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Background: International student exchanges are a significant part of medical education, and experiences of North American and European medical students abroad have been extensively examined. By contrast, knowledge of visiting medical students in the United States (US) is limited largely to surveys of administrators and course directors., Objective: To understand US attending physicians' thoughts on visiting international student clinical externships., Design and Participants: Three clinician-educator physician focus groups were conducted across two US medical schools with broad representation of training backgrounds, clinical disciplines, and career stages. Focus groups and constant comparison analysis of transcripts were performed iteratively to identify emerging themes., Main Measures: Qualitative themes and subthemes., Key Results: Two main themes emerged from the data: (1) administrative requirements for success: hosting international students requires careful planning and coordination, which is daunting amidst demanding faculty responsibilities. Externships must address experiences of the people directly involved in the clinical setting, leadership, communication, and institutional, financial, physical, and personnel resources. (2) Impact of student qualities: When working with international students, the importance of administrative details and student characteristics increases due to higher student variability overall, inconsistent language and cultural fluency, and the consequent recognition of the student as an ambassador for their home institution and country., Conclusions: Amidst already busy schedules, clinician educators identify the hosting of international medical students as a commitment resembling that for their own trainees. Linguistic and cultural distances, and the overall variability of international students amplify the importance of effective administration. The findings have influenced related processes at the University of Pittsburgh., Competing Interests: Declarations:. Conflict of Interest:: The authors declare that they do not have a conflict of interest., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Background: Against a background of significant changes in UK medical education at both undergraduate and postgraduate levels, the Royal College of Surgeons of Edinburgh (RCSEd) established the Wade Programme in Surgical Anatomy in 2012, as a means of supporting the study of surgical anatomy throughout training. This article provides a 10-year review of the Wade Programme and its educational foundation., Methods: A novel methodology, the 'Wade Educational Approach', was used in the design and development of a portfolio of professional courses at three training levels: Level 1 - RCSEd Affiliate, Level 2 - Early Years (MRCS) and Level 3 - Later Years (FRCS and CPD). The Wade Approach is founded on the principles of visualization ('visualize'), conceptual understanding ('conceptualize') and the active application of anatomical knowledge to all aspects of surgical practice ('apply')., Results: From 2012 to 2022, 105 courses were delivered to 1191 delegates across the globe, with a feedback form response rate of 95%. Feedback was uniformly excellent across the complete course portfolio, with the Wade Approach cited as a novel strategy for principle-based learning and teaching. The two-fold development of a novel educational approach and modular course design proved adaptable across a wide range of different courses, levels and specialties., Conclusion: The Wade Programme was established to support the study of surgical anatomy throughout training, from undergraduate study to consultant practice. The Wade Approach should also be of help to all who are engaged in anatomy education and the training of the next generation of clinicians., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Australia and Aotearoa New Zealand (AANZ) medical schools have been impacted by curricular changes and the introduction of virtual microscopy (VM). No survey has explicitly described the outcome of these events on histology education in AANZ. This study provides a cross-sectional overview of histology education in accredited medical schools across AANZ in 2022-2023. Responses were received from 83% (19/23) of Australian medical schools, and 50% (1/2) of medical schools in Aotearoa New Zealand. VM, either exclusively (42%) or combined with traditional microscopy (37%), emerged as the preferred mode for delivering histology education. Common instructional methods included face-to-face lectures (26%) and synchronous online live lectures (26%). A significant proportion (84%) of educators supplemented resources with virtual microscopy websites. Integration of histology education was prevalent (79%), primarily with pathology (32%) or gross anatomy (26%). On average, medical students in the region spent a maximum of 21 ± 17 h in face-to-face histology laboratories throughout their degree. Histology education was predominantly taught by academics with a PhD degree. This study also examined the similarities and differences in histology education between AANZ and the global landscape. Through this examination, the present study positions AANZ within the broader context of histology education worldwide discusses key factors impacting histology education, and advocates for action to mitigate a looming shortage of pathologists in AANZ. In light of these findings, AANZ medical schools should integrate histology and pathology, establish a core curriculum, and promote flexible teaching modalities., (© 2024 The Author(s). Anatomical Sciences Education published by Wiley Periodicals LLC on behalf of American Association for Anatomy.)

Virtual patients (VPs) are increasingly used in medical education to train clinical reasoning (CR) skills. However, optimal VP design for enhancing interactivity and authenticity remains unclear. Novel interactive modalities, such as large language model (LLM)-enhanced social robotic VPs might increase interactivity and authenticity in CR skill practice. To evaluate medical students' perceptions of CR training using an LLM-enhanced social robotic VP platform compared with a conventional computer-based VP platform. A qualitative study involved 23 third-year medical students from Karolinska Institutet, who completed VP cases on an LLM-enhanced social robotic platform and a computer-based semi-linear platform. In-depth interviews assessed students' self-perceived acquirement of CR skills using the two platforms. Thematic analysis was employed to identify themes and sub-themes. Three main themes were identified: authenticity, VP application, and strengths and limitations. Students found the social robotic platform more authentic and engaging. It enabled highly interactive communication and expressed emotions, collectively offering a realistic experience. It facilitated active learning, hypothesis generation, and adaptive thinking. Limitations included lack of physical examination options and, occasionally, mechanical dialogue. The LLM-enhanced social robotic VP platform offers a more authentic and interactive learning experience compared to the conventional computer-based platform. Despite some limitations, it shows promise in training CR skills, communication, and adaptive thinking. Social robotic VPs may prove useful and safe learning environments for exposing medical students to diverse, highly interactive patient simulations., Competing Interests: Declarations. Ethical approval: Participation in the study was voluntary, and all participants provided written informed consent prior to inclusion. The Swedish Ethical Review Authority reviewed and approved the study protocol prior to initiation (registration number: 2022-04437-01). Conflict of interest: IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia, BMS, Elli Lilly, Gilead, GSK, Janssen, Novartis, Otsuka, and Roche. GS is a co-founder and Chief Scientist at Furhat Robotics. The other authors declare that they have no conflicts of interest., (© 2024. The Author(s).)

Background: Junior doctors often feel inadequately prepared for clinical practice. Current approaches to optimising the pre-clinical to clinical transition generally overlook intrinsic factors, yet motivation and emotional engagement are likely to be important in building clinical competence. To address this gap, we explored the attitudes of medical undergraduates and clinicians towards learning and how these attitudes seemed to affect learning motivation., Methods: We conducted semi-structured individual or group interviews with 22 medical undergraduates and eight clinicians. Interviews were transcribed and thematically analysed., Results: Students and clinicians had differing perspectives on the content and context of learning, as well as divergent attitudes towards learning. Students focused on factual knowledge and examination performance, preferably with simple, clear-cut answers, privileged book learning, and equated medical knowledge with clinical competence. Conversely, clinicians focused on soft skills and clinical reasoning, emphasised learning through observation and experience, assessments that acknowledged complexity and context, and saw knowledge as a foundation for practice. Further, clinicians mostly felt that the pre-clinical curriculum over-emphasised factual recall of knowledge that was neither useful nor relevant for clinical practice., Conclusion: We found that students tended to be extrinsically motivated by examination performance, which led to adopting surface learning approaches. This in turn led to a mismatch between the pre-clinical emphasis on factual recall and the higher-order skills necessary for clinical practice. We propose that a shift away from content overload and high-stakes assessment towards patient-centric teaching approaches may help re-orientate students towards intrinsic motivation and more effective learning methods., (© 2024 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Purpose: This study aimed to systematically evaluate the effectiveness of case-based learning (CBL) within a basic-clinical integrated educational program using the Context, Input, Process, and Product (CIPP) evaluation model., Methods: The CBL program was integrated into the Pharmacology-Clinical Case Practice component of the pharmacology course, a mandatory course for first-year medical students. To evaluate the program, a CIPP model-based questionnaire was developed, assessing needs, goals, resources, educational management, and outcomes. To ensure the reliability and validity of the variables, factor analysis was performed, reducing an initial set of 28 items to 18 final observation variables distributed across four factors. The survey, designed to measure learner satisfaction, was administered to 37 students who participated in the Pharmacology-Clinical Case Practice course during the first semester of 2022., Results: Participants rated their satisfaction with the CBL program based on the CIPP model (on a 5-point scale), giving an average score of 4.17. This suggests that learners who followed the CBL program combining basic and clinical components generally found the program operationally effective with positive outcomes., Conclusion: The teaching model and evaluation model applied in this study can be utilized in various majors when operating CBL classes that link basic and clinical education in medical schools in the future.

