International Medical Education

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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