International Medical Education

Interprofessional service-learning programs can help to break down the education and training silos between public health and health care in the United States. This paper describes the development and implementation of one such program between the University of Massachusetts, Amherst, School of Public Health and Health Sciences, Bay Path University Physician Assistant Program, and the Wa-West Health District in Ghana. The program brought together Master of Public Health students and Physician Assistant students to complete an applied practicum and training experience in a low-resource community that faces significant health care and public health delivery challenges. In 2017 and 2018, nine students participated in the two-year pilot program, UMass Amherst Interprofessional Integrated Service Learning and Community-Based Participatory Collaboration. Students completed projects designed by Ghanaian health officials over two summers in direct collaboration with the communities. Findings from the evaluation of the pilot program revealed that though the students faced some challenges with the program, such as language barriers, transportation issues due to poor roads, and difficulty scheduling meetings while completing their projects in Ghana, the majority described their experience as positive and were satisfied. Some expressed the idea that their experiences were something that they could incorporate into their current and future practices. In addition, they reported that interprofessional communications and collaborations were effective. Recommendations are offered to address the program’s challenges for its continuation and formalization. Full article

Suboptimal knowledge of clinical pharmacology, therapeutics, and toxicology (CPT) and poor-quality prescribing are threats to patient safety. Our previous national survey of medical faculty identified limited confidence in medical student graduates’ ability to safely prescribe, as well as an interest in a national prescribing competence assessment. Given the in-person challenges posed by the restrictions related to the COVID-19 pandemic, we aimed to re-evaluate opinions and gauge the interest in e-learning resources and assessments. Using public sources, a sampling frame of medical school leaders from all 17 Canadian medical schools, including deans, vice-deans, and program directors for clerkship, residency, and e-learning, were invited to participate in a cross-sectional survey. Survey questions were finalized after several rounds of testing, and analyses were descriptive. Of 1448 invitations, 411 (28.4%) individuals reviewed the survey, and, among them, 278 (67.6%) completed at least one survey question, with representation from all schools. While more than 90% of respondents agreed that medical students should meet a minimum standard of prescribing competence, only 17 (7.9%) could vouch for their school meeting objectives in CPT, and many had significant concerns about their own or other schools’ recent graduate prescribing abilities. Given the lack of local CPT e-curricula resources, there was strong interest in a national online course and assessment in CPT. Our national survey results suggest an ongoing inadequacy of medical trainees’ prescribing competence, and also provide a strong endorsement for both a national online CPT course and assessment during medical school. Full article

(1) Background: Final-year medical students often feel under prepared for their transition into clinical practice. Clinical ward rounds and shadowing approach this issue by building transferable skills; however, they are highly variable, with teaching clinicians experiencing a large number of work-related interruptions. Simulated ward rounds have garnered significant interest by translating clinical encounters into standardised educational opportunities for students. This review evaluates the impact of simulated ward rounds in promoting the clinical competencies required for work in final-year medical students and assesses the impact of simulated ward rounds on the experience of clinical learning for medical students. (2) Methods: A computer-assisted search was performed in the Medline, Embase, and CINAHL databases. Studies that evaluated simulated ward rounds in final-year medical student cohorts were included. (3) Results: In total, 107 articles were identified by the search and 26 articles were eligible for full-text analysis. The analysis of these studies showed that simulated ward rounds were effective in improving confidence, as well as the technical and non-technical skills of final-year medical students; however this is on the basis of highly heterogeneous and lower-quality evidence. (4) Conclusion: Our systematic review highlights that simulated ward rounds provide final-year medical students with increased confidence and preparedness for clinical work and identifies the need to pursue more methodologically rigorous research to inform the best practice delivery of simulated ward rounds. Full article

Digital health, encompassing the use of digital technologies in healthcare, and telemedicine, facilitating healthcare delivery across long distances, have witnessed widespread applications across various healthcare domains. The COVID-19 pandemic accelerated the adoption of digital solutions in healthcare, overcoming barriers to access and fostering transitions to new care models. However, healthcare professionals often lack digital health competencies, necessitating targeted training initiatives. This study presents a project initiated by the Order of Physicians and Dentists of Rome, promoting a comprehensive training program in digital health for healthcare professionals. This investigation aims to describe the project, report demographic characteristics of participants, and analyze survey results on participants’ perceptions of the training program. The Erasmus+ project, titled ‘Training of Physician Trainers in Telemedicine, eHealth, and Digital Medicine,’ facilitated the digital transition of the healthcare sector through international training. The project involved structured courses, job-shadowing, and support activities in Malta and Madrid. A survey, developed using the Delphi methodology, assessed participants’ views on telemedicine. Thirty participants, selected based on merit, engaged in the project. Survey responses highlighted a strong impact on participants’ understanding of digital health concepts and increased confidence in utilizing digital tools. Notably, 85% acknowledged significant skill acquisition in healthcare digitalization. The project addressed a critical training gap among healthcare professionals, emphasizing the need for ongoing education in digital health. Despite existing recommendations, formal digital health education remains limited. The study underscores the importance of educational efforts to foster a digitalized healthcare model. Full article

