International Medical Education

The integration of Generative Artificial Intelligence (GenAI) into health professions education (HPE) is rapidly transforming learning environments, raising questions about its impact on teaching and learning. This mixed methods study explores clinical educators’ and undergraduate students’ perceptions and attitudes about using GenAI tools in HPE at a tertiary hospital in Singapore. Using the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) as theoretical frameworks, we designed and administered a survey and conducted interviews to assess participants’ perceived usefulness, ease of use, and concerns related to GenAI adoption. Quantitative survey data were analyzed for frequencies and percentages, while qualitative responses underwent thematic analysis. Results showed that students demonstrated higher GenAI adoption rates (68.7%) compared to educators (38.5%), with GenAI perceived as valuable for efficiency, research, and personalized learning. However, concerns included over-reliance on GenAI, diminished critical thinking, and ethical implications. Educators emphasized the need for institutional guidelines and training to support responsible GenAI integration. Our findings suggest that while GenAI holds great potential for enhancing education, structured institutional policies and ethical oversight are crucial for its effective use. These insights contribute to the ongoing discourse on GenAI adoption in HPE. Full article

A major aspect of transition of care is the patient handover, during which miscommunication can significantly cause medical error and harm in patient care. Few medical schools in the U.S. offer formalized instructions on patient handovers, with most medical students learning from interns and residents through unstructured teaching. The aim of this study was to assess the effectiveness of a patient handover curriculum we developed for fourth-year medical students to increase their confidence and skills. Graduating fourth-year medical students (N = 98) enrolled in a two-week Transition to Residency (TTR) course attended an interactive session on patient handovers. During this session, students were presented with the I-PASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic, went over case vignettes, and practiced giving and receiving handovers with a partner using the I-PASS template. At the end of TTR, students participated in an OSCE (Objective Structured Clinical Exam) activity that consisted of two standardized patient cases on blood transfusion and informed consent. Overall, our students did well with including important information in their Patient Summary (P: Case Scenario 1 Mean Score 56%; Case Scenario 2 Mean Score: 68%) and Action List (A: Case Scenario 2 Mean Score; 78%; Case Scenario 2 Mean Score: 87%) in their simulated patient case scenario. Pre-and-post survey results also indicated a significant improvement on student level of confidence (agreed or strongly agreed) in giving a patient handover (Pre: 53.1%; Post: 93.6%, p < 0.001), in receiving a patient handover (Pre: 58.2%; Post: 92.5%, p < 0.001), and in knowing what pertinent information to include in a patient handover (Pre: 62.2%; Post: 89.4%, p < 0.001). This study underscores the importance of systematic and repeated patient handover education throughout medical school training. Full article

This study assessed the needs and perceptions of mentorship among students and staff at the Faculty of Medical Sciences (FMS) across all University of the West Indies (UWI) campuses. A cross-sectional survey was conducted from February to May 2023, targeting FMS students and staff across four UWI locations. Data analysis included descriptive statistics and inferential tests, with results presented in proportions and averages. A total of 234 responses were received (138 students, 96 staff). The majority of students (88%) and staff (71%) were affiliated with the Bachelor of Medicine, Bachelor of Surgery (MBBS) programme. Both groups agreed that mentoring should focus on career guidance, professional goals, networking, and role modelling. Interest in mentorship was high among students (77%) and staff (89%), with no gender preference. Most mentees (72%) preferred faculty mentors, and mentors preferred to guide two to five mentees. A blended mentorship model was most preferred. While 29% of students had a mentor, 65% of staff reported prior mentorship experience (p < 0.001). These findings highlight the need for structured mentorship programmes in Caribbean medical education. Implementing and monitoring mentorship initiatives within UWI’s FMS can enhance professional development and academic success for both mentors and mentees. Full article

