such as information overload and fragmented documentation, and provided recommendations on enhancing data synthesis for clinical decision making. Conclusions: This study emphasises the value of structured EHR instruction in enhancing the confidence and proficiency of medical students in using electronic records. The integration of structured EHR education to medical curricula can better prepare future physicians in managing information overload, improve diagnostic accuracy, and enhance the quality of patient care. Future research should explore the long-term impact of structured EHR training on clinical performance, diagnostic accuracy, and patient outcomes during real-world clinical placements and postgraduate training. Full article

Introduction: Diagnostic accuracy is essential for good-quality medical practice, and yet diagnostic errors remain widespread, influencing patient outcomes, healthcare costs, and clinician confidence. “Misdiagnosis Tracker” aims to instil error analysis into medical education and shift the focus toward the learning of lessons from errors in diagnosis. This study investigates how systematic review of diagnostic errors enhances medical students’ competence in diagnostic reasoning, identification of cognitive bias, and identification of atypical presentations. Methods: A cohort of 65 final-year medical students participated in a structured three-phase educational intervention comprising preparation, case study analysis, and reflection. Students examined 20 diagnostic error case studies to identify contributory factors, such as cognitive biases, atypical presentations, and systemic barriers. Quantitative data were obtained from pre- and post-study surveys assessing confidence and knowledge, while qualitative insights were gathered through group reports, reflective journals, and debriefing sessions. Results: The results indicated significant improvements in confidence in diagnostic reasoning (3.0 to 4.4, p < 0.01), awareness of cognitive bias (2.9 to 4.5, p < 0.01), and recognition of atypical presentations (3.1 to 4.6, p < 0.01). Qualitative results highlighted increased insight into red flags, systemic issues, and reflective development. Actionable recommendations made by the students were systematic diagnostic frameworks, better interprofessional communication, and focused education on cognitive bias. Conclusion: This study illustrates how the “Misdiagnosis Tracker” greatly enhances medical students’ reflective and diagnostic reasoning skills and better prepares them for clinical practice. By fostering an environment of learning from diagnostic mistakes, this approach could ultimately result in fewer diagnostic errors and improved patient outcomes. Longitudinal studies are essential to determine the long-term effect of this model on clinical competence and its application in different education settings. Full article

Background: Traditionally, community-based education (CBE) programmes have been utilised for teaching medical students clinical and interpersonal skills through placement in underserved environments. This pilot cohort study tested an extended model of CBE by infusing patient education into student-conducted consultations with the dual objectives of stimulating improved learning for the students and improved health literacy for the patients. Methods: The intervention involved 38 final-year medical students and 85 adult patients and from underprivileged communities in North West London. The students first undertook online preparatory workshops on health literacy, communication skills, and cultural competence. Subsequently, they imparted 20–30 min educational sessions on chronic disease management and preventive care to the patients on their clinical placements. The quantitative measurement used pre- and post-intervention questionnaires, and the qualitative measurement was based on reflective diaries and patient feedback. Paired t-tests were used for statistical comparisons, while a thematic analysis was used for textual answers. Results: Student confidence in breaking down medical jargon improved from 2.8 ± 0.7 to 4.4 ± 0.5 (p < 0.01), and confidence in making use of visual aids improved from 2.5 ± 0.8 to 4.2 ± 0.6 (p < 0.01). Understanding among the patients of their health conditions improved from 27% to 74% (p < 0.001), and self-confidence in their ability to manage their health improved from 31% to 79% (p < 0.001). The qualitative feedback noted improved empathy, cultural sensitivity, and a positive effect on patient empowerment through tailored education. Conclusions: This CBE intervention had two benefits: improving teaching and communication skills in students and greatly enhancing health literacy in underserved patients. The integration of structured education into usual care encounters holds the promise of a scalable, sustainable method for addressing health disparities. Longer longitudinal studies are necessary to assess its long-term success and incorporation into medical education. Full article