Medical students (MS) are at higher risk for depression than their peers. Incoming U.S. MS completed a survey that included the validated RS-14, which measures resilience and its two subcomponents: self-assuredness and drive. Surveys were administered before classes started in 2019 (pre-pandemic-cohort; n = 178) and 2020 (pandemic-cohort; n = 181). Resiliency, self-assuredness, and drive were not different between cohorts. Demographic subgroup analyses revealed that underrepresented in medicine (URiM) MS in the pre-pandemic-cohort scored higher on drive (p = 0.007) than non-URiM MS (6.07 ± 1.00 vs. 5.59 ± 0.97); however, this difference was not significant in the pandemic-cohort. Additionally, students in the pandemic-cohort were more likely to agree that peer discussions about emotional challenges would be beneficial (p = 0.014). Qualitative analysis revealed that 45.9% of pandemic-cohort respondents felt more motivated to pursue medicine. This is the first study to report differences in drive between URiM MS cohorts matriculating before and during a pandemic, a positive correlation between multiple-mini-interview (MMI) scores and drive, and a negative correlation between MCAT scores and drive. Collectively, these results suggest that the circumstances of 2020 may have negatively influenced the drive of URiM students, positively impacted the receptivity of MS to peer discussions, and motivated students to pursue medicine. Full article

In the context of Canadian medical education, Distributed Medical Education (DME) plays a crucial role in addressing healthcare disparities, particularly in rural areas. This study focuses on the Department of Psychiatry at Dalhousie University, analyzing psychiatrists’ engagement and willingness to participate in research at DME sites in Nova Scotia (NS) and New Brunswick (NB). The cross-sectional study, encompassing data from an environmental scan, surveyed 60 psychiatrists involved in medical education across seven health zones. Results revealed significant associations between gender, type of graduates, and specialist training. A majority of psychiatrists (68.3%) do not currently engage in mental health or translational research, citing barriers such as a lack of protected time and financial incentives. Notably, participants expressed interest in future research areas, including health services/quality improvement and addiction research. Geriatric psychiatry, predominantly female-dominated, lacked current research activities. The study emphasizes the need to address barriers and promote motivators, both intrinsic and extrinsic, to enhance psychiatrists’ research engagement. This strategic approach is essential for fostering active participation in research, thereby contributing to the expansion of DME sites in Atlantic Canada and beyond. Full article

South Africa faces healthcare challenges due to inefficiencies, resource constraints, and disease burden. The AfriMEDS curriculum framework was adopted as part of curriculum reform to facilitate the training of comprehensive healthcare professionals capable of addressing healthcare challenges. However, the curriculum ideologies underlying this framework have not been explored. This research aimed to qualitatively describe the curriculum ideologies underlying the AfriMEDS framework as a proxy to determine how it could facilitate the training of healthcare practitioners fit to address South African healthcare challenges. ChatGPT was used to extract data from the framework using a previously validated document analysis protocol. Interpretive analysis was employed to analyze the extracted data to determine inferred curriculum ideologies. A complex interplay of curriculum ideologies was found, with the discipline- and service-centered ideologies most dominant, followed by the citizenship-centered ideology, while the student-centered ideology was found the least. It was also found that the six components of curriculum ideologies exhibit varying degrees of ideological representation. It is concluded that, while the AfriMEDS curriculum framework could produce technically skilled and service-oriented practitioners, its effectiveness in nurturing well-rounded medical professionals may be limited. Integrating a balanced representation of all curriculum ideologies is recommended. Full article