The use of electronic cigarettes (e-cigarettes), or vaping, has risen significantly over the past decade as an alternative to traditional smoking. Despite growing evidence of vaping’s adverse health effects, limited data exist on medical students’ knowledge, attitudes, and behaviors regarding vaping, as well as the extent of education they receive on this topic. This study aimed to assess medical students’ perceptions of vaping-related harms and their evaluation of vaping education in medical school. A cross-sectional online survey was conducted among currently enrolled students at St. George’s University’s School of Medicine (n = 5794) over a five-week period from February to March 2024. The survey focused on students’ experiences, behaviors, attitudes, and perceptions toward e-cigarettes and vaping and their assessment of vaping-related education. Of 5794 invited students, 1400 (24%) responded, with 1193 (94%) completing the survey. While 82% had never used conventional tobacco cigarettes, 29% reported having vaped at least once. Nearly all respondents (97%) recognized vaping as a health risk; however, 75% reported receiving no formal education on vaping in their curriculum, and 68% rated their education on the topic as poor or very poor. Despite awareness of vaping’s risks, a notable proportion of medical students have engaged in the practice. The findings highlight a gap in medical education, underscoring the need for improved curriculum coverage to equip future physicians with the knowledge necessary to address vaping-related health concerns. Full article

Nazarbayev University School of Medicine selected the University of Pittsburgh School of Medicine to guide their curricular development. University of Pittsburgh faculty members teaching in the medical school were asked to help develop the curriculum in Nazarbayev. Some were asked to travel to Nazarbayev University to provide mentoring. Realizing that this would be a new activity, we wanted to investigate the perceived motivations, rewards, and barriers to participation. We conducted open-ended interviews of University of Pittsburgh faculty members, who were asked to participate in a project about motivations for accepting or rejecting the offer. We asked those accepting about the benefits and negatives. Nineteen faculty members agreed to 30 min interviews, which were digitally recorded and transcribed. All interviews were coded. Participating faculty members felt that reviewing their courses improved them. Most noted increased altruism and felt improved as educators. Some felt angst in providing their curricula. Several felt that traveling was challenging, but video conferencing technologies facilitated communication. Interviewees desired tangible rewards. This study highlights faculty perceptions of international curricular development. Faculty members felt that rewards included an improved native curriculum and personal and professional enrichment. Time constraints and distance were the main challenges and the primary reason others declined. The faculty perceived multiple benefits from this curricular development and collaboration. More transparency regarding expectations and the degree of assistance Nazarbayev University needed may have assuaged these fears. Full article

Background: The traditional presentation of results of cognitive test and surveys using simple percentages or average score obscures topics failed or mastered by test takers. However, the Rasch technique revolutionises the presentation of a test result by connecting respondent latent knowledge (or ability) with the test items using Wright maps. Aim: To assess nurses and midwives’ knowledge of managing primary postpartum haemorrhage using a Wright map Methods: A twelve-item dichotomous (YES/NO) computer-based test developed from the recently updated WHO’s treatment bundle was presented to the respondents for fifteen minutes. A nine-member panel reviewed the test to ensure clarity and relevance to Nigeria’s public maternity setting. All the respondents were nurses and midwives with previous experience of responding to primary postpartum haemorrhage. Ethical approval was provided by the University of Huddersfield and the nurses’ association. After eight weeks of data collection, both descriptive and inferential analyses were conducted using a Wright map. Results: The 180 responses analysed on a Wright map showed that the lowest, average and highest measures to be 476.3 logits, 495.9 logits and 521.7 logits respectively. Also, 178 (98%) respondents incorrectly answered the question on the source of treatment evidence but correctly answered that uterine atony is the main cause of postpartum haemorrhage. However, all the respondents who scored below average (495.6 logits) incorrectly answered the question on oxytocin as the best uterotonic. Conclusions: Wright map analysis confirms the problem of the inadequate knowledge of maternity staff as a major barrier to the effective treatment of maternal bleeding. A significant difference was found in the knowledge of the treatment among the three levels of maternity settings, implying the need for effective educational intervention strategies. Full article

Acknowledgement of the importance of students interacting with faculty in a social context has prompted the development of Learning Communities (LCs) in many medical schools. Understanding successful LC and fruitful mentor–mentee relationships is essential to recognize the perspective of multiple stakeholders, i.e., both mentors and mentees. This study used inductive qualitative analysis methods to compare the key attributes and competencies of mentors that are most important to mentors with those most important to mentees in LCs. Six mentor focus groups (N = 50) and four mentee focus groups (N = 22) were conducted. Thematic analysis revealed twelve distinct themes. Three were categorized as mentor/mentee similarities: (1a) individualized approach, (1b) history and physical skills, and (1c) group interaction. Three were categorized as mentor/mentee differences: (2a) teaching versus relationship competence, (2b) mentor as a relatable figure, and (2c) faculty development. Four themes were unique to mentees: (3a) cultural competence and role modeling, (3b) feedback to students, (3c) one-on-one sessions, and (3d) clinical pearls, and two themes were unique to mentors: (4a) communication and (4b) peer development. Formative evaluation is needed to recognize new styles of learning preferences and new forms of feedback. Awareness of the similarities and differences in the perspectives of mentors and mentees can inform modifications to LCs that can potentially improve the experience of both mentors and mentees. Full article

