Medical Education[JOURNAL]
Sun
200 papers
Peer tutoring in clinical simulation for health sciences education: a systematic review.
Bertiola-Flores C, Infante-Villagrán VA, Palma-Vidal N … +3 more , Ferrada-Peña C, Mazzo A, Díaz-Guio DA
BMC Med Educ · 2026 Jun · PMID 42298541 · Full text
BACKGROUND: Simulation-Based Education and peer tutoring have become relevant pedagogical strategies in health sciences education, as they promote active, safe, and collaborative learning. However, studies demonstrating...
BACKGROUND: Simulation-Based Education and peer tutoring have become relevant pedagogical strategies in health sciences education, as they promote active, safe, and collaborative learning. However, studies demonstrating their combined benefits have not yet been sufficiently systematized. This systematic review analyzes the evidence on the implementation of peer tutoring and simulation-based teaching for the development of technical and non-technical skills among health sciences students, based on experimental and quasi-experimental interventions. METHODS: A search was conducted in the Web of Science, Scopus, and PubMed databases, including experimental and quasi-experimental studies published between 2020 and 2025. Eleven studies met the inclusion criteria, with a total sample of 860 students and 107 peer tutors. RESULTS: The results show that most interventions were implemented in low- to medium-complexity simulation settings and primarily reached Level 2 of Kirkpatrick's evaluation model, assessing knowledge, skills, and attitudes. Peer tutoring demonstrated significant benefits in technical skills (e.g., specific clinical procedures) and in non-technical skills such as self-confidence, self-efficacy, communication, motivation, and reflection. Additionally, high levels of student satisfaction, reduced anxiety, and the creation of psychologically safe learning environments were reported. The role of the peer tutor is characterized by cognitive and social proximity to students, acting as a learning facilitator, provider of feedback, and promoter of a climate of trust. However, the studies also revealed methodological limitations, including small sample sizes, non-randomized designs, and the absence of longitudinal follow-up. CONCLUSIONS: In conclusion, the combination of Simulation-Based Education and peer tutoring represents a cost-effective and pedagogically sound strategy for health professions education. Future research should incorporate more rigorous designs, larger samples, and long-term evaluations, as well as formal training programs for peer tutors under faculty supervision.
Application of a virtual simulation teaching model in enhancing the clinical understanding of cataract surgery among undergraduate medical students: a single-arm pre-post interventional study.
Xiang X, Zhu X, Ji Z … +1 more , Lu M
BMC Med Educ · 2026 Jun · PMID 42298528 · Full text
BACKGROUND: Although the advantages of virtual simulation in medical education are increasingly apparent, research on its application in ophthalmic surgery education remains in the exploratory stages. As such, this study...
BACKGROUND: Although the advantages of virtual simulation in medical education are increasingly apparent, research on its application in ophthalmic surgery education remains in the exploratory stages. As such, this study aimed to evaluate the feasibility and learner acceptance of a virtual simulation platform for cataract surgery in helping Chinese undergraduates understand the principles of cataract surgery and develop clinical cognition. METHODS: A single-arm pre-post interventional study was conducted. Fourth-year undergraduate students majoring in clinical medicine participated in learning via a virtual simulation platform for cataract surgery, which comprised 18 teaching modules covering the entire clinical pathway. We collected students' initial and highest scores, as well as data from the teaching effectiveness evaluation questionnaire. Data analysis included the Wilcoxon signed-rank test, Spearman's correlation analysis, and content analysis. RESULTS: The median of the students' best scores was significantly higher than their initial scores. Students' evaluations of the platform's various dimensions were generally positive, with higher self-reported scores for clinical reasoning skills, overall satisfaction, and willingness to recommend. Among learning resources, "immediate feedback on incorrect operations" and "surgical step prompts" were rated the highest. The most frequently practiced surgical steps were continuous circular capsulorhexis and phacoemulsification of the lens nucleus. Among the most memorable procedures, corneal incision and posterior capsule rupture management were the most frequently mentioned. Correlation analysis revealed a strong positive correlation between platform satisfaction and willingness to recommend, as well as between the detail of high-risk step simulations and understanding of complication management. CONCLUSION: This single-arm pre-post study provides preliminary evidence that a virtual simulation platform for cataract surgery is feasible and well accepted by undergraduate medical students. The students reported high satisfaction and perceived improvements in their procedural understanding and risk awareness. However, due to the absence of a control group, small sample size, and reliance on self-reported outcomes, causal conclusions could not be drawn. The observed score improvements may, in part, reflect testing effects. Despite these limitations, the high level of student acceptance provides a useful foundation for future controlled studies. At the same time, technical fluidity and instructional guidance could be further improved.