Traditional approaches to marking short-answer questions face limitations in timeliness, scalability, inter-rater reliability, and faculty time costs. Harnessing generative artificial intelligence (AI) to address some of these shortcomings is attractive. This study aims to validate the use of ChatGPT for evaluating short-answer assessments in an undergraduate medical program. Ten questions from the pre-clerkship medical curriculum were randomly chosen, and for each, six previously marked student answers were collected. These sixty answers were evaluated by ChatGPT in July 2023 under four conditions: with both a rubric and standard, with only a standard, with only a rubric, and with neither. ChatGPT displayed good Spearman correlations with a single human assessor (r = 0.6–0.7, p < 0.001) across all conditions, with the absence of a standard or rubric yielding the best correlation. Scoring differences were common (65–80%), but score adjustments of more than one point were less frequent (20–38%). Notably, the absence of a rubric resulted in systematically higher scores (p < 0.001, partial η² = 0.33). Our findings demonstrate that ChatGPT is a viable, though imperfect, assistant to human assessment, performing comparably to a single expert assessor. This study serves as a foundation for future research on AI-based assessment techniques with potential for further optimization and increased reliability. Full article

Background: The development of clinical reasoning (CR) abilities in Thai medical students during their pre-clinical years lacked well-designed establishment. Methods: This study utilized a pre-test and post-test design without a control group and was conducted at Walailak University, Thailand, in May 2022. We collected participant baseline characteristics and compared scores evaluated by the instructor and participants before and after the intervention. Additionally, we conducted a post-intervention survey on workshop satisfaction, perspectives on CR, and its learning impact. Results: Nineteen third-year medical students were included in the analysis, and twelve (63.2%) were women. The mean age was 20.6 years (standard deviation, SD: 0.5). The total score evaluated by the instructor after the intervention (8.95; SD, 1.81) was significantly higher than that before the intervention (1.68; SD, 0.67), p < 0.001. The total score evaluated by the participants after the intervention (8.22; SD = 1.44) was significantly higher than that before the intervention (2.34; SD, 2.06), p < 0.001. Overall, satisfaction was high. Conclusions: A short interactive workshop effectively taught CR principles and practice to Thai third-year medical students. These findings support the possibility of implementing this in pre-clinical curricula to prepare them for clinical practice. Full article

This narrative review is a detailed look at how we make multiple-choice questions (MCQs) based on medical cases in today’s medical teaching. Moving from old-style MCQs to ones that are more related to real clinical situations is really important. It helps in growing critical thinking and practical use, especially since MCQs are still the primary method for testing knowledge in medicine. We look at the history, design ideas, and both manual and computer-based methods that have helped create MCQs. Technologies like Artificial Intelligence (AI) and Natural Language Processing (NLP) are receiving a lot of focus for their ability to automate the creation of question. We also talk about the challenges of using real patient cases, like the need for exact clinical information, reducing unclear information, and thinking about ethical issues. We also investigate the measures of validity and reliability that are crucial to maintaining the honesty of case-based MCQs. Finally, we look ahead, speculating on where medical education is headed as new technologies are incorporated and the value of case-based evaluations continues to rise. Full article

Background. There are few studies about post myocardial infarction follow-up using telemedicine. We organized a post-discharge telemedicine service with a dedicated team. To do this, it was necessary that all stakeholders involved in the organization and use of the telemedicine service were properly educated and informed. Methods. We designed a theoretical–practical mini-course to train healthcare personnel and increase skills, with excellent learning outcomes and satisfaction. Thereafter, we enrolled patients affected by acute myocardial infarction with ST elevation (STEMI), MINOCA (myocardial infarction with no obstructive coronary atherosclerosis), Takotsubo syndrome or spontaneous coronary dissection, and high-risk acute myocardial infarction without ST elevation (NSTEMI). At discharge, the cardiology technician performed counselling for the patient, using regional platforms, such as televisit, at 1 and 4 months, allowed us to monitor major adverse cardiac events (MACE), heart failure, arrhythmias, unstable angina and non-cardiovascular events, therapy adherence, target therapy and customer satisfaction. Results. Between November 2021 and February 2023, we enrolled 110 patients: 72% affected by STEMI, 22% by NSTEMI. At the 1-month follow up, 12 patients did not reach the pressure target and 23 patients did not reach the LDL target. We observed three patients requiring hospital readmission, three requiring hospital visits for further investigation, and one death. To date, a four month follow up was performed for 54 patients. No readmissions or deaths occurred. We detected a rate of 96% of customer satisfaction. Conclusions. A health coordination center with a dedicated team makes televisit safe as a follow-up for post-myocardial infarction patients. Beforehand, it is fundamental for healthcare professionals to acquire theoretical knowledge and updates, and the acquisition of manual, technical and practical skills. Full article

