Editor’s Choice Articles

Background: Clinical reasoning (CR) is fundamental in medical education. However, the Italian curriculum has not incorporated a structured CR format yet. Therefore, we introduced the Clinical Case Discussions (CCD), to medical students attending the University of Bologna as a tool for developing CR abilities. CCDs are a case-based peer-teaching format, simulating the diagnostic process using published patient cases. Methods: Students of all clinical years of the University of Bologna Medical School were invited to voluntarily participate in a two-day CCD training program. They completed pre- and post-training questionnaires assessing their expectations before and impressions after the training and comparing learning outcomes to their usual classes. Results: Twenty-one students participated in this pilot program. Before the training, more than half of the participants expressed either interest or a strong interest in all proposed learning objectives. Afterward, 84.6% of the students stated that the training much exceeded (63.5%) or exceeded (23.1%) their expectations considering its utility for their future medical activities. A total of 92.3% strongly agreed (84.6%) or agreed (7.7%) to have improved their CR. Conclusions: Although this pilot program had some intrinsic limitations, the students’ positive feedback on this CCD format (combining the benefits of case-based learning and peer teaching) encourages further research on its potential role in the Italian curriculum. 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

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

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

Artificial intelligence-powered generative language models (GLMs), such as ChatGPT, Perplexity AI, and Google Bard, have the potential to provide personalized learning, unlimited practice opportunities, and interactive engagement 24/7, with immediate feedback. However, to fully utilize GLMs, properly formulated instructions are essential. Prompt engineering is a systematic approach to effectively communicating with GLMs to achieve the desired results. Well-crafted prompts yield good responses from the GLM, while poorly constructed prompts will lead to unsatisfactory responses. Besides the challenges of prompt engineering, significant concerns are associated with using GLMs in medical education, including ensuring accuracy, mitigating bias, maintaining privacy, and avoiding excessive reliance on technology. Future directions involve developing more sophisticated prompt engineering techniques, integrating GLMs with other technologies, creating personalized learning pathways, and researching the effectiveness of GLMs in medical education. Full article

(1) Background: This qualitative study aimed to identify and describe course components which affect a student’s motivation to learn within a blended-learning competency-based curriculum. (2) Methods: The data were gathered via two consecutive semi-structured group interviews. The participants were purposefully sampled from medical students attending the Family Medicine (FM) class at Saarland University (UdS) in Winter 2020. The two interviews were transcribed verbatim and inductively analysed using content analysis. (3) Results: Three categories of curricular components that affected motivation were inductively formed: (a) the provision of structure (curriculum design), where providing external learning milestones to self-regulated learning positively influenced an interviewee’s learning motivation; (b) the provision of interpersonal interactions and emotional relatedness by staff, where constructive feedback and enthusiasm from a teacher facilitated intrinsic motivation and real-life examples helped the students to remember content more easily; and (c) perceived gain in self-efficacy, where a participant’s motivation to learn a particular subject area was especially high if it appeared to be highly relevant to practice or exams and the applicability of the knowledge gained was readily apparent. (4) Conclusions: It is important for educators to be aware of how they influence a student’s motivation. This study may help to provide an orientation on what to avoid and what to include in a curriculum design project to purposefully foster motivation in students. Full article

Background: As a contribution to developing interprofessional education (IPE) synergy between medical education systems in the European Higher Education Area (EHEA), this review aims to describe the IPE experiences for undergraduate medical students implemented in EHEA member countries. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted on SCOUPS and MEDLINE databases. Inclusion criteria were peer-reviewed English language articles about undergraduate medical students, interprofessional education, and EHEA countries, published January 2000–September 2022. Results: The 32 included studies were from 14 of the 49 EHEA countries. In most of the studies, the theoretical background leading the intervention was not reported (n = 25), and in several studies (n = 16) the students were from two professions only. The reported outcomes were related to self-assessment knowledge about IPE and satisfaction about the program. In 24 studies, the assessment was based on the study’s ad hoc measures only. Limitations ranged from selection bias to lack of objective measures. Conclusion: Future directions should envision developing IPE among EHEA countries, including agreement and consistency across EHEA countries in reporting theories, educational methods, and standardized IPE evaluation measures. Full article

