International Medical Education

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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

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

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

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

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

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

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

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

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

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

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

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

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

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