Formative assessment is a valuable tool in medical education as it allows students to reflect on their own learning and make necessary corrections. The use of innovative techniques in formative assessment can make it more engaging and effective for students, particularly utilizing electronic tools. A word cloud is a visual representation of data that is created using text inputs from a group of individuals. The resulting image shows the most frequently used words in a larger font, allowing quick understanding of the common themes and concepts in the group's responses. Mentimeter is an online platform for interactive presentations where students can provide their responses to a question, which can then be visualized as a word cloud. The study aims to explore the benefits and drawbacks of using word cloud formation as a formative assessment technique in the classroom, utilizing the online platform Mentimeter. NEW & NOTEWORTHY The current study was conducted to present a novel formative assessment classroom technique using Mentimeter. The benefit of this novel technique is that it is easy to implement, quick, anonymous, and strengthens student's conceptual learning. It also gives the teacher an opportunity to give feedback and stress commonly committed mistakes.

Anatomy is the cornerstone of medical education. Virtual reality (VR) and augmented reality (AR) technologies are becoming increasingly popular in the development of anatomy education. Various studies have evaluated VR and AR in anatomy education. This meta-analysis aims to evaluate the effectiveness of VR and AR in anatomical education. The protocol was registered in Prospero. Scopus, PubMed, Web of Science, and Cochrane Library databases were searched. From the 4487 articles gathered, 24 randomized controlled trials were finally selected according to inclusion criteria. According to the results of the meta-analysis, VR had a moderate and significant effect on the improvement of knowledge scores in comparison with other methods (standardized mean difference = 0.58; 95% CI = 0.22, 0.95; p < 0.01). Due to the high degree of heterogeneity (I 2  = 87.44%), subgroup analyses and meta-regression were performed on eight variables. In enhancing the "attitude," VR was found to be more "useful" than other methods (p = 0.01); however, no significant difference was found for "enjoyable" and "easy to use" statements. Compared with other methods, the effect of AR on knowledge scores was non-significant (SMD = -0.02; 95% CI = -0.39, 0.34; p = 0.90); also, in subgroup analyses and meta-regression, the results were non-significant. The results indicate that, unlike AR, VR could be used as an effective tool for teaching anatomy in medical education. Given the observed heterogeneity across the included studies, further research is warranted to identify those variables that may impact the efficacy of VR and AR in anatomy education., (© 2024 American Association for Anatomy.)

The coronavirus disease 2019 pandemic has fundamentally reshaped anatomy education, offering invaluable insights to guide the future of anatomy pedagogy. As we transition into a post-pandemic era, it is crucial to integrate the lessons learned to create a more resilient, flexible, and effective educational environment. This paper examines the transformative strategies implemented at Universiti Sains Malaysia during the pandemic, focusing on the empowerment of blended learning, technology-enhanced tools, student-centered learning practical sessions, and enhancement of formative assessment. These strategies include integrating digital learning resources, such as the Virtual Anatomy Museum and online histology quizzes, with in-person instruction, fostering a supportive and interactive learning environment. Additionally, practical sessions were redesigned to emphasize collaborative learning, peer teaching, and developing critical thinking and communication skills. Formative assessments were integrated to provide continuous feedback and support ongoing learning. This comprehensive approach not only enhanced students' understanding of anatomical concepts but also improved their emotional well-being and overall learning experience. The lessons learned from the pandemic have paved the way for a more innovative and adaptive anatomy education that is well-prepared for future challenges.

Mini-clinical evaluation exercise is a compound tool that allows assessment and feedback from a knowledgeable assessor. When it is conducted during clinical rotations, it gives the margin of improvement in skills via constructive feedback. The current study was planned to assess if miniclinical evaluation exercise is an effective assessment tool. Starting from January 15, 2022, 80 medical students of the 4th year were enrolled, with 40(50%) of them having had conventional rotation of one month, and the other 40(50%) having had to exposure to mini-clinical evaluation exercise mini-CEX during their rotations. At the end of rotation on February 15, 2022, clinical skills of the 2 groups were assessed. The score of the intervention group having had mini-clinical evaluation exercise exposure was better than the control group. Hence, miniclinical evaluation exercise was found to be a formative assessment tool for 4th year undergraduate medical students.

The significance of assessment in driving learning is undeniable, particularly in oral assessments like viva voce where students express themselves verbally. However, traditional viva voce examinations' challenges include reliability, objectivity, content validity, time constraints, varying question difficulty levels, inconsistency in questioning among students, the influence of the "halo" effect, and issues with the test environment. Thus the study aimed to evaluate the effectiveness of Objective, Integrated, Clustered Examination Software (VOICES) compared to traditional viva voce methods. Using a mixed-method design with 103 students, questions were framed using VOICES software created by the National Informatics Center (NIC), Chhattisgarh State Center, Government of India, and students responded through voice messages. Faculty graded students based on personalized videos created by the app. Then, feedback was given, and a focused group discussion was conducted for the students. Traditional viva voce examinations were conducted as part of internal assessments, and the marks obtained from these assessments were compared to evaluate their effectiveness in comparison to the VOICES app. There was no significant difference in the marks obtained using both methods indicating that viva voce using an oral assessment app is equally effective. Students responded positively to the VOICES method. The formative oral assessment conducted through the use of the VOICES app successfully addresses the challenges typically associated with traditional viva voce examinations. NEW & NOTEWORTHY Traditional viva voce examination encounters challenges including reliability, objectivity, content validity, time constraints, varying question difficulty levels, inconsistency in questioning among students, the influence of the "halo" effect, and issues with the test environment. Formative oral assessment conducted through the use of the Objective, Integrated, Clustered Examination Software (VOICES) app developed by the National Informatics Center (NIC) successfully addresses the challenges typically associated with traditional viva voce examinations.

Background: This study aimed to evaluate the efficacy and feasibility of a cognitive fitness training (CFT) program on the development of emotional intelligence and stress management skills in medical students during their 3rd year surgery clerkship., Methods: MS3s (n ​= ​80) were randomized into a training or control group. The training group received CFT during their clerkship, the control group received online access afterwards. A cognitive fitness (CF) assessment was administered before and after the clerkship., Results: The training group demonstrated a significant improvement in cumulative assessment scores (126.4-146.5, p ​< ​0.0001) and most dimensions of CF assessment. Integration of the curriculum did not adversely impact performance on surgery NBME or surgery OSCE when compared to control (p ​> ​0.05)., Conclusions: The CFT provided to MS3s resulted in significant improvements in CF, including most subcategories. The CFT also did not have an adverse impact on academic performance indicating its feasibility within medical education curricula., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: The traditional method of oral examination, though a good tool for assessing the depth and breadth of student's knowledge, has its shortcomings. A variable number of questions with variable difficulty levels by different examiners with different expectations can introduce bias in scores. The process aspect of oral examinations of first-year undergraduate medical students was improved by structuring them and by creating uniformity in the number, time, and difficulty level of questions for assessment, and feedback was taken regarding its acceptance as an improved tool of assessment., Methods: After finalizing the topics, questions from a viva viewpoint were structured and categorized into three difficulty levels covering all aspects of chosen topics validated by subject experts. The number of questions asked per difficulty level, time, and marks given to each question was pre-decided. After briefing the students, the structured viva was conducted, and feedback was taken from students and examiners., Results: The majority (87%) of first-year undergraduate students undertook the structured viva and filled in the feedback form. Nearly all students felt that the structured oral examination was a fair and unbiased assessment tool with less subjectivity compared to traditional viva. Most students (83.9%) felt that the topics were comprehensively covered, and 96.4% of students felt less stressed. Among examiners, there was 100% agreement on the uniformity of questions asked, topics covered, less subjectivity, and no carryover effect., Conclusion: The examiners have accepted it as one of the formative assessment tools for future batches of students and are ready to explore its utility as a summative assessment tool.