For non-English-speaking nations such as Japan, proficiency in English has emerged as an indispensable skill, particularly in scientific fields like medicine. This research paper extends prior investigations into the motivations of Japanese medical students for learning English and delves into their willingness to communicate (WTC) in English. Importantly, it explores the impact of the COVID-19 pandemic on these motivations and communication behaviors. This study reveals that Japanese medical students are strongly instrumentally and vocationally motivated, viewing English as a practical asset for their future medical careers. They also exhibit a strong international posture, demonstrating an eagerness to engage with global cultures through English. Notably, the students’ motivation to study English remains resilient despite the pandemic’s challenges, such as the shift to remote learning and travel restrictions. However, their WTC in English exhibits nuanced changes. While overall WTC remains stable, students’ inclination to give presentations in English decreases significantly, possibly due to reduced face-to-face interactions in virtual learning environments. Additionally, their interest in participating in international events and activities wanes, possibly influenced by pandemic-related travel anxiety. These findings underscore the importance of offering specialized English classes and study abroad/international exchange experiences to sustain students’ motivation to learn English. Full article

Medical schools often rely on clinicians to provide guest lectures in foundational science courses. These guest lecturers may teach only once or sporadically in the undergraduate curriculum, which brings about several challenges that can impact their effectiveness. This guide, drawn from evidence-based teaching principles, medical student feedback, the authors’ training in educational and cognitive psychology, and experience as a clinical teacher, is designed to support clinical guest lecturers in meeting the educational standards and expectations for teaching in the preclinical setting as well as give insight into the needs of foundational science course directors and students. Full article

Reflection facilitates medical education and professional practice by enhancing active and deep learning from experiences. The reflection period is a time for self-awareness and self-assessment of learning events and experiences to improve future experiences (e.g., skill acquisition). Advocates for reflection suggest that reflective practice has the power to enhance professionalism as it provides an opportunity for critical thinking. It can be of variable length and depth; however, the process should be explorative and factual. Critical reflection is a broader and in-depth consideration of historical, cultural and political contexts to challenge and change one’s or a group’s assumptions and actions. Although the process is beneficial to achieving the intended learning objectives, its impact on educational and clinical outcomes remains unclear in anaesthesia. The usefulness of reflection in the learning process or work practices varies depending on personal, professional and organisational factors. Several models and approaches are described to facilitate the reflection process. However, assessment of reflection within the curriculum boundaries and for workplace-based learning activities is complex and challenging due to the lack of validated tools for different types of reflection. PubMed and Google Scholar were searched for articles on reflection and its application in anaesthesia. The anaesthesia literature has minimal information on the theoretical and research aspects of reflective learning and teaching. This review aims to outline the purpose of reflection, discuss the utilisation of commonly used reflection models and underline the intricacy of reflection in anaesthesia learning, teaching and practice. This article highlights crucial factors which may foster or hinder reflection and its effectiveness in achieving meaningful intended outcomes. Full article

During the COVID-19 pandemic, the education sector of Bangladesh suffered a lot. To adapt to this uncertain situation, the online teaching–learning method was introduced for the first time in the dental colleges to continue regular classes. This qualitative study explored the in-depth perception among students of this new, affordable, flexible online learning method and to find out the scope of improvement of the delivery method. Two focus group discussions (FGD) were conducted, each including 6–8 participants (N = 16, the male/female ratio was 7:9) for gaining an in-depth understanding of the perception of online teaching among dental students. With the help of the trigger questions, the facilitator and moderators conducted both FGDs. By analyzing the focus group discussion, four distinct themes were identified. The main themes extracted from the data refer to the difficulties which students faced during participation in online classes (e.g., low attention span, unusual timing of classes, internet accessibility, power cut, boring content, etc.), advantages of online learning (e.g., saves time, able to continue studying during the lockdown, saves money, avoids commuting, being safe during a pandemic situation, one can participate in classes if sick, etc.), disadvantages of online classes (e.g., not feasible for clinical classes and lab works, lack of social interactions, lack of group study, long screen time, lack of after-class peer discussion, lack of engagement, etc.), and also scopes of improvements (e.g., technological training for staff, recorded classes, technological orientation for students, more engaging contents, online support, more interactive lessons, short duration of the class, break after 30–45 min, and also teachers training for online facilitation, etc.). In Bangladesh, the online teaching–learning method is not a regular practice. Most of the institutions were forced to adopt this method on very short notice because of the COVID-19 pandemic lockdown. Online education in a clinical subject such as dentistry requires a special training program, online content preparation, and interactive lesson delivery setup, which are big challenges for a resource-constrained medical education setup. The focus group discussion unveiled some key issues which indicated that there are many scopes for improvement in online teaching methods. With the help of the medical education department and through faculty development, the online learning sessions can be made attractive as well as beneficiary for the key stakeholders. Full article