Self-regulated and socially shared regulation of learning in adaptive collaborative educational environments: a scoping review.
Ikram F, Yasmeen R, Fayyaz H
BMC Med Educ · 2026 Jun · PMID 42298519 · Full text
BACKGROUND: Collaborative learning is central to higher education, yet its effectiveness depends on learners' ability to regulate learning both individually and collectively. While self-regulated learning (SRL) and socia...
BACKGROUND: Collaborative learning is central to higher education, yet its effectiveness depends on learners' ability to regulate learning both individually and collectively. While self-regulated learning (SRL) and socially shared regulation of learning (SSRL) are recognised as complementary processes, their interaction within adaptive collaborative learning environments remains insufficiently synthesised. The objective of this scoping review was to map and synthesise existing literature describing the components, processes, and adaptive strategies underpinning the interplay between SRL and SSRL in collaborative learning contexts in higher education, and to identify the current evidentiary base within high-stakes fields like health professions education. METHODS: A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR guidelines. Searches were performed across PubMed/MEDLINE, Google Scholar, ScienceDirect, Semantic Scholar, and Taylor & Francis for studies published between 2004 and 2024. Eligible studies addressed SRL, SSRL, collaborative learning, and/or adaptive learning in higher or health professions education. Data were systematically charted and analysed using a hybrid inductive-deductive thematic analysis. RESULTS: A total of 31 studies met the inclusion criteria, including 14 empirical, 12 conceptual/theoretical, 4 review-based contributions and one bibliometric analysis. Regulation in collaborative learning was found to be dynamic, involving continuous shifts between individual and shared processes across affective, cognitive, metacognitive, and motivational domains. Recurrent challenges included emotional strain, misaligned goals, invisible reasoning, uneven participation, and coordination breakdowns. Adaptive learning supported regulatory processes through personalised feedback, scaffolding, dashboards, and prompts. However, these systems largely operated in parallel, addressing either individual regulation or group-level processes, with limited emphasis on harmonising SRL and SSRL. Empirical evidence from health professions education was limited. CONCLUSIONS: Effective collaborative learning depends on dynamic coordination between self- and socially shared regulation. Although adaptive learning environments show promise, current designs provide limited support for coordinating individual and collective regulatory processes. Notably, empirical research applying these frameworks within higher education is critically scarce, particularly in health professions education. This highlights a major gap for future theory-informed adaptive designs that must harmonise individual autonomy with shared accountability.
Teaching at scale: a mixed-methods study of team-based learning analytics to enable early support in medical education.
Sheader E, Donlan L, Allen C … +14 more , Betteridge N, Dixon M, Gouldsborough I, Grady R, Kingston M, Kouskoff V, Parris K, Pocock T, Raza M, Shore P, Stafford N, Tournier C, Webb M, Smith MP
BMC Med Educ · 2026 Jun · PMID 42298515 · Full text
BACKGROUND: Medical schools are under increasing pressure to teach larger cohorts while maintaining an excellent student experience. The University of Manchester replaced Problem-Based Learning (PBL) with Team-Based Lear...
BACKGROUND: Medical schools are under increasing pressure to teach larger cohorts while maintaining an excellent student experience. The University of Manchester replaced Problem-Based Learning (PBL) with Team-Based Learning (TBL) in 2023 to meet growing demand for medical education. While the educational effectiveness of TBL is well established, this study evaluated how the routine data generated within large-scale TBL could be potentially used to support early intervention, monitor curriculum quality, and validate peer assessment processes. METHODS: We conducted a prospective mixed-methods evaluation of two consecutive Year-1 medical cohorts at a large UK medical school (2023-24, n = 435; 2024-25, n = 426). Data included TBL individual readiness assurance test (iRAT) scores, student experience surveys, operational measures, and end-of-semester examination results. In the second year, the 50 lowest-performing students after four teaching themes were identified using iRAT data and offered tailored academic and wellbeing support through their academic advisors. RESULTS: TBL maintained high student satisfaction (74% rated sessions "excellent") whilst simultaneously reducing weekly staff facilitator hours by 63% (160 h vs. 59 h) and room use by 84% (80 h of bookings vs. 13). Student individual weekly performance, as measured by iRAT scores, was strongly predictive of summative performance (R²≈0.38-0.41) and this finding is reproducible over consecutive years. Theme-level variation in iRAT performance also identified differences in content difficulty and alignment, providing a programme-level indicator of curriculum quality and areas of weaker delivery. Early identification and intervention of struggling students increased semester performance by 20% (p < 0.0001) among the bottom 50 students, improved summative exam marks by 5%, and reduced exam failure rate by 41%, without inflating whole cohort attainment. CONCLUSIONS: This study shows how routine TBL data can function as a scalable analytics system to support early intervention, continuous curriculum monitoring, and quality assurance of peer assessment, while also reducing operational demands. These findings provide a transferable model for institutions seeking to expand capacity while maintaining educational quality and equity.