Introduction: Effective teaching and learning initiatives on transitions of patient care, especially from hospital to home, are frequently lacking within medical school curricula. We trialled an integrated test-enhanced active learning strategy to prepare students for the safe management of these patient transitions., Methods: This randomised, prospective, single blinded, interventional study assessed medical students' knowledge, regarding patients' hospital-to-home transition. The intervention was a purpose-designed transitions of care workshop, the assessment tool was a multiple-choice assessment based on prior studies. Students were randomly allocated to the application of the assessment both pre- and post-workshop or to assessment solely post-workshop to determine the potential for the assessment to prime student learning., Results: Sixteen students enrolled for the workshops. Significant knowledge gaps were identified. No student identified that medication errors were the most common source of post-discharge adverse events. Only 42% of participants knew that age >65 contributes to medication non-adherence, with 50% knowing that the medical reconciliation process should include discontinued medications. The workshop increased student knowledge, addressing identified knowledge gaps (74% pre-workshop versus 87% post-workshop, p < 0.005). Students self-perceived level of competency after completing the workshop intervention was increased (5.5 pre-workshop versus 15 post-workshop, p < 0.001). All aspects of student self-assessed competency increased significantly from the pre-workshop scores. There was no priming effect of the pre-workshop assessment on student knowledge scores or perceived competency., Discussion: Important gaps in student knowledge skills and attitudes exist regarding the hospital to home transition. Our active learning strategy addressed these gaps, enhancing student understanding and confidence around transitions of patient care., (© 2023 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Many publications describe use of ultrasound imaging in teaching of clinical courses, primarily integrated with clinical applications. More recently there have been increasing numbers of papers describing ultrasound as a tool primarily for teaching basic anatomy and physiology concepts rather than clinical applications. Of these, many have described qualitative analysis with a consensus that its use is viewed very positively by students for aiding learning. Far fewer studies have attempted quantitative analysis to support this belief, and conclusions have been varied. A review of studies was conducted that included those that used ultrasound to teach physiology and anatomy concepts. Studies were excluded if they did not contain quantitative or qualitative assessment of efficacy. Medline and Embase databases were searched (11/16/22) and screened by two independent reviewers. Forty-six studies were included, with data extracted relating to cohort characteristics, ultrasound intervention, quantitative or qualitative assessments, and any barriers to implementation. It was confirmed that both student and teacher opinions are extremely favorable in most cases. Although conclusions from quantitative studies were not as clear, there was evidence that ultrasound is at least as effective as more conventional teaching methods and could have significantly better performances in short-term assessments. However, varied methods of teaching intervention, experimental protocols, and assessment of learning may have contributed to the lack of clarity. Within this context, some of the problems encountered with implementing ultrasound as an educational tool (such as financial and temporal constraints), and in conducting more definitive studies, are discussed. NEW & NOTEWORTHY This first systematic review of ultrasound use as a teaching tool in basic anatomy and physiology confirmed that students and staff believe incorporation is beneficial to learning and is highly popular. Quantitative data are scarcer but show that it is at least as effective as more conventional teaching methods and can enhance short-term recall. Good-quality studies with adequate comparisons and assessment methods are still lacking, so further work in this area is needed.

The equilibrium potential of an ion species is a crucial concept for medical students, as it is a prerequisite to fully understanding the pathophysiology of K + imbalances (hyperkalemia and hypokalemia) in clinical practice. However, it remains a challenging concept because current medical physiology textbooks are too simplistic and overlook several essential points. In this article, we present a total of five small but impactful additions to advance the introduction of the equilibrium potential that will eliminate confusion and facilitate mastery-level comprehension. NEW & NOTEWORTHY This novel approach to advance teaching of the equilibrium potential ( E ion ) addresses and fills common educational gaps by 1 ) making a critical point explicit, rather than implicit; 2 ) introducing overlooked concepts to prevent confusion; 3 ) adding an effective assessment to promote mastery; and 4 ) emphasizing the importance of strengthening medical students' understanding of E ion . These targeted additions facilitate a more comprehensive and transformative learning experience for medical students.