Aims/Background: Medical education is largely clinical and biomedical with little emphasis being put upon the social determinants of health (SDH) and patient-centredness. A programme entitled “Walking a Day in My Shoes” was devised as a pilot cohort study with the view of evaluating the impact of a clinical shadowing experience upon the empathy, SDH awareness, and patient-centredness of medical students. Methods: A prospective cohort study, involving 28 final-year London-area medical students, employing a three-phase teaching programme comprising preparation, observation, and reflection was carried out. Students’ confidence in the management of non-medical barriers, SDH awareness, and empathy before and after shadowing were measured using pre- and post-shadowing questionnaires. Qualitative analysis of patient feedback and journals also occurred. Results: Statistically significant improvements were observed in students’ empathy (mean score increase from 6.8 to 8.9, p < 0.001), understanding of SDH (advanced comprehension rose from 35% to 93%), confidence in addressing non-clinical barriers (from 39% to 86%), and awareness of logistical challenges (from 31% to 81%). Qualitative analysis highlighted key themes, including systemic barriers (transportation, polypharmacy, and social isolation) and students’ increased awareness of the emotional toll of chronic illness. Patients expressed high satisfaction, with 97% agreeing that the programme improved students’ understanding of chronic disease management. These findings suggest the programme’s practicality and scalability in medical education. Conclusions: This pilot cohort study demonstrated the significant enhancement of the students’ empathy, perception of SDH, and patient-centredness preparation through immersive shadowing. The findings support the use of experiential learning programmes as curricular interventions. Full article

Background: Chronic diseases require long-term and multidimensional care, but traditional medical education has emphasised acute care and episodic interventions. This gap limits the understanding of future clinicians about the complexity of managing chronic conditions over decades. This mix-methods quantitative–qualitative pilot study describes “Time Capsule Medicine”, an innovative educational framework in which medical students acted out the progressive challenges that patients with chronic illnesses might face over a continuous period of 20 years. This paper aims to report the outcomes of this innovative educational technique. Methods: Thirty final-year medical students were engaged in the three-phase programme which included preparation, immersive simulation, and reflection and evaluation. The preparation consisted of online workshops in chronic disease progression, age-related changes, and continuity of care, while the immersive simulation featured appropriate role-play exercises in small groups that simulated the chronic disease process across four five-year increments. The reflection and evaluation consisted of debriefing sessions and reflective journals, while pre- and post-simulation questionnaires tested learning outcomes. The physical constraints included weighted garments with visual impairments simulating the age-related limitations. Results: A gender- and ethnically diverse cohort of thirty final-year medical students from three medical schools in North London participated in the programme. The simulation significantly enhanced students’ confidence in managing long-term disease trajectories (pre-simulation score: 2.8 ± 0.9; post-simulation score: 4.3 ± 0.6; p < 0.01) and understanding of age-related challenges (from 3.1 ± 1.0 to 4.5 ± 0.5; p < 0.01). Empathy scores increased from 3.0 ± 0.9 to 4.7 ± 0.5 p < 0.01. The qualitative analysis showed an increased appreciation of the continuity of care, recognition of systemic barriers, and insights into the emotional burdens of chronic conditions. For many students, the simulation was transformative, changing the way they approached holistic, patient-centred care. Conclusions: This experiential learning approach has succeeded in effectively addressing one of the most important gaps known in traditional medical education in developing empathy, understanding, and confidence in the long-term management of chronic diseases. The integration of similar simulations into medical curricula may adequately arm future clinicians with the complexities of continuity of care and patient management. Further studies need to be performed exploring scalability and its impact on long-term clinical practice. Full article

Traditional Chinese medicine (TCM) gathers patient information through inspection, olfaction, inquiry, and palpation, analyzing and interpreting the data to make a diagnosis and offer appropriate treatment. Traditionally, the interpretation of this information relies heavily on the physician’s personal knowledge and experience. However, diagnostic outcomes can vary depending on the physician’s clinical experience and subjective judgment. This study employs AI methods to focus on localized tongue assessment, developing an automatic tongue body segmentation using the deep learning network “U-Net” through a series of optimization processes applied to tongue surface images. Furthermore, “ResNet34” is utilized for the identification of “cold”, “neutral”, and “hot” constitutions, creating a system that enhances the consistency and reliability of diagnostic results related to the tongue. The final results demonstrate that the AI interpretation accuracy of this system reaches the diagnostic level of junior TCM practitioners (those who have passed the TCM practitioner assessment with ≤5 years of experience). The framework and findings of this study can serve as (1) a foundational step for the future integration of pulse information and electronic medical records, (2) a tool for personalized preventive medicine, and (3) a training resource for TCM students learning to diagnose tongue constitutions such as “cold”, “neutral”, and “hot”. Full article