Background: Interprofessional education in the healthcare sector is becoming increasingly recognized in Germany; it is increasingly being included in the curriculum. The learners are usually the focus of the research. This study focusses on the teachers, as they are the ones who carry out the teaching and thus prepare the learners for practice. The aim of this study is to find out what skills interprofessional teachers should have for joint teaching and how the joint assumption of responsibility can be achieved in an interprofessional setting. Methods: Using a mixed-methods design, interprofessional courses were first identified across Germany in relation to the three professions of medicine, nursing and physiotherapy. Based on 76 fully completed quantitative questionnaires, the respondents’ views were surveyed with regard to the competences of the teachers, among other things. In 15 interviews based on these results, experts were asked more in-depth questions about competence limits and the assumption of responsibility, and the resulting data material was analyzed using Kuckartz’s structuring qualitative content analysis. Results: The quantitative results show that 70% of respondents (n = 53) consider it important to recognize profession-specific boundaries, while only 46% (n = 35) consider it important to assume joint responsibility. The qualitative part of the study shows that a basic understanding of the other professions is seen as conducive to dialog and collaboration. Furthermore, a shared assumption of responsibility is seen as an essential component of interprofessional teaching. Conclusions: In order to develop a shared assumption of responsibility, (self-)reflection is required; this also requires a conscious negotiation and development process on the part of the teachers. Teachers must align their joint actions with the needs of the learners so that they can later think and act across professions in patient care. As the process of (self-)reflection rarely takes place in mono-professional training programmes, opportunities to learn it are needed. Full article

Community engaged learning (CEL) is a teaching methodology which aims to bridge the gap between academia and society by collaborating on community-based projects. Inspired by theories of experiential learning and social constructivism, CEL celebrates learning by doing and is a rather novel teaching methodology within the predominantly theoretical bachelor medical curriculum. Despite CEL’s potential benefits, its implementation faces significant challenges. Here, we investigated how students, accustomed to traditional academic teaching, learn during CEL-infused courses, specifically studying student perception of their learning and identifying the various facilitators and barriers to learning during CEL. The study conducted at Utrecht University’s Faculty of Medicine included second-year medical students participating in a newly introduced CEL course. Using thematic analysis, the study analyzed students’ written reflections collected before and after completion of the course. CEL contributed to developing valuable competencies like empathy, leadership, and communication skills, which go beyond the realm of textbook and classroom-based knowledge. The study further identified key barriers and facilitators, both at personal and organizational levels influencing learning outcome of students. Based on these data, several recommendations have been formulated for all involved parties (students, academic institutions, community partners) which could contribute towards a sustainable embedding of CEL. Full article

The field of radiology heavily relies on image interpretation and reporting. Radiology residents undergo evaluations primarily based on their interpretation skills, often encountering varied cases with differing complexities. Assessing resident performance in such a diverse setting poses challenges due to variability in judgment among assessors. One aspect of training that can be standardized is the reporting process. Developing a structured reporting system could aid in evaluating resident milestones and achievement of Entrustable Professional Activities (EPAs), facilitating standardized assessment and comparison among peers. From our experiences, we describe a logical reasoning pathway followed by residents in their training, progressing from recognizing abnormalities to describing findings, identifying associated positive and negative findings, and recommending appropriate management. Each step provides evidence of milestone achievement and can be assessed through structured reporting. We propose that a grading system can be applied to assess perception skills, description accuracy, recognition of associated findings, formulation of differential diagnoses, recommendations, and consultation with clinicians. Comparison between junior and senior resident reports allows for monitoring progression and identifying areas for improvement. Although implementing this grading system poses challenges, it offers potential benefits in providing standardized assessment and guiding individualized learning curves for residents. Despite its limitations, once established, the system could enhance residency training in diagnostic imaging. Full article

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

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

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

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

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

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

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

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

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