Background: Advancement in medical education has led to the adoption of online learning platforms in the development and execution of learning modules. Online learning platforms are appraised and accessed regarding their capability of ensuring a seamless experience and enhancing satisfaction in users, especially students. In this study, the satisfaction and learning experience of medical students were studied with emphasis on their sociodemographic features., Method: Data were collected using a structured questionnaires distributed to a group of medical students in a medical college in Eastern Nigeria. 300 undergraduate students from Enugu State University of Science and Technology participated in this survey from four departments: anatomy, medical laboratory, nursing, and medicine. The questionnaires included closed-ended questions divided into sociodemographic information, learning experience, and satisfaction with online learning., Result: Results from the survey indicate that sociodemographic factors like the course of study and sex of respondents show a noticeable relationship to the learning experience and satisfaction with online learning platforms while other factors have no impact. The majority of respondents (63.1%) strong agreed that online learning platform effectively delivers medical course content with a mean value of user learning experience of online learning platform as 4.15., Conclusion: Feature perception, learning experience, and satisfaction level of medical students were dependent on their course of study and sex, thus independent course curriculum was relevant in determining satisfaction of students. The findings of this study add to the empirical and practical understanding of students' satisfaction with using online learning platforms as a success in medical education and its use is recommended by other medical institutions., Competing Interests: Declarations. Ethics approval and consent to participate: Approval was sort and obtained from the Faculty of Basic Medical Sciences Research and Ethical Committee (Reference Number: ESUT/ANA/2024/023). Consent forms were presented to the study participant to enable them to give a written informed consent to participate in the studies. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The advent of pre-trained generative transformers, exemplified by ChatGPT, has significantly impacted medical education, catalysing a wealth of research focused on enhancing educational methodologies. Despite this, the application of ChatGPT in the specific area of career planning for medical students remains relatively unexplored. This study seeks to rigorously evaluate the potential of ChatGPT-4o in facilitating the career planning of medical students, comparing its effectiveness with that of traditional human educators. It also aims to identify optimal strategies for integrating ChatGPT-4o with human educators to maximise support in career planning for medical students., Methods: Adopting a mixed-methods approach, this research combines qualitative insights from interviews with quantitative data from questionnaires. The research is bifurcated into two primary segments: first, evaluating the proficiency of ChatGPT-4o in aiding medical students' career planning, and second, identifying effective collaborative practices between ChatGPT-4o and human educators., Discussion: The study focuses on assessing ChatGPT-4o's utility in career planning for medical students and determining how it can be best used within medical education by both educators and students. The aim is to augment the career planning consultation process, thereby enhancing the efficiency and quality of human educators' contributions. This includes exploring how ChatGPT-4o can supplement traditional teaching methods, providing a more robust and comprehensive support system for career planning in medical education., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In 2014, the Faculty of Health Sciences at Walter Sisulu University introduced a 20‑week long integrated longitudinal clinical clerkship (ILCC) rotation block as part of its commitment to community‑based education and social responsiveness, with the goal of ensuring that the curriculum is updated to align with the contemporary health system challenges in South Africa. Aim: To explore whether medical student participants underwent social and personal transformative learning in understanding complex societal health needs during their integrated longitudinal community clerkship program. Methods: This was an exploratory qualitative research study conducted among 113 5 th year medical students based at 8 selected hospitals during their 20‑week‑long community clerkship. Data were collected through six focus group discussions, complemented by data from reflective learning journal entries. Audio recordings were transcribed verbatim and merged with complementary data for thematic analysis in NVivo Version 13®. Results: Adaptation challenges, improved social relations, coping with work demands, acquisition of relevant knowledge and skills, perceived inadequate support from the training institution and perceived lengthy programme duration emerged as key themes and were linked to personal and social transformation. Conclusion: Personal and social transformation may have transpired amongst the student participants, as demonstrated by the observed thematic consistency between data sources. Further complementary studies are required to assess whether there was a shift in students' understanding of community health needs and how the ILCC may have assisted the students in responding to community needs to have a comprehensive conclusion on whether the ILCC can be a tool for transformative learning., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Clinical decision-making (CDM) refers to physicians' ability to gather, evaluate, and interpret relevant diagnostic information. An integral component of CDM is the medical history conversation, traditionally practiced on real or simulated patients. In this study, we explored the potential of using Large Language Models (LLM) to simulate patient-doctor interactions and provide structured feedback., Methods: We developed AI prompts to simulate patients with different symptoms, engaging in realistic medical history conversations. In our double-blind randomized design, the control group participated in simulated medical history conversations with AI patients (control group), while the intervention group, in addition to simulated conversations, also received AI-generated feedback on their performances (feedback group). We examined the influence of feedback based on their CDM performance, which was evaluated by two raters (ICC = 0.924) using the Clinical Reasoning Indicator - History Taking Inventory (CRI-HTI). The data was analyzed using an ANOVA for repeated measures., Results: Our final sample included 21 medical students (age mean = 22.10 years, semester mean = 4, 14 females). At baseline, the feedback group (mean = 3.28 ± 0.09 [standard deviation]) and the control group (3.21 ± 0.08) achieved similar CRI-HTI scores, indicating successful randomization. After only four training sessions, the feedback group (3.60 ± 0.13) outperformed the control group (3.02 ± 0.12), F (1,18) = 4.44, p = .049 with a strong effect size, partial η 2  = 0.198. Specifically, the feedback group showed improvements in the subdomains of CDM of creating context (p = .046) and securing information (p = .018), while their ability to focus questions did not improve significantly (p = .265)., Conclusion: The results suggest that AI-simulated medical history conversations can support CDM training, especially when combined with structured feedback. Such training format may serve as a cost-effective supplement to existing training methods, better preparing students for real medical history conversations., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from the ethics board (“Ethik-Kommission Westfalen-Lippe”) under the reference 2023-438-f-N. Informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The current objective of preventive medicine reform is to guarantee that clinical medical students possess a comprehensive understanding of preventive medicine concepts, knowledge, and skills. Previously, case-based learning (CBL) was mostly employed to reform the clinical medicine curriculum, but there was a lack of reform in preventive medicine for clinical students in Sino-foreign joint training programs. The aim of this study was to investigate the impact of case-based learning in the Sino-foreign joint program of preventive medicine., Methods: A total of 79 clinical medical students from the Sino-foreign joint program at Wenzhou Medical University were selected as participants to engage in 10 case-based learning sessions. The effectiveness of the instruction was assessed by analyzing the final exam scores and questionnaire responses, which encompassed instructor evaluation, self-assessment, and course learning effectiveness evaluation (CLEE)., Results: In contrast to the traditional approach, which yielded a final score of 69.2, the case-based students achieved an average of 77.62. The results of instructor evaluation showed that students' academic performance, problem-solving capabilities, research cooperation and communication, and learning attitude all improved significantly following case-based learning (P < 0.05). The self-assessment scores for all five case discussion courses exceeded 75 points, suggesting that students believed their overall competence had increased significantly. The CLEE demonstrated that CBL had a positive impact on students' learning and was highly advantageous for students., Conclusions: It is deserving of active promotion in medical education reform that case-based learning can enhance students' comprehensive quality and classroom participation. Further research is required to ascertain whether it can replace traditional teaching methods., Trial Registration: Not clinical trial., Competing Interests: Declarations. Ethics approval and consent to participate: This study has been approved by the Ethic Committee of the Wenzhou Medical University, China (NO.2022033). The study protocol was conducted in accordance with the principles described in the Declaration of Helsinki. All participants were fully informed and consented to their participation in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Formative assessment promotes positive learning outcomes and evaluates students over time. We aimed to evaluate students' learning achievements after implementing a formative assessment technique by using a normalised gain method., Methods: This retrospective observational study was conducted at the School of Medicine and Health Science, Faculty of Medicine, Prince of Songkla University, Thailand. There were 118 fifth-year medical students who attended a general pediatric course in the 2021-2022 academic year., Results: In the summative assessment, the post-test scores were significantly greater than the pretest scores (mean difference 20.53, 95% CI (18.63-22.44), P < 0.001). The median value of the overall student learning gain (g) was 0.34 (0.23, 0.45). Students with medium gains had significantly higher scores than those with low gains (P < 0.001). Students' learning gains had a positive correlation with post-test scores. (R = 0.6, P = 0.01)., Conclusions: The formative assessment technique is a valuable method for enhancing students' learning outcomes by offering timely and effective feedback through mentoring systems. It is essential to integrate formative assessments into standard assessment strategies in undergraduate medical education., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Human Research Ethics Committee (REC. 65-486-1-1), Faculty of Medicine, Prince of Songkhla University, Thailand. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated., Methods: In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles. These students experienced the same clerkship curriculum and requirements with additional CBME components such as coaching, an entrustment committee to review their data, a dashboard to visualize their assessment data in real-time, and meeting as a community of practice., Results: Students shared their experiences with growth during the clerkship year. They conveyed the importance of learning from mistakes, but pushing past their discomfort with imperfect performance was a challenge when they feel pressure to perform well for grades. This tension led to significant effort spent on impression management while also trying to identify their role, clarify expectations, and learn to navigate feedback., Conclusions: Tension exists in the clinical environment for clerkship students between an orientation that focuses on maximizing grades versus maximizing growth. The former defined an era of medical education that is fading, while the latter offers a new vision for the future. The threats posed by continuing to grade and rank students seems incompatible with goals of implementing CBME., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Well-designed escape room games engage students with complex problems and challenge clinical and teamwork skills, but their impact on learning has been uncertain. This study aimed to estimate the effect size of escape room game on performance in a broad knowledge test., Methods: During clinical rotation in reproductive endocrinology and infertility (REI), medical students participated in a 3-hour small-group class. For 2 semesters, groups had traditional patient visits and case discussions, and for 3 semesters, patient visits and an escape room game including debrief. The game was set up in the outpatient clinic, the puzzles were taken from clinical problems in REI, and challenges included operating an ultrasound scanner on a mannequin. Mid-semester, students completed a test of general knowledge in REI. To estimate the effect of small group class on declarative knowledge, test scores of students who had already had the class (exposed) were compared to scores of those who had not yet had the class (control)., Results: Students were highly satisfied with gamified teaching. Those who attended the small group class without the escape room game achieved similar scores on knowledge test than control students (Cohen's d = 0.05, 95%CI -0.58 to 0.68, n = 71). Students who played the escape room game achieved marginally higher score than respective controls (Cohen's d = 0.22, 95%CI -0.1 to 0.53, n = 182)., Conclusions: Escape room game may improve learning outcome of a traditional small group class, but the effect of a single game session on declarative knowledge is modest and is unlikely to exceed related instructional methods like simulation., Competing Interests: Declarations. Ethics approval and consent to participate: Approval from research ethics committee was not sought and individual consent of students was not obtained, as it is waived by Norwegian Agency for Shared Services in Education and Research in case of analysis of anonymous data https://sikt.no/en/tjenester/personverntjenester-forskning/personvernhandbok-forskning/carrying-out-project-without-processing-personal-data . . Data on student satisfaction and teamwork quality were collected with a secure webform service operated by the University of Oslo using data anonymity settings. Individual MCQ test results during plenary session were anonymized, and students were only identified by whether they had the plenary session before or after the small group class during the semester. Consent for publication: Not applicable. Clinical trial number: This study does not report on a health care intervention and was not registered as a clinical trial. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The efficacy of flipped classroom in ophthalmology education has not been well proved. This study aimed to investigate the efficacy of flipped classroom on diabetic retinopathy (DR) and glaucoma in ophthalmology education. Ninety-three medical students in Peking Union Medical College participated and were randomly assigned into two groups. Students in "Group A" participated in a flipped classroom on diabetic retinopathy (DR) and a regular course on glaucoma, while students in "Group B" had a flipped classroom on glaucoma and a regular one on DR. The primary outcome measure of this study was the exam score after class. The secondary outcome measure was the result of a post-classroom questionnaire. The final exam revealed numerically better scores for questions in the same section as flipped classroom that students joined with no statistical significance. The post-class questionnaire revealed an overall satisfaction rate of 93.48%. Most students thought the flipped classroom enhance personal abilities compared with the traditional lecture-based class. However, further amendments should also be made to improve defects such as students' comprehension of basic knowledge and the overall degree of involvement of students. The concept of the flipped classroom could be applied to diabetic retinopathy and glaucoma with satisfactory results., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360° videos in VR headsets, followed by peer debrief and group discussions, may strengthen students' social and emotional learning., Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway., Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions., Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60%), while occupational therapy students less often had prior experience (37%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers., Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking., (©Gry Mørk, Tore Bonsaksen, Ole Sønnik Larsen, Hans Martin Kunnikoff, Silje Stangeland Lie. Originally published in JMIR Medical Education (https://mededu.jmir.org), 19.11.2024.)