Problem-based learning (PBL) is an active learning technique that promotes a life-long learning approach to understanding and using the principles of clinical medicine. It does so by helping learners hone their critical thinking skills in a team-based environment. It was originally developed for use in live, in-person settings. During the COVID-19 pandemic, it has had to be rapidly adapted for online delivery. In this article, we first highlight the key challenges faced by educators and learners in making this transition. We then share five lessons for effectively translating in-person PBL curricula to online and hybrid learning formats. Full article

Background: Delivering impactful feedback is a skill that is difficult to measure. To date there is no generalizable assessment instrument which measures the quality of medical education feedback. The purpose of the present study was to create an instrument for measuring educator feedback skills. Methods: Building on pilot work, we refined an assessment instrument and addressed content and construct validity using expert validation (qualitative and quantitative). This was followed by cognitive interviews of faculty from several clinical departments, which were transcribed and analyzed using ATLAS.ti qualitative software. A research team revised and improved the assessment instrument. Results: Expert validation and cognitive interviews resulted in the Educator Feedback Skills Assessment, a scale with 10 items and three response options for each. Conclusions: Building on the contemporary medical education literature and empiric pilot work, we created and refined an assessment instrument for measuring educator feedback skills. We also started the argument on validity and addressed content validity. Full article

Immersive technology is a growing field in healthcare education—attracting educationalists to evaluate its utility. There has been a trend of increasing research in this field; however, a lack of quality assurance surrounding the literature prompted the narrative review. Web Of Science database searches were undertaken from 2002 to the beginning of 2022. The studies were divided into three mixed reality groups: virtual reality (VR), augmented reality (AR), 360 videos, and learning theory subgroups. Appraising 246 studies with the Medical Education Research Study Quality Instrument (MERSQI) indicated a gap in the validation of measures used to evaluate the technology. Although, those conducted in VR or those detailing learning theories scored higher according to MERSQI. There is an educational benefit to immersive technology in the healthcare setting. However, there needs to be caution in how the findings are interpreted for application beyond the initial study and a greater emphasis on research methods. Full article

Superstition is a belief that is not based on scientific knowledge. Traditional healers usually use superstition in their practices to manage human health problems and diseases; such practices create a conflict with the medical profession and its evidence-based practices. Medical professionals confirm that this kind of practice is unsafe as it is performed by untrained people (e.g., traditional healers) utilizing unsterilized instruments within unhygienic environments. Most of the cases eventually develop a variety of complications, which are sometimes fatal. Female genital mutilation, uvulectomy, oral mutilation (tooth bud extraction to cure “Ibyinyo”), and eyebrow incisions are examples of the many different types of superstitious practices which occur commonly in other parts of the world. We describe how these traditional practices of superstition have been and continue to be performed in various parts of the world, their complications on oral and general health, and how such practices hinder modern medical practices and highlight huge inequalities and disparities in healthcare-seeking behavior among different social groups. This paper aims to increase health literacy and awareness of these superstition-driven traditional and potentially harmful practices by promoting the importance of evidence-based medical practices. Full article

Background: The urgency for heightened levels of the Coronavirus disease of 2019 (COVID-19) awareness is due to their estimated face-to-face participation in the COVID-19 pandemic and similar pandemics. The unavailability of updated pandemic information is a significant challenge. There is no available data or previous studies undertaken to investigate the level of pandemic awareness of medical students in Trinidad, Tobago, or the wider Caribbean. Methods: A cross-sectional study of medical students, years one to five, at the University of the West Indies (UWI) St. Augustine campus, Faculty of Medical Sciences, was conducted using random sampling. Data was collected using a 20-item questionnaire structured to test awareness. Chi-square analysis was done using SPSS version 28.0.1.0 (142). Results: Of the 137 participants, 100% claimed to be aware of the COVID-19 pandemic, mainly via social media and the Ministry of Health press conferences. Though all claimed to be aware, 98.5% were aware of COVID-19 being a viral infection, whilst 87.6% were aware of the modes of transmission. Less than half of the population (45.3%) stated they were prepared to be a frontline worker exposed to and treating COVID-19 patients, while the majority (76.6%) were worried about exposure to the virus. Conclusions: The data collected in this research indicated that the level of awareness increases with higher levels of education, whereas age has no effect. Additionally, it was determined that undergraduate medical students had an average knowledge base of COVID-19 but would need training programs to increase their preparedness as future healthcare professionals. Lastly, it was discovered that the two top sources of information were social media and press conferences held by the government. Full article