Recently, study abroad and elective programs have been facilitated via university partnerships based on student-exchange agreements. This study examined international medical student exchange agreements, focusing on reciprocity and stratification in the Japanese context. An empirical analysis was conducted using 581 agreements involving student exchanges with medical institutions in foreign countries based on a survey conducted by the Japanese Ministry of Education. We found that the average reciprocity rate via mutual tuition waivers was 52.84%: equivalent in Asia, slightly lower in Europe (49.61%), and higher in North America (58.06%). Europe has a balanced inbound and outbound exchange, Asia has a higher inbound exchange, and North America has an excess of outbound exchange from Japan. Moreover, selective institutions, such as former imperial or medical universities, have more than twice the number of agreements per university compared to others. In conclusion, it can be observed that international medical university partnerships are stratified, and reciprocity is intertwined with tuition waivers and the number of exchange students in the partnering institutions. As the results highlight the distinct characteristics of international education partnerships in Japan’s medical field compared to partnerships in all academic fields, it is necessary to investigate and develop international partnerships separately by field. Full article

Empathy is a crucial human quality that enables healthcare professionals to connect with patients, providing physical and emotional support to enhance patient-centered care. Empathy in healthcare is critical for establishing patient-provider (healthcare) trust, increasing patient satisfaction, and, eventually, delivering high-quality healthcare. However, there is growing concern about the declining levels of empathy among healthcare providers, partly related to increased workload, burnout, and empathic distress fatigue. Moreover, the recent emphasis of medical education on the technical aspects of healthcare over empathetic care also contributed to the decline of empathy among healthcare providers with compromised patient care. This brief article summarizes the potential causes and consequences of declining empathy in medical practice with future implications on the quality of humanized healthcare. Full article

The pandemic forced final year clinical students in six health-profession programs in a Caribbean University to suddenly transition from a clinical learning environment to an exclusively online environment for clinical instruction. The change in curriculum delivery allowed students to compare teaching of clinical skills using clinical and online learning environments. In June 2020, 278 students (78% response rate) completed a survey rating the online teaching experience. Students from each discipline also participated in a focus group discussion. Of the sample, 88% of students felt that the online environment was enthusiastic and stimulating but did not view it as satisfactory for skills transfer; 77% felt connected with their teachers but deprived of the social connectedness, peer support, and vicarious learning afforded by face-to-face instruction. Clinical students perceived the online environment as a convenient and beneficial platform to deliver didactic components of the clinical curriculum, thus providing downtime for students and ensuring equitable exposure of all students to all teachers. In the post-pandemic era, medical teachers should make the effort to maintain and refine online approaches, not just for use in times of emergency, but for integration into curriculum delivery strategies to improve the clinical learning environment and student satisfaction, while maintaining the hands-on method of clinical instruction. Full article

Background: Pharmacology and pharmacotherapy (P&PT) is a foundational subject within the medical curriculum, preparing students for safe prescribing. The characteristics of students entering medical school change with time, and novel insights on teaching and learning also become available. A periodic review of the curriculum is required to investigate whether the current P&PT teaching optimally supports learning. Methods: To investigate this, the students’ perceptions of their knowledge and competence in various P&PT topics were studied. A total of 152 third-year bachelor’s students were invited to answer a 40-point online questionnaire. Results: The response rate for completing the questionnaire was 32% (N = 49). Students valued P&PT teaching, did not skip P&PT topics and desired more P&PT classes. Interestingly, students were hesitant to use recommended literature and textbooks to prepare themselves for classes. Concerning perceptions of knowledge and competence, students rated lower confidence in prescription writing skills and knowledge of drugs acting on the central nervous system. Conclusions: Although there are many positive elements within the current curriculum, the incorporation of teaching methodologies to ensure active student engagement is warranted. These modifications are essential to properly training the current generation of medical students for their role as future prescribers. A relatively low response rate and overestimation of one’s competencies remain potential biases in the study. Full article