Introduction: The competency-based catalogue of learning objectives "Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland" (PROFILES) based on Entrustable Professional Activities (EPAs) was newly introduced in 2018 in undergraduate medical education in Switzerland. Clerkships provide opportunities for students to train clinical skills and competencies within the curriculum. This study aims to assess the students' experiences during paediatric clerkships and whether they achieve the expected competency level of certain EPAs by the end of their training., Methods: An online survey was conducted among all 316 students in their last year of medical school (3 rd year master) enrolled at the University of Zurich. A total of 113 students who had completed a clerkship in paediatrics in different hospitals, were asked about their general expectations and experiences, and to rate their achievement of competency levels in 26 selected EPAs. An EPA was considered accomplished if a minimum of 2/3 of all students reached at least level 3., Results: Paediatric clerkship was generally viewed as positive experience by most students. However, a desire for more integration into clinical teams, increased training in clinical skills, and feedback was expressed. The expected level 3 of competency (indirect supervision) was achieved in 14 out of 26 EPAs by at least 2/3 of students. Level 3 was however not reached for more specific EPAs such as neonatal examination, rating of psychomotor and pubertal development, and clinical reasoning., Conclusion: Paediatric clerkships are regarded as valuable clinical training opportunities. To enhance the learning of competencies, integration into clinical teams and faculty training is crucial. The implementation of EPAs in the clinical context aligns with these goals., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Baumann et al.)

Objectives: Our study assesses the current knowledge and prior awareness of undergraduate medical students in Pakistan regarding palliative care., Study Design: This descriptive Cross-sectional online survey was distributed among undergraduate medical students across Pakistan, with a sample size of 246 participants. The questionnaire, adapted from the PaCKS questionnaire by Kozlov et al. (JAMA 15(5):524-34, 2017), was designed to assess the students' prior knowledge about palliative care., Results: The mean PaCKS score was 9.7 out of 13, with a standard deviation of 2.76. Having heard of palliative care before participation in the study was significantly associated with higher PaCKS scores. Key factors associated with a higher incidence of prior awareness of palliative care included attending private institutions, being in a more advanced year of study, and having a higher mean monthly family income (P < 0.001 for each factor)., Conclusion: This study explores medical students' understanding of palliative care in Pakistan, finding that while many have a basic grasp of the concept, there are notable misconceptions, particularly in differentiating palliative care from hospice care and understanding its broader role. Interestingly, students' knowledge did not significantly improve as they advanced through medical school, suggesting potential shortcomings in the curriculum. The findings highlight the need for more precise education and targeted training to better equip future healthcare providers for delivering patient-centered care., Competing Interests: Declarations Ethics approval and consent to participate Our study was submitted to the Ethics Review Committee at the Aga Khan University for an exemption and was approved.All participants were asked for informed consent before filling out the questionnaire. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Immune literacy garnered significant attention in recent years due to the threat posed by emerging infectious diseases. The pace of immunological discoveries and their relevance to society are substantial yet coordinated educational efforts have been rare. This motivated us to create a task force of educators to reflect on pedagogical approaches to teaching immunology and to draft, develop, and evaluate key competencies for undergraduate immunology education. The research questions addressed include: 1) Which competencies are considered important by educators? 2) Are the illustrative skills clear, accurate and well aligned with the core competencies listed in the Vision and Change report?; 3) What are the concerns of immunology educators about competencies and skills? We collected data on the draft competencies using surveys, focus groups, and interviews. The iterative revision phase followed the community review phase before finalizing the framework. Here, we report a hierarchical learning framework, with six core competencies, twenty illustrative skills, and companion immunology-specific example learning outcomes. Predominant themes from interviews and focus groups, which informed revisions of this framework are shared. With the growing need for immunology education across the sciences, the ImmunoSkills Guide and accompanying discussion can be used as a resource for educators, administrators and policymakers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Pandey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Sedating and anesthetic drugs are widely used in clinical practice; however, relevant teaching remains underrepresented in undergraduate medical education. We developed a 2-hour flipped classroom activity integrating foundational science topics, evidence-based medicine, and clinical reasoning on anesthetic pharmacology for preclinical medical students., Methods: Presession, second-year medical students reviewed a study guide and completed a readiness assessment. The flipped classroom session was facilitated in a large-group format with learners in small groups. At session end, students completed a consolidation quiz. Two case-relevant questions were included on the midterm and one on the final exam. Student satisfaction was assessed through an anonymous postsession survey., Results: One hundred ten students participated in the session. Mean performance on the readiness assessment was 96%. Mean performance on the postsession quiz was also 96%. Mean performance on the three midterm and final exam questions was higher than the national mean (94% vs.72%, p < .005). Seventy-six students (69%) completed the survey, with mean satisfaction of 4.6 ( SD = 0.7) on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree )., Conclusion: We developed a flipped classroom session teaching pharmacology of sedating and anesthetic drugs for preclinical medical students. Students performed well on pre- and postsession assessments and above the national mean on National Board of Medical Examiners questions, suggesting adequate knowledge acquisition. This session was found to be a highly satisfactory and effective teaching tool requiring students to integrate foundational and clinical science knowledge., (© 2024 Nunez et al.)

Background: Competence in palliative medicine is required in clinical practice. Based on a literature review, we developed a two-week elective course in palliative medicine for 5th and 6th year medical students. We wanted to study learning outcomes from the course, especially related to knowledge, confidence, and reflections on the doctor's role in palliative care., Methods: A multiple-choice questionnaire (MCQ) assessed knowledge in palliative care pre and post course. The Thanatophobia Scale (TS) and the Self-efficacy in Palliative Care Scale (SEPC) measured confidence in communication with patients close to death and in providing palliative care, respectively. Reflection notes were analysed using Systematic Text Condensation, a cross-case thematic analysis. Lave & Wenger's theory about situated learning was used to support interpretations., Results: From 2018 to 2022 we ran four courses for a total of 48 students. Test results improved over the course in all four groups. On average, MCQ scores increased by 22% (range 13-33), TS scores were reduced by 28% (24-32), and SEPC scores increased by 50% (42-64), reflecting increased confidence in dealing with seriously ill and dying patients and their relatives. The participants prepared reflection notes describing their main impressions and take-home messages from the course, focusing specifically on the role of the doctor. They described the doctor's role linked to an overarching task of creating a sense of security for patients and relatives. Through the course, and especially through talking to patients and relatives and being part of the interprofessional team, the participants learned how this sense of security was built by gaining competence in the following domains: 1) Patient-centred communication about the disease, expected trajectory, and needs, establishing common ground and support; 2) Being the medical expert in symptom relief and decision-making, providing guidance and reassurance in difficult situations; 3) Professionalism rooted in a holistic and relational approach; and 4) Being a good team player, aware of their function and limitations., Conclusions: A two-week student-selected course in palliative medicine improved knowledge and skills and increased confidence in providing palliative care. The comprehensive understanding of the doctor's role obtained in this course may also be relevant to other clinical specialties., Trial Registration: Not applicable (no clinical trial)., (© 2024. The Author(s).)

Introduction: Incarcerated patients are a vulnerable patient population with unique barriers to health care that physicians in every specialty encounter. Current medical school curricula lack universal education on health care for incarcerated people., Methods: We developed an interactive workshop to provide third-year medical students at the University of Kentucky with information about delivering care outside of dedicated carceral settings to individuals who are incarcerated. The workshop included education on the demographic characteristics and medical conditions present in these populations along with understanding incarcerated persons' rights to health care and how to interact with them and the associated jail/prison workforce often accompanying them on medical visits. The workshop also discussed advocacy tools aimed at providing equitable health care for incarcerated people. Our workshop consisted of a 30-minute large-group didactic session providing a basic understanding of the health care needs of incarcerated people, followed by a 30-minute small-group discussion of a JAMA Viewpoint article focused on advocacy for equitable health care for this patient population. Workshop effectiveness was assessed with a survey before and after the session., Results: One hundred and five students (55%) completed a self-assessment before and after the workshop, demonstrating an increase in knowledge and confidence on all but one question, with statistically significant p values less than .05., Discussion: Our 1-hour, interactive workshop for medical students in their clinical years demonstrated significant improvement in students' knowledge and confidence regarding providing health care to people who are incarcerated., (© 2024 South et al.)

Objective: There is conflicting evidence whether decreased clerkship duration is associated with reduced NBME shelf examination performance. We hypothesized that scores would remain stable for students in a shortened 2-week flipped classroom-based virtual rotation as compared to the traditional 4-week Neurology clerkship., Background: There is conflicting evidence whether decreased clerkship duration is associated with reduced NBME shelf examination performance. We hypothesized that Neurology shelf exam scores would remain stable for students in a shortened 2-week flipped classroom-based virtual rotation as compared to the traditional 4-week Neurology clerkship with direct patient care supplemented by didactics., Methods: This is a retrospective observational cohort study. In April 2020, the neurology clerkship at Rutgers Robert Wood Johnson Medical School switched from a traditional 4-week in-person clinical rotation supplemented by didactics to a 2-week flipped classroom-based virtual-only curriculum decoupled from a supplementary 2-week in-person clinical rotation to be completed later. Students were offered the opportunity to test after the 2-week virtual curriculum. NBME shelf scores for these "exam before clinical rotation" (EBC) students over the final quarter of the academic year 2019-2020 were compared to those of the "exam after clinical" (EAC) students undergoing the 4-week traditional rotation from July 2018 to March 2020., Results: 321 students completed the shelf exam between July 2018 and June 2020, of which 284 students comprised the EAC cohort and 37 students, the EBC cohort. Mean scores did not differ between the EBC and EAC cohorts (81.8 ± 6.7 versus 81.8 ± 6.5, p = 0.96). Additional analyses showed no significant differences in the performance of EBC students as compared to the EAC students that tested within the same academic year 2019-2020 or within the matched quarter of the prior academic year 2018-2019, and students completing the virtual rotation who delayed testing after the clinical experience., Conclusions: Testing after a 2-week flipped classroom-based virtual curriculum in Neurology without additional clinical training did not negatively affect neurology NBME shelf scores. Decoupling clinical experiences from knowledge acquisition and the evaluation of that knowledge base by means of NBME shelf examination is not likely to disadvantage learners with respect to shelf examination performance., (© 2024. The Author(s).)

Background: As online teaching gains prevalence in higher education, traditional face-to-face methods are encountering limitations in meeting the demands of medical ethics, the availability of experimental resources, and essential experimental conditions. Consequently, under the guidance of the BOPPPS (bridge-in, objective, preassessment, participatory learning, postassessment, summary) teaching model, the application of virtual simulation platform has become a new trend. The purpose of this study is to explore the effect of BOPPPS combined with virtual simulation experimental teaching on students' scores and the evaluation of students' participation, performance and teachers' self-efficacy in preventive medicine experiment., Methods: Students from Class 1 and Class 2 of 2019 preventive medicine major in Binzhou Medical University were selected as the research objects. The experimental group (class 2) (n = 51) received the teaching mode combined with BOPPPS and virtual simulation platform, while the control group (class 1) (n = 49) received the traditional experimental teaching method. After class, the experimental report scores, virtual simulation scores, students' engagement scale (SES), Biggs questionnaires, and teachers' sense of self-efficacy (TSES) questionnaires were analyzed., Results: The experimental report results demonstrated a significant increase in the total score of the experimental group and the scores of each of the four individual experiments compared to the control group (P < 0.05). To investigate the impact of the new teaching model on students' learning attitudes and patterns, as well as to evaluate teachers' self-efficacy, a questionnaire survey was administered following the course. The SES results showed that students in the experimental group had high performance scores on the two dimensions of learning methods and learning emotions (t = 2.476, t = 2.177; P = 0.015, P = 0.032). Furthermore, in the Biggs questionnaire, the total deep learning score of the experimental group was higher than that of the control group (t = 2.553, P = 0.012), and the deep learning motivation score of the experimental group was higher than that of the control group (t = 2.598, P = 0.011). The TSES questionnaire shows that most teachers think it is easier to manage students and the classroom and easier to implement teaching strategies under this mode., Conclusions: The combination of BOPPPS and the virtual simulation platform effectively enhances the experimental environment for students, thereby improving their academic performance, engagement and learning approach in preventive medicine laboratory courses., (© 2024. The Author(s).)

Introduction/background: Peer-led teaching sessions (PLTS) supplement conventional medical education, allowing students to share knowledge effectively. PLTS have shown significant academic benefits for student instructors. However, the impact on attendees, especially concerning NBME-style examinations, remains underexplored., Methods: This study analyzed de-identified data from 67 first-year medical students at Kirk Kerkorian School of Medicine, divided into PLTS attendees (study group) and non-attendees (control group) based on session participation. Data were collected before two NBME examinations, with attendees defined as those attending at least five Peer-led teaching sessions. Academic performance was measured using NBME Customized Assessment Services (CAS) exam scores. Statistical analyses, including p-tests, chi-square, and t-tests, assessed differences in performance and potential biases based on MCAT scores, first-generation status, and socioeconomic background., Results: The study group initially had 26 students, and the control group had 31 students. Post-first examination, the study group adjusted to 22 students, and the control group to 35 students. MCAT scores and demographics showed no significant differences between groups. The first examination revealed a significant higher score in PLTS attendees' scores (4.28% increase, p = 0.036), indicating a positive impact of PLTS on basic science knowledge. The second examination on organ systems physiology showed no significant difference (p = 0.722)., Discussion: PLTS effectively enhance foundational science understanding but may be less impactful for advanced topics. The diminishing effect may result from increased use of diverse study resources and adaptation to medical school. Future research should explore long-term benefits, optimal implementation strategies, and the impact of instructor quality and engagement. Therefore, the overall conclusion is that PLTS positively influence NBME-style exam performance in early medical education, but benefits decrease over time., (© 2024. The Author(s).)

Introduction: Military families face unique stressors beyond civilian life, such as deployments, frequent relocations, and the potential for combat, all of which can significantly impact well-being. A trauma-informed care (TIC) approach to military medicine is paramount; however, a critical gap exists, with no published curricula to guide practitioners in employing TIC in the care of military-connected individuals., Methods: We delivered a 50-minute interactive and virtual session to second-year medical students at the Uniformed Services University (USU) that reviewed the neurobiology of adversity and the relevance of TIC in caring for military-connected populations. Participants completed a 14-question pre- and posttest on perceived knowledge, attitudes, practice, and confidence, as well as posttest questions evaluating session quality. The USU Institutional Review Board approved this evaluation., Results: One hundred sixty medical students participated in the session, with 78 matched pre- and posttest responses. We observed a statistically significant pre-post improvement ( p ≤ .05) in all category scores, with the largest changes in knowledge (1.33) and confidence (1.33). On a 5-point Likert scale, with 5 being best, mean scores for overall quality of the session and relevance of the material to participants' learning and future practice were 3.95 and 4.20, respectively., Discussion: By equipping health care providers with knowledge and confidence to apply TIC in military medicine, we can improve the well-being of service members and their families across both military and civilian health care settings. Broader implementation of this program has potential to improve patient outcomes and overall health care delivery for this population., (© 2024 Chokshi et al.)

Background: Healthcare simulation is critical for medical education, with traditional methods using simulated patients (SPs). Recent advances in artificial intelligence (AI) offer new possibilities with AI-based simulators, introducing limitless opportunities for simulation-based training. This study compares AI-based simulators and SPs in undergraduate medical education, particularly in history-taking skills development., Methods: A randomized controlled trial will be conducted to identify the effectiveness of delivering a simulation session around history-taking skills to 67 fifth-year medical students in their clinical years of study. Students will be assigned randomly to either an AI-simulator group (intervention) or a simulated patient group (control), both will undergo a history-taking simulation scenario. An Objective Structured Clinical Examination (OSCE) will measure the primary outcomes. In contrast, secondary outcomes including student satisfaction and engagement, will be evaluated following the validated Simulation Effectiveness Tool-Modified (SET-M). The statistical approach engaged in this study will include independent t-tests for group performance comparison and multiple imputations to handle missing data., Discussion: This study's findings will provide valuable insights into the comparative advantages of artificial intelligence-based simulators and simulated patients. Results will guide decisions regarding integrating AI-based simulators into healthcare education and training programs. Hybrid models might be considered by institutions in the light of this study, providing diverse and effective simulation experiences to optimize learning outcomes. Furthermore, this work can prepare the ground for future research that addresses the readiness of AI-based simulators to become a core part of healthcare education., (© 2024. The Author(s).)

Background: Empathy is an important factor in the doctor-patient relationship, but mental illness is more difficult to understand than other diseases. Besides traditional skills, virtual reality (VR) has been identified as a promising tool in empathy education. This study aimed to investigate the ability of empathy enhancement, the feasibility of depression education, and the changes in thoughts and attitudes in medical students through a single VR experience., Methods: We recruited medical students and randomly assigned them to two groups based on their completed Interpersonal Response Index scores. Two sets of VR systems were provided; the intervention group experienced the daily life of the depressed medical student, while the control group experienced the general medical student scenario. The improvement of empathy was assessed using the Jefferson Scale of Empathy-Health Professional Students (JSE-HPS), and the change of attitude was assessed through the Implicit Association Test. In addition, other questionnaires were used to evaluate the user experience of this VR system, and correlation analysis was conducted to examine the association between the use of VR and changes in the JSE and IAT scores., Results: A total of 59 medical students were enrolled in this study. The intervention group showed a significant increase in the perspective-taking (pre: mean 5.817, SD 0.536; post: mean 5.947, SD 0.620; P = .03) and compassionate care (pre: mean 5.546, SD 0.581; post: mean 5.721, SD 0.629; P = .01) domains of the JSE score and a significant decrease in the standing in the patient's shoes (SP) domain (pre: mean 3.583, SD 1.253; post: mean 2.967, SD 1.252; P = .002). The Pearson correlation analysis found a significant positive correlation between the JSE score with immersion aspect (r = .308, P = .049) and presence aspect (r = .415, P = .01), and we also found a significant negative correlation between the IAT score and presence aspect (r=-.333, P = .04)., Conclusions: This study is the first randomized case-control study to investigate the effect of two different versions of VR on empathy development toward depression for medical students. Although the single VR experience was unable to induce a great improvement in empathy or attitude, the VR system could help medical students enhance their understanding of depressive disorders., Trial Registration: This trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (21/03/2024, ACTRN12624000297527). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386683&isReview=true ., (© 2024. The Author(s).)

Background: Understanding human anatomy is fundamental to building medical competencies. This study explored the diverse perceptions of medical students in Saudi Arabia and Egypt concerning virtual dissection applications., Methods: Students from different Saudi and Egyptian governmental universities were invited. The online questionnaire covered the sociodemographic characteristics, students' perception of the advantages of virtual anatomy applications, satisfaction with their efficiency, and their recommendation to use them. Comparisons were performed in country-wise and then university-wise patterns. Significance was considered with a P < 0.05., Results: The mean age of 401 participants was 20 ± 1.6. Females were 63% and the males were 37%. Saudi universities participated by 47% and Egyptian universities by 53% with various academic levels. The traditional program covers 25% of the participants and 75% are in integrated programs. Virtual dissection applications were used by 84% of the sample while the remaining 16% did not use them. No significant differences between Saudi participants and those from Egypt in the adopted teaching methods and the usual use of virtual dissection applications. However, significant differences in considering the ease of virtual applications (P = 0.016), their perfectness in lectures (P = 0.04), and their perception (P = 0.034). Also, there was no significant difference in satisfaction while their recommendation differed significantly (P = 0.034). The university-wise comparisons elaborated significant differences in the feasibility, reality, usefulness, preference, and perfectness of virtual dissection applications in lecturing., Conclusion: Technology can be an efficient complementary, not a replacement resource to support the educational process. Also, students' perceptions are valuable in maximizing the educational benefits of curricula., (© 2024. The Author(s).)

Introduction: Virtual learning is characterized by the fact that the sender and the receiver are not present in the development of the learning sessions or in the same physical space; it can be synchronous or asynchronous. In certain subjects such as Human Anatomy, the teaching was face-to-face, which is why the question arose whether the virtual teaching of human anatomy was effective or ineffective., Objective: To determine the relationship between virtual environments and learning achievements in the subject of human anatomy in students of a Peruvian university during the COVID-19 pandemic., Methods: Quantitative, descriptive correlational study, 187 undergraduate students participated in the Human Anatomy subject of the Faculty of Human Medicine of the Universidad Nacional Mayor de San Marcos. The virtual survey was used as a technique and a Likert-type scale as an instrument, whose content validity coefficient was 0.9062 and reliability, applying Cronbach's Alpha, was 0.956., Results: Of 100% (187), 82.9% (155) of the respondents considered the virtual environment favorable and 17.1% (32) considered it unfavorable. Of those who responded favorably, the learning achievement was considered: Good 53.5% (100); regular 21.4% (40); greater 6.4% (12) and minimum 1.6% (3). The virtual environment and learning achievements are related according to Pearson=7.785, p value=0.051 less than ɑ=0.10 and there is a moderate association with Cramer's V 0.204., Conclusions: There is a moderate association between the virtual environment and the learning achievement of the subject of human anatomy.

Objective: Extreme variation exists in teaching and clinical exposure for medical students, both from specialty-to-specialty but also between universities. There is mounting literature highlighting the need to reform and standardize surgical education to allow for unified graduate competency. In line with the recommendations from the GMC and the Royal College of Surgeons England (RCSEng), Queens University Belfast (QUB) significantly revised their undergraduate medical programme. Within this new curriculum is the introduction of Specialty Focus week in Surgery. This report reviews the processes used in the introduction of this week., Design: The initial week was formulated with a weekly timetable consisting of tutorials, bedside teaching and students following a peri-operative case. Run charts were populated with an alert when feedback dropped below a certain standard, which then triggered an intervention., Participants: Feedback was collected via a QR code from the first 200 surgical student., Settings: Belfast City Hospital in association with QUB undergraduate curriculum., Results: Run charts resulted in an alert when feedback dropped below 8/10. Following this we implemented smaller group bedside teaching. There was a significant improvement in feedback post intervention (p = 0.04) with no further alerts. Overall feedback had a nonsignificant feedback improvement post intervention (p = 0.07) with once again, no further alerts., Conclusion: This review has shown how we have provided some standardization of local surgical teaching, as well as having a process centered model of monitoring. This approach is easy to implement and could be reproduced elsewhere., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Fine microsurgical motor skill acquisition can be challenging. With increasing technological innovation, the methods of microsurgical skills acquisition may change. Studies show that laboratory-based microsurgical training programmes on a 2D microscope significantly improves the microsurgical skill acquisition of novices. However, it remains to be seen if these skills are transferable to a 3D microscope or if gaming agility is more important? We present a randomised control trial of three interventions, namely laboratory tabletop microscope training (LM), high-fidelity video gaming (Sony PlayStation 4 console; VG) and high-fidelity virtual reality gaming (Sony PlayStation VR console; VR) versus a control group., Methods: Forty novice medical students were block randomised to four groups: control (no intervention) n = 10, LM n = 10, VG n = 10 and VR n = 10. Participants performed chicken femoral artery anastomosis using the Aesculap Aeos® 3D microscope platform at the baseline and again after the intervention. Performance was evaluated using a modified structured assessment of microsurgery skills (mSAMS) score, time taken to complete anastomosis and time taken for suture placement by two blinded independent assessors., Result: No statistically significant difference was noted between the groups at the baseline. There was a statistically significant improvement in the LM arm between the baseline and post-training for mSAMS score and time for suture placement. In the VG, VR and control groups no statistically significant difference was observed., Conclusion: Our study demonstrates that during early microsurgical training, an intense laboratory-based microsurgical training programme significantly improves a novice's anastomotic performance on a 2D microscope, and these skills are transferable when a 3D anastomosis is carried out. However, focused gaming had no significant effect, and the results were akin to that of the non-intervention group., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Near-peer teaching is increasingly used in medical education, supporting or replacing faculty teaching. It has positive aspects for learners and tutors, some of which are explained by higher social and cognitive congruence between learners and near-peer tutors (NPTs). This study investigates the optimal combination of faculty tutors (FTs) and NPTs in an abdominal ultrasound course., Methods: Sixty-four third-year medical students underwent a basic ultrasound course, with 75% of lessons taught by NPTs and 25% by FTs. Each of four groups had a different faculty teaching timing. A mixed methods approach used a survey and semi-structured interviews at the course end to elicit learners' preferences, and end-of-course examination scores to look for differences in outcomes., Results: Most learners preferred having faculty teaching in the second half of the course, saying it would be overwhelming to start with FTs. Learners preferred between a quarter and a third of the teaching to be from FTs, with NPTs rated better at teaching basics, and FTs contributing unique, helpful clinical knowledge. There was no significant between-group difference in examination scores., Conclusions: Medical students preferred most of their teaching to be from NPTs, with some faculty input in the second half of the course.

Background: Traditional surgical education often lacks targeted preparation for the interactive components of examinations, such as viva voce and objective structured clinical examination (OSCE) assessments. We present our approach and explore the efficacy of a near-peer tutoring program aimed at enhancing final-year students' readiness for such assessments., Methods: Project SEPFYR (surgical exam prep for final year exam readiness) was conducted within a near-peer tutoring framework and comprised interactive discussions of selected case scenarios focusing on viva voce techniques and OSCE responses. Pre- and postprogram anonymized web-based surveys were employed to assess perceived self-efficacy among participants, while the Stanford Faculty Development Program-26 (SFDP-26) tool was used to evaluate the performance of tutors., Results: Near-peer tutoring intervention resulted in improvements in perceived self-efficacy scores among final-year students. Additionally, tutors demonstrated high-quality facilitation skills as evaluated by the SFDP-26., Conclusions: Near-peer tutoring is a promising approach to enhance surgical examination readiness, particularly in addressing interactive assessment components. This model fosters a supportive learning environment while leveraging the expertise and relatability of near-peer tutors., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Negative stereotypes associated with surgery by medical students are well documented in literature. Many cite long hours, poor work-life balance, pessimism, mean personalities, and cynicism as pervasive among surgeons and operating room culture. If allowed to persist, these negative perceptions can deter otherwise interested students from pursuing surgical subspecialties., Design: Incorporation of peer-teaching in the third-year clerkship to not only illuminate the hidden curriculum in surgery but adequately prepare students to participate in the operating room is paramount to taking steps to improve student perception as well as success as clerkship students., Setting: An academic medical center., Participants: Pre-clinical medical students., Results: One-hundred and forty-three third year clerkship students were surveyed with pre- and postinstruments. Students who participated in these pre clerkship peer-teaching sessions reported significant improvements in their ability to identify surgical anatomy (p < 0.001), an increased confidence in answering questions from attendings about anatomy and function as well as in identifying anatomical abnormalities (all p < 0.001). Students also reported significantly improved perceptions about surgeons as teachers and their willingness to support students pursuing surgery., Conclusion: This study demonstrates that the incorporation of an immersive orientation prior to the start of the surgery clerkship has significantly positive impacts on the learning experience and confidence of medical students. Increased efforts should be made to introduce students to surgeons, surgical careers, and the operating room prior to the surgery clerkship, being sure to incorporate aspects of the hidden curriculum, to address the negative perceptions that continue to exist regarding surgical fields., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors., Design: We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods., Setting: Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics., Participants: Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys., Results: Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001)., Conclusions: With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Ultrasound use as a procedural guide and diagnostic tool has led many to herald it as the "new stethoscope." Thus, medical schools are seeking to integrate ultrasound training into their longitudinal curricula. While various methods have been trialed, incorporating ultrasound into basic science courses as a supplementary learning tool often offers students their first exposure. This study seeks to identify factors that affected student excitement and perceived value of ultrasound training as part of an anatomy course., Materials and Methods: A brief survey was distributed to first-year medical students after completing ultrasound education in a clinical human anatomy course. This survey gauged student excitement and perceived value of the ultrasound sessions. Through free-response, students expounded on factors that affected their ratings. Qualitative student feedback was organized, coded, and associated with student excitement and perceived value ratings using thematic analysis., Results: Responses were returned from 26.2% of the surveyed group. Ten and 6 themes were identified in response to students' excitement and perceived value ratings of the sessions, respectively. Clinical relevance/utility was identified consistently as the most influential factor affecting student engagement. In addition, students' personal motivation and incentive, as well as the structure and learning environment of the sessions, were found to impact student engagement., Conclusions: We identified multiple factors that may impact student engagement with ultrasound sessions that are included as part of an anatomy course. Medical schools seeking to incorporate ultrasound sessions in a similar fashion could consider these factors when designing their own curricula., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Objective: To measure the readiness for self-directed learning among medical undergraduates of private and public medical colleges, and to evaluate their performance and strategies., Methods: The cross-sectional study was conducted in Lahore, Pakistan from February to July 2023, and comprised medical undergraduate students of either gender from 1 private and 1 public academic institution. Data was collected using a prevalidated structured questionnaire having self-management, desire for learning, and self-control domains to explore self-directed learning readiness. Data was analysed using SPSS 26., Results: Of the 330 subjects, 166(50.3%) were females and 164(49.7%) males, while 166(50.3%) were from the private institution and 164(49.7%) were from the public institution. There were 183(55.4%) students in the 3rd year, 89(27.0%) in the 4th year and 58(17.6%) in the final year of their coursework. Self-directed learning readiness was significantly higher in students from the private institution (p<0.05)., Conclusions: There was a significant correlation between self-directed learning readiness in private and public medical education institutions, with readiness being higher in the private sector.

Introduction: While musculoskeletal disorders are leading causes of medical visits, musculoskeletal education is underrepresented in US medical curricula. Previous studies have demonstrated that undergraduate medical students often fail to demonstrate competency surrounding musculoskeletal disorders. More educational content is needed to support musculoskeletal knowledge in learners., Methods: We developed an online, case-based musculoskeletal module for second-year medical students alongside their standard course material and presented clinical cases with multiple-choice question quizzes regarding the presentation, diagnosis, and anatomic correlation of musculoskeletal conditions. Cases, under 10 minutes each, targeted common, medically important areas of musculoskeletal health., Results: Grades in the required musculoskeletal course were significantly and positively correlated with online module quiz performance. 258 (73%) of 354 students completed at least one quiz, and students completed an average of 14 out of 15 quizzes. Learners who completed more than 50% of the quizzes performed significantly better in the course than those who completed fewer quizzes; this was true for a formative internal course exam ( p = .035), an NBME customized assessment ( p = .008), and the course overall ( p = .021). Additional analyses of students' perceptions revealed that students valued the self-directed online learning environment. The high completion rate (73%) for the online module also signaled student value in the content and format., Discussion: This module represents educational material that has been demonstrated to improve medical student musculoskeletal learning. Additionally, the module could be expanded to address inadequacies in orthopedic education among other students, such as allied health learners., (© 2024 Robertson et al.)

Background: Oral assessments are essential components of board certification in numerous fields, as they provide insight into problem-solving capacity and clinical reasoning. The development of clinical reasoning often begins in undergraduate medical education and remains a challenge to assess., Objective: We developed a pilot oral assessment to evaluate medical student oral presentations and systematically assess clinical reasoning. This was incorporated into a previously existing cumulative assessment at the conclusion of the third year of medical school, with the intent to demonstrate feasibility and future reliability of this exam format., Methods: This pilot oral assessment was developed using content taught during third year clerkships. A modified Assessment of Reasoning Tool (ART) was used as the evaluation metric. It was conducted virtually to include faculty members from multiple disciplines and accommodate schedules and space limitations., Results: A total of 152 third year medical students completed the exam, with a total of 15 faculty examiners. 89% of medical students scored as complete in hypothesis directed history, 93% in problem representation, 86% in prioritized differential diagnoses, and 67% in effectively directing management. Most examiners felt an oral assessment is effective to determine a medical student's clinical reasoning ability., Conclusions: Virtual oral assessments of clinical reasoning can be incorporated in undergraduate medical education to identify students struggling with components of clinical reasoning, while also allowing maximum flexibility for the clinician educator workforce as examiners. Longitudinal use of these exams would be valuable to track the development of clinical reasoning across the medical school curriculum., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.