Paper-based gamification to enhance competency-based education in an obstetrics clerkship.
Umezaki Y, Shinto A, Yamashita N … +4 more , Kobayashi M, Fujii M, Tsuruhisa A, Okugawa K
BMC Med Educ · 2026 Jun · PMID 42298486 · Full text
BACKGROUND: Clinical clerkships are essential for competency-based medical education (CBME). However, students' learning opportunities often vary by case availability, rotation timing, and supervisory practices. Gamifica...
BACKGROUND: Clinical clerkships are essential for competency-based medical education (CBME). However, students' learning opportunities often vary by case availability, rotation timing, and supervisory practices. Gamification may support learner engagement, but many interventions rely on digital platforms that can be difficult to implement in busy clinical environments. This study evaluated whether a low-resource, paper-based gamification tool could support structured learning in an undergraduate obstetrics and gynecology clerkship. METHODS: This quasi-experimental study included 102 fifth-year medical students who completed a required obstetrics and gynecology clerkship at Saga University between October 2023 and September 2024. Students were assigned by the institutional rotation schedule to either a conventional clerkship group (n = 50) or an intervention group using a paper-based "stamp rally" (n = 52). The intervention consisted of 20 observable clinical tasks mapped to clerkship competencies and requiring instructor verification. Outcomes included self-reported satisfaction, sense of achievement, self-efficacy, self-directed learning, task completion rate, written examination score, and free-text comments. RESULTS: Compared with the conventional group, the intervention group reported higher satisfaction (4.3 ± 0.6 vs. 3.6 ± 0.7, p < 0.01), sense of achievement (4.4 ± 0.5 vs. 3.5 ± 0.6, p < 0.01), self-efficacy (4.2 ± 0.6 vs. 3.7 ± 0.7, p < 0.05), and self-directed learning (4.3 ± 0.5 vs. 3.6 ± 0.7, p < 0.01). The intervention group also had a higher documented task completion rate (92.3% ± 7.3% vs. 75.9% ± 10.5%, p < 0.01) and higher short-term written examination scores (85.0 ± 5.9 vs. 78.2 ± 6.8, p < 0.05). Free-text comments suggested that the intervention clarified expectations, promoted proactive engagement, and provided visible progress feedback. CONCLUSIONS: A paper-based gamification tool was associated with higher motivation-related outcomes, greater documented completion of listed clinical tasks, and higher short-term written examination scores in an undergraduate obstetrics and gynecology clerkship. By translating clerkship objectives into visible and verifiable activities, this low-resource approach may help operationalize CBME-oriented clinical learning. Further multicenter and longitudinal studies are needed to evaluate whether improvements in engagement and task completion translate into durable competency development and workplace-based performance.
School development via the digital transition in nursing schools: Using empirical data to customize DigCompOrg for nursing education.
Kalkmann F, Lienenbrink S, Behrens J … +7 more , Hoferichter J, Borcherding G, Bräutigam C, Evans-Borchers M, Laser J, Theil T, Hülsken-Giesler M
BMC Med Educ · 2026 Jun · PMID 42289693 · Full text
BACKGROUND: The digital transition increasingly poses challenges for educational organizations, as illustrated by the diverse approaches to digitalization processes adopted by German nursing schools. DigCompOrg, an Europ...
BACKGROUND: The digital transition increasingly poses challenges for educational organizations, as illustrated by the diverse approaches to digitalization processes adopted by German nursing schools. DigCompOrg, an European Union policy framework, addresses the complexity of digitalizing educational organizations and provides guidance on how to develop them accordingly. METHODS: Five focus groups (N = 33) were conducted as part of a mixed-methods study. These focus groups aimed to address the question what nursing-specific characteristics influence the digitalization processes at nursing schools. RESULTS: The level of digitalization at German nursing schools varies considerably. In addition to general conditions around nursing education, such as legal frameworks, institutional strategies, financial resources, and funding guidelines, the digital transition in nursing education is influenced by subject-specific factors. These subject-specific factors were found to be highly connected to the seven dimensions outlined in DigCompOrg. As a result, the specification of DigCompOrg was successfully defined in relation to nursing education at nursing schools. We found that facilitating the digital transition requires a shared professional understanding of nursing itself; cooperation between learning environments incorporating a third learning environment; critical reflection; and the pedagogical justification of technology use regarding body-related work in nursing. The specific characteristics of the profession must be considered alongside the existing dimensions of DigCompOrg in digitalization processes. CONCLUSION: A DigCompOrg framework specifically designed for nursing education can support the digital transition of nursing schools and can help schools focus their organizational development in the context of nursing education.
"Building the boat while sailing" - adapting towards telementoring literacy.
Humblet MH, Jacobs EMR, Bagenda G … +10 more , Mujumbusi L, Lingard L, Leroy PLJM, Van Mook WNKA, van den Brink J, Serres-Créixams X, Nasinghe E, Joloba M, Bijker EM, Brouwer E
BMC Med Educ · 2026 Jun · PMID 42289687 · Full text
BACKGROUND: As telemedicine becomes a core component of modern healthcare, its effective application involves more than just the use of digital tools. An evolving skill set is required for current and future clinicians t...
BACKGROUND: As telemedicine becomes a core component of modern healthcare, its effective application involves more than just the use of digital tools. An evolving skill set is required for current and future clinicians to adapt to this environment. Telementoring is a subset of telemedicine that involves clinician-to-clinician interaction, providing remote expert guidance in clinical care and medical education, with the potential to reduce global disparities. Yet, how trainees and mentors adapt to this virtual setting for effective learning remains unclear. To generate transferable insights across contexts, research on technology-enhanced environments must use designs that are both practice-oriented and theoretically grounded. Therefore, to investigate how telementoring shapes clinicians' competency development, this study adopts a theory-informed case study of a telementoring Point-of-Care Ultrasound (POCUS) program in a resource-limited setting. METHODS: We applied a design-based research approach to bridge educational theory and practice and to enhance understanding of complex learning in authentic environments. This project took place in two healthcare centers in Uganda. Three design principles (authentic learning, deliberate practice, and scaffolding complexity) guided a two-cycle iterative design, evaluation, and re-design of telementoring sessions following initial in-person POCUS training, attended by 24 clinicians. Data sources included field notes, observations, and semi-structured interviews with seven POCUS trainees, two department heads, and two POCUS mentors collected over the twenty-one-month project duration. Data were analyzed using reflexive thematic analysis. RESULTS: Our findings capture the adaptive, iterative learning trajectories of clinician trainees and mentors engaged in telementored POCUS training in real-world contexts, characterized by participants as "building a boat while sailing." Their adaptive capacity developed through (1) cultivating an enhanced situational and socio-cultural awareness, (2) refining feedback and mentorship practices, and (3) scaffolding technological and task complexities. Our project also showed a limit to adaptability and competency development via telementoring in relation to task complexity. CONCLUSIONS: We introduce the concept of 'telementoring literacy' as the adaptive capacity of clinicians -- at both ends of the digital connection -- to effectively engage with clinical skill training and patient care through telementored interactions. Refining the components of telementoring literacy will further enable trainees and mentors to enhance telementoring implementation across different settings.
Impact of a vertically integrated, symptom-oriented teaching program for hematuria management on clinical competency transfer among urology clerkship students.
Peng S, Wei Y, Dai C … +2 more , Liang Y, Huang L
BMC Med Educ · 2026 Jun · PMID 42289683 · Full text
OBJECTIVE: To create a pathway-based, vertically integrated teaching program on hematuria management that encourages competency development, and to analyze its effect in competency transfer among urology clerkship studen...
OBJECTIVE: To create a pathway-based, vertically integrated teaching program on hematuria management that encourages competency development, and to analyze its effect in competency transfer among urology clerkship students. METHODS: Eighty clerkship students were recruited (intervention group, n = 40; control group, n = 40) in a single-center, quasi-experimental controlled study. Data on weekly tests, case presentation score, end-of-rotation comprehensive score, and a modified OSCE were collected. Between-group comparisons were performed using Welch-corrected independent-samples t tests for continuous outcomes, Fisher's exact test or χ² test for categorical baseline variables, and covariate-adjusted linear regression with HC3 robust standard errors for the OSCE total score. RESULTS: The two groups had similar age, sex, and major composition. The intervention group obtained a relatively higher formative assessment performance with a higher mean weekly test score than the control group (94.09 ± 2.58 vs. 86.50 ± 8.10, P < 0.001), and a slightly higher case score (7.39 ± 0.60 vs. 7.14 ± 0.46, P = 0.045), while the end-of-rotation comprehensive score did not meet the significance level (P = 0.771). The simulation-based OSCE showed a significantly higher OSCE total score in the intervention group (85.39 ± 4.02 vs. 80.00 ± 5.16, P < 0.001), with main differences in domains related to management and communication; the group effect remained significant after covariate adjustment (beta = 5.56, P < 0.001). CONCLUSION: The hematuria-focused, vertically integrated teaching program was associated with improved formative assessment performance and case presentation quality, and with better performance in a simulation-based modified OSCE assessing competency transfer. Future larger-scale randomized controlled studies are needed to further validate these findings.
The learning curve of a high-fidelity cataract surgical simulator.
Ren M, Dai H, Dong Z … +5 more , Ye L, Pan AP, Zhou K, Yuan Y, Xu X
BMC Med Educ · 2026 Jun · PMID 42289672 · Full text
OBJECTIVE: To identify the number of iterations required to reach a performance plateau for each module on the HelpMeSee MSICS high‑fidelity cataract surgical simulator, and to evaluate the inter-rater reliability of the...
OBJECTIVE: To identify the number of iterations required to reach a performance plateau for each module on the HelpMeSee MSICS high‑fidelity cataract surgical simulator, and to evaluate the inter-rater reliability of the assessment rubric and the consistency of the simulator's visuo-haptic feedback. METHODS: Twenty medical students (Group A) and 12 residents (Group B) were recruited. All participants performed 10 iterations on five modules of the HelpMeSee MSICS high-fidelity surgical simulator. All operation videos were recorded and scored by two observers using the simulator assessment rubric. Intraclass correlation coefficient, Friedman test, and Mann-Whitney U test were used to evaluate inter-rater reliability, intra-module learning curves, and inter-group differences, respectively. RESULTS: Learning curves were demonstrated in both groups across all five modules and total score (all P < 0.01). Residents achieved higher initial performance and reached performance plateaus earlier than students. Inter-rater reliability was excellent for all modules and total score (ICC > 0.80, all P < 0.05). CONCLUSION: Medical students and residents without independent cataract surgery experience improved and reached performance plateaus on the simulator through repeated practice, suggesting that the simulator provided consistent visuo-haptic feedback conducive to initial skill acquisition. However, these simulator-based improvements did not directly translate to improved real-life surgical performance and required separate validation through clinical outcome studies.
An integrated teaching model combining PBL and medical humanities education for pathology laboratory teaching: a randomized controlled study.
Wang S, Shen J, Qiang B … +3 more , Xu H, Huang X, Wang L
BMC Med Educ · 2026 Jun · PMID 42289671 · Full text
OBJECTIVE: To evaluate the educational effectiveness of an integrated teaching model combining problem-based learning (PBL) and medical humanities education for pathology laboratory teaching. METHODS: This randomized con...
OBJECTIVE: To evaluate the educational effectiveness of an integrated teaching model combining problem-based learning (PBL) and medical humanities education for pathology laboratory teaching. METHODS: This randomized controlled study was conducted from September 2025 to January 2026 among undergraduate anesthesiology students enrolled in a pathology laboratory course at Wannan Medical University. Four classes were randomly assigned at the class level to either the experimental group, which received the integrated PBL and medical humanities teaching model (n = 56), or the control group, which received a traditional LBL teaching model (n = 59). Following the instructional intervention, theoretical examination scores, microscopic image interpretation scores, questionnaire-based teaching effectiveness outcomes, and overall student satisfaction were compared between groups. RESULTS: Both groups showed significant improvements in theoretical examination scores after the intervention compared with baseline (both P < 0.001). After adjustment for class-level clustering using linear mixed-effects models, no significant between-group difference was observed in post-intervention theoretical examination scores (P = 0.122), while microscopic image interpretation scores showed a borderline between-group difference favoring the experimental group (P = 0.061). Compared with the control group, students in the experimental group achieved significantly higher scores in learning motivation, self-directed learning ability, and communication and expression skills (all P < 0.05). Teamwork ability showed a borderline between-group difference (P = 0.058), whereas differences in professional ethics awareness and understanding of healthcare-related social responsibility were not statistically significant. Overall teaching satisfaction was significantly higher in the experimental group than in the control group (P = 0.002). CONCLUSION: Compared with traditional LBL teaching, the integrated teaching model combining PBL and medical humanities education was associated with more favorable questionnaire-based outcomes in learning motivation, self-directed learning ability, and communication and expression skills, as well as higher student satisfaction. This integrated instructional approach may provide a useful reference for the ongoing reform and improvement of pathology laboratory education.
Comparing medical school strategies to reduce regional physician shortages: lessons from the United States and Japan.
Park S, Yang EB
BMC Med Educ · 2026 Jun · PMID 42289670 · Full text
BACKGROUND: Regional maldistribution of physicians remains a global challenge undermining equity in healthcare access. While numerous studies have examined the impact of student recruitment and training strategies on rur...
BACKGROUND: Regional maldistribution of physicians remains a global challenge undermining equity in healthcare access. While numerous studies have examined the impact of student recruitment and training strategies on rural retention within single countries, comparative analyses across nations with contrasting systems remain limited. This study aimed to compare student admission policies and educational programs of medical schools in the United States (US) and Japan to address regional disparities in physician distribution and draw implications for countries facing similar challenges. METHODS: Ten medical schools in the US and Japan were compared. Data were collected from institutional resources, national reports, and peer-reviewed literature, and analysed using Bereday's comparative framework. Implications for adopting strategies were drawn from Phillips and Ochs's educational policy borrowing model. RESULTS: The US medical schools employ decentralised, pipeline-based admission strategies that intervene prior to matriculation, while Japanese institutions rely on a nationally led regional quota system with post-graduation service obligations supported by financial incentives. Despite these differences, both countries emphasized the selection of students with regional backgrounds with similar selection criteria and tools. Educational programs in both countries were more convergent in program objectives-cultivating knowledge, skills and attitudes necessary for rural physicians-and community members were actively involved in facilitating learning. However, contextual differences in the community healthcare of each country were reflected in educational contents and US medical schools had more diverse organisational structures for operating programs. CONCLUSION: Targeted recruiting strategies of the medical schools to select prospective physicians for future regional workforce vary according to the degree of centralization of its medical education system in each country. Despite the contextual differences, educational programs to promote students' willingness in regional healthcare commonly focus on providing them with practice-based experiences. Medical schools in the countries facing a similar challenge in their regional physician workforce should consider adopting practices from the US and Japan into their local contexts and internalizing them to ensure selection and training are integrated with each other.
The development of a consensus-based curriculum for a Bespoke Online Neonatal Education for Transfers (BONNETs) course.
Pillay S, Head J, Horn A … +12 more , de Wet W, Davidge R, Dickson-Hall M, Felix G, Kali G, Khan W, Klein B, Nakwa F, Venter M, Vlok N, Wege M, Stassen W
BMC Med Educ · 2026 Jun · PMID 42289668 · Full text
BACKGROUND: High neonatal mortality in Sub-Saharan Africa (SSA) is driven by multiple systemic barriers, including insufficient neonatal transport infrastructure and limited provider training. Although specially trained...
BACKGROUND: High neonatal mortality in Sub-Saharan Africa (SSA) is driven by multiple systemic barriers, including insufficient neonatal transport infrastructure and limited provider training. Although specially trained neonatal retrieval teams are recommended for interfacility neonatal transfers, resource constraints lead to non-specialist emergency medical services (EMS) cadres performing these roles, potentially compromising the safe transport of critically ill neonates. OBJECTIVE: To develop a bespoke, online neonatal interfacility transfer curriculum, informed by expert consensus and South African research to address critical gaps in provider knowledge and confidence, thereby improving neonatal transfer outcomes. METHODS: Building on Kern's Six-Step Framework for curriculum development, an initial curriculum was derived through a comprehensive literature review, a retrospective chart analysis of neonatal cases in South Africa, and detailed interviews with experts and learners. Consequently, consensus on this curriculum was sought using a virtual, modified Nominal Group Technique (NGT) over two consensus rounds. A refined course curriculum is proposed. RESULTS: Fourteen expert participants (neonatologists, paediatricians, neonatal nurses, and Advanced Life Support (ALS) providers with ≥