Quitério AB, Dos Santos Borges W, de Carvalho Engel AMRPVT
… +10 more, Menezes JDS, Dos Santos ER, Martinez WD, da Silva MQ, de Carvalho SRPVT, do Vale Lopes SB, Bianchin MA, Brienze VMS, de Sales Floriano JA, André JC
INTRODUCTION: Self-efficacy, the belief in one's capacity to execute actions necessary to achieve specific objectives, is a significant predictor of academic performance and well-being in medical training. Longitudinal s...INTRODUCTION: Self-efficacy, the belief in one's capacity to execute actions necessary to achieve specific objectives, is a significant predictor of academic performance and well-being in medical training. Longitudinal studies examining the dynamic evolution of self-efficacy throughout undergraduate medical education remain scarce in the Brazilian context. This study prospectively evaluated perceived self-efficacy among medical students during critical curricular transitions. METHODS: A prospective longitudinal study followed 50 medical students from a Brazilian public university at four time points: course entry (T1-2021), end of first year (T2-2022), midpoint of clinical cycle (T3-2023) and beginning of fifth year/internship (T4-2025). The Self-Efficacy Scale for Higher Education (SESHE), a validated 34-item instrument assessing five dimensions, was administered. Statistical analyses included repeated measures ANOVA, Wilcoxon test and effect size calculations (Cohen's d). RESULTS: The study observed a dynamic evolution in perceived self-efficacy, characterised by a notable shift in total self-efficacy from 2021 to 2023, followed by partial recovery by 2025. This pattern included significant reductions in several dimensions. Self-efficacy in proactive actions experienced the most pronounced change (d > 0.8), while self-efficacy in social interaction demonstrated relative stability. Baseline analyses revealed higher self-efficacy in social interaction among male students (d = 0.51). CONCLUSION: These findings suggest that the observed changes in self-efficacy represent an adaptive recalibration, moving toward a more realistic self-assessment essential for professional development. Therefore, strategies that support this healthy recalibration are crucial. These interventions should aim to facilitate adaptive adjustment, fostering robust and accurate self-efficacy throughout medical training.
Art and surgery have long shared a symbiotic relationship, each rooted in observation, precision and creativity. I was reminded of this early as a medical student during my cardiothoracic surgery and general surgery rota...Art and surgery have long shared a symbiotic relationship, each rooted in observation, precision and creativity. I was reminded of this early as a medical student during my cardiothoracic surgery and general surgery rotations, when I began making 2-min 'thumbnail' sketches after cases-just enough lines to capture planes, landmarks and instrument angles. What started as a way to stay focused quickly changed how I saw operative anatomy: messy, layered, dynamic and rarely like the textbook plate. Although drawing has anchored surgical understanding from Vesalius and Da Vinci to Cheselden and Bell, the habit has faded in modern curricula, displaced by digital imaging and largely passive viewing, especially as a medical student in surgical rotations. My experience suggests the opposite approach is both feasible and valuable. Brief, structured sketching sharpened my spatial reasoning and helped me retain operative steps; the gaps in my redraws mapped exactly to the questions I asked on rounds the next morning. Drawing not only refines visual-spatial skills but also promotes deeper cognitive processing and long-term retention-qualities essential for surgical trainees. Despite its proven benefits, many students and clinicians shy away from drawing due to perceived lack of skill, time constraints or undervaluing of artistic learning. Integrating structured drawing exercises and art-based reflection into surgical training may not only enhance anatomical comprehension but also foster mindfulness, empathy and critical observation. Reviving art within surgical education is, therefore, not an indulgence in aesthetics, but an investment in cultivating more perceptive, reflective and precise surgeons.
INTRODUCTION: Healthcare education was traditionally delivered in a face-to-face format. Technological advances gradually integrated online components, with the COVID-19 pandemic accelerating this shift. There is a deart...INTRODUCTION: Healthcare education was traditionally delivered in a face-to-face format. Technological advances gradually integrated online components, with the COVID-19 pandemic accelerating this shift. There is a dearth in the literature postpandemic examining student's views since universities have adjusted and refined online provision. Previous research examines the views of medical and nursing students; postgraduate students of Health Professions' Education combining clinical roles with advanced study on healthcare education theory could hold valuable insights into the current experience of online learning. METHODOLOGY AND METHODS: This was a qualitative study with an interpretivist paradigm. One-on-one semi-structured remote interviews were conducted with 15 postgraduate students of Health Professions' Education across six higher education institutes. Transcripts were analysed using Braun and Clarke's six-phase approach to reflexive thematic analysis. RESULTS: Four themes were identified. Convenience and flexibility enabled participants to integrate study into demanding clinical schedules. Social interaction and peer connection were reduced compared to in-person learning though the perceived importance of this varied based on stage of education. Engagement and participation challenges included difficulties sustaining attention online balanced with a positive experience of interactive teaching strategies. Finally, participants discussed their experiences of online assessments with some appreciating the convenience of remote exams, but concerns remained surrounding validity and technological stressors. DISCUSSION: Online education can provide a crucial adaptation particularly for postgraduate students. Sustaining engagement, fostering connection and ensuring reliable assessment depend on thoughtful pedagogical design and institutional support. As institutions continue to develop virtual programmes, learner-centred designs are critical to maximising educational outcomes.
This How to… guide aims to offer a framework for selecting research methodologies in health professions research, in response to the lack of explicit guidance on selection appropriate research methodologies. Despite an a...This How to… guide aims to offer a framework for selecting research methodologies in health professions research, in response to the lack of explicit guidance on selection appropriate research methodologies. Despite an awareness of how methodological decisions shape research processes, and ultimately outcomes, the practicalities of making robust methodological choices often remain tacit as early career researchers navigate a fragmented methodological landscape. As such, we provide a six-step process to articulate what we have found to be helpful in our decision-making, offering also a worked example. We recognise that methodological decision-making is ultimately shaped by reflexivity and individual heuristics and there is no single 'best' methodology, not way to choose a methodology. Nonetheless, we hope this offers a springboard for decision-making.
BACKGROUND: The transition to Competence by Design (CBD) and the introduction of Entrustable Professional Activity (EPA) assessments have elicited mixed emotions among residents and faculty, which is important as negativ...BACKGROUND: The transition to Competence by Design (CBD) and the introduction of Entrustable Professional Activity (EPA) assessments have elicited mixed emotions among residents and faculty, which is important as negative emotions have been shown to hinder learning. Hence, this study explores the experiences, perceptions and associated emotions of residents and faculty regarding EPA assessment processes, including when and how experiences are linked with emotions. METHODS: This qualitative descriptive study employed semistructured interviews with residents and faculty from Pediatrics, General Surgery and Emergency Medicine programs at a university (2023-24). Inductive reflexive thematic analysis was conducted to analyse the data. RESULTS: Participants included 10 residents and 13 faculty. Seven themes were identified: (1) Residents and faculty describe changing emotions regarding EPA assessment experiences across implementation stages; (2) Residents and faculty feel uncertain about the educational relevance of EPAs, while procedural EPAs and assessments are perceived as more meaningful for learning; (3) Faculty and residents describe frustration when EPA assessment platforms disrupt workflow and assessment engagement; (4) Confusion and frustration arise when numerical scores do not align with feedback in EPA assessments; (5) Emotions regarding simulation-based EPA assessments depend on perceived authenticity and opportunities for learning; (6) Residents and faculty feel overwhelmed and fatigued when high assessment volume is perceived as misaligned with learning and realities of the clinical setting; (7) Sharing EPA assessment experiences with leadership and colleagues: Not as common as one might think. CONCLUSIONS: Residents and faculty have mixed perceptions and emotions associated with EPA assessment processes, influenced by specialty-specific implementation and logistical challenges. Our findings may support residency programs in recognizing instances of negative emotions, and optimizing EPA assessment processes to support learning.
Descriptive phenomenology seeks to understand the essence of lived experience. This article focuses specifically on the analysis of descriptive phenomenological data in Health Professions Education and introduces Colaizz...Descriptive phenomenology seeks to understand the essence of lived experience. This article focuses specifically on the analysis of descriptive phenomenological data in Health Professions Education and introduces Colaizzi's method as a practical, seven-step approach. Throughout the analysis, the importance of reflexivity, bracketing (epoché), transparent documentation of analytic decisions and close grounding of themes in participants' words is emphasised.
BACKGROUND: Although professionalism and ethics are core competencies in medical education, assessing students' preparedness for ethically challenging situations remains difficult. The aims of this study were to (1) asse...BACKGROUND: Although professionalism and ethics are core competencies in medical education, assessing students' preparedness for ethically challenging situations remains difficult. The aims of this study were to (1) assess student preparedness for ethical dilemmas in practice, (2) pilot a training day and examine its impact on students' preparedness and (3) evaluate students' performance in OSCE stations. APPROACH: We developed a Professionalism and Ethics Simulation Clinical Examination (PESCE) for Year 4 medical students. Following a preparatory session, students rotated through simulated clinical scenarios reflecting common ethical challenges encountered by junior doctors before undertaking a formative OSCE station. EVALUATION: Preintervention and postintervention surveys demonstrated increased preparedness for ethical dilemmas (mean 3.08 to 3.89, p < 0.001). Students valued the realism and opportunity for rehearsal. Assessor feedback identified strong empathy and professionalism but difficulty articulating procedural next steps. IMPLICATIONS: Integrating ethics-focused simulation into OSCE assessment offers a practical way to strengthen engagement with ethics and professionalism. It aligns with workplace-based learning and better prepares students for everyday ethical encounters in clinical practice.
INTRODUCTION: Research in nursing, occupational therapy and dental hygiene indicates that clinical practice engagement enhances academic faculty's credibility with students and skill retention. However, common barriers i...INTRODUCTION: Research in nursing, occupational therapy and dental hygiene indicates that clinical practice engagement enhances academic faculty's credibility with students and skill retention. However, common barriers include limited time, institutional constraints and unclear policies. Despite ongoing clinical involvement among physical therapy faculty, little is known about how these activities influence teaching performance and workload management. This study examined the experiences of full-time faculty members with clinical practice, focusing on the perceived benefits, barriers and institutional factors that affect their ability to sustain patient care while fulfilling academic duties. METHODS: This phenomenological pilot study examined the lived experiences of seven full-time physical therapy faculty at a public land-grant institution. Data were collected through semistructured interviews and analysed using Colaizzi's method with thematic coding. Research questions addressed experiences, perceived benefits and barriers and the influence of personal and institutional factors on clinical engagement. RESULTS: Four themes emerged: the experiences of engaging in physical therapist clinical practice, the perceived benefits of clinical practice, the perceived barriers to clinical practice and the impact of participant characteristics on experience. CONCLUSION: Clinical practice was viewed as essential for maintaining competence and enhancing teaching. Faculty valued it as a professional motivator, but institutional barriers often limited participation. Formalising clinical practice through policies, workload models and curricular integration may help sustain dual academic and clinical roles. These findings suggest that supporting faculty in maintaining clinical engagement benefits educators and students in physical therapy education.
Bedside teaching represents an immensely valuable learning experience for students, fostering acquisition of clinical skills alongside wider professional competencies. Despite such benefits, the practice of bedside teach...Bedside teaching represents an immensely valuable learning experience for students, fostering acquisition of clinical skills alongside wider professional competencies. Despite such benefits, the practice of bedside teaching is in decline, and there remains a paucity of available guidance regarding how best to conduct bedside teaching. Learning theories can enhance teaching through providing evidence-based frameworks; Kolb's experiential learning theory is of particular relevance to bedside teaching due to its immersive and hands-on nature. This article critically applies experiential theory to bedside teaching and derives relevant considerations for tutors. It is found that bedside teaching is rooted in and evidenced by experiential learning theory and should thus be prioritised within clinical placements. Experiential theory can be used to optimise the learning experience provided, structure learning within clinical contexts and emphasise reflection and subsequent student learning. However, there is a need for dynamic adaptation of the model in response to unpredictable environments and for tutors to support and guide students through the learning cycle. Further empirical research is required to establish the efficacy of direct employment of Kolb's learning cycle within bedside teaching and to optimise the concrete experience provided.
Visual Thinking Strategies (VTS) is a structured, evidence-based pedagogical method that has been increasingly embraced in medical education to foster essential clinical competencies such as observation, interpretation,...Visual Thinking Strategies (VTS) is a structured, evidence-based pedagogical method that has been increasingly embraced in medical education to foster essential clinical competencies such as observation, interpretation, communication and empathy. Originally developed for use in K-12 classrooms, VTS involves a standardised facilitation method centred on three carefully sequenced questions posed in response to a visual artwork. Although deceptively simple in format, effective facilitation of VTS requires extensive training and adherence to specific practices that activate collaborative and critical thinking processes. As interest in arts-based pedagogies grows in medical education, VTS stands out as a method with defined guidelines and demonstrable educational outcomes. However, this paper argues that the expanding adoption of VTS be accompanied by a commitment to fidelity-in how the method is implemented, studied and described in the academic literature. While an increasing number of medical educators are enthusiastically incorporating VTS into their curricula, the literature belies a concerning trend of deviations from the method's core components. These include altered wording of the three core questions, inconsistent naming of the method, facilitation by untrained individuals and inadequate or inaccurate methodological descriptions. Such deviations, even when subtle, can compromise the internal validity of research findings and risk misrepresenting the nature and effectiveness of the intervention. This lack of fidelity could threaten the integrity of educational outcomes and the credibility of arts-based approaches in the broader field of medical education. Compounding the issue, peer reviewers and journal editors may lack sufficient familiarity with VTS to identify these inaccuracies, enabling flawed implementations to persist in the literature. We contend that ensuring fidelity to the original VTS methodology is a shared responsibility across researchers, educators, institutions and scholarly publications. Adherence to the method maintains its pedagogical and scholarly value. To that end, we offer practical recommendations, such as formal VTS facilitator training (with greater accessibility to educators in low-resource settings), accurate reporting standards, peer reviewer education and the cultivation of a community of certified practitioners. As VTS continues to gain traction, we recommend that educators aim for fidelity in its use and study, ensuring that its full potential to enrich clinical education is realised and preserved for future generations of learners.
BACKGROUND: Best-practice item writing and blueprint alignment are recommended for medical school assessments, yet few studies examine whether exam redesign improves both psychometric quality and external validity of pre...BACKGROUND: Best-practice item writing and blueprint alignment are recommended for medical school assessments, yet few studies examine whether exam redesign improves both psychometric quality and external validity of preclinical block exams in the Step 1 pass/fail era. We therefore examined how consolidating two moderate-reliability gastroenterology (GI) examinations into a single vignette-based exam affected reliability and its relationship with the NBME Comprehensive Basic Science Examination (CBSE). APPROACH: We conducted a retrospective analysis of six cohorts (2019-2025; N = 867) who completed the GI examination(s) and the CBSE. Item statistics and KR-20 reliability coefficients were obtained from the examination platform. Associations between exam average and CBSE total and GI subsection scores were evaluated using Spearman correlations (ρ), and cohort trends were explored using Welch-corrected ANOVA. EVALUATION: Mean exam average declined modestly (91.6-86.1), whereas CBSE means were stable (≈57-67). Exam reliability rose steadily (KR-20 = 0.51-0.75), with the largest gain after blueprint revision (0.55-0.69). Across all students, exam average correlated moderately with CBSE total (ρ = 0.44, p < 0.001) and GI subsection (ρ = 0.36, p < 0.001). Cohort-specific correlations strengthened over time, increasing from ρ = 0.36 in 2019-2020 to ρ = 0.57 in 2024-2025; cohorts with KR-20 ≥ 0.65 demonstrated stronger predictive validity than earlier cohorts. IMPLICATIONS: A clinician-led, vignette-rich, blueprint-driven redesign improved exam reliability and strengthened alignment with national benchmarks despite reduced testing frequency, supporting clinically integrated assessments as a strategy to enhance step-readiness without increasing assessment burden.
INTRODUCTION: Our medical school aimed to involve students in changes to the Year 4 curriculum. We had feedback from graduates; however, there was little guidance available on how to meaningfully involve students. Most l...INTRODUCTION: Our medical school aimed to involve students in changes to the Year 4 curriculum. We had feedback from graduates; however, there was little guidance available on how to meaningfully involve students. Most literature regarding curriculum co-design in medical schools are case reports, with few using students in partnership such as in participatory action research (PAR). We used this process to determine how best to involve students in curriculum design. METHODS: We recruited Year 4 medical students to discuss their experiences of the current curriculum, their opinions on potential new curriculum options and their reflections on the experience of this co-design process. The PAR approach allowed researchers and participants to work in partnership to identify and analyse themes raised. We analysed transcripts of focus groups using reflexive thematic analysis. RESULTS: Six students attended three focus groups, sharing congruent experiences from diverse perspectives. We considered students' perspectives on partnership working in curriculum design in terms of three major relationships: the student-faculty relationship, the relationship to curriculum and the peer-to-peer relationship. We discuss these findings in relation to pedagogic and feminist theories and use Arnstein's ladder of citizen participation to assess our current and prospective level of involvement. CONCLUSION: Previous research has shown that involving students in curriculum design has benefits for both the students and the teaching institution. Our action-research project allowed the review of a potential new curriculum by the students and combined practice and theory to generate guidelines to be used for future involvement of medical students in curriculum co-design.
Problem representation (PR) is a concise synthesis of clinical information that captures the core diagnostic problem in a single statement, often referred to as a 'one-liner'. Although central to diagnostic reasoning, th...Problem representation (PR) is a concise synthesis of clinical information that captures the core diagnostic problem in a single statement, often referred to as a 'one-liner'. Although central to diagnostic reasoning, this skill is frequently underdeveloped in medical training. Many trainees struggle to transform clinical data into meaningful representations, which can hinder communication, diagnostic reasoning and patient safety. The Assessment of Reasoning Tool-Reconstructed (ART-R) provides a structured framework that educators can adapt as a coaching rubric to strengthen PR during clinical teaching. Using the ART-R, faculty can guide trainees to refine their PR by focusing on three elements: (1) clarity of the synthesized clinical problem; (2) emphasis on diagnostically relevant positive and negative findings; (3) use of precise medical terminology. This micro-coaching approach can be naturally embedded into clinical rounds through brief prompts that encourage trainees to refine their one-liner summaries. Through repeated practice, trainees develop increasingly abstracted representations that activate illness scripts and support diagnostic hypothesis generation. Coaching PR in this way provides a practical, low-burden strategy for strengthening diagnostic reasoning during routine clinical teaching. Integrating this approach into patient presentations can help educators cultivate stronger diagnostic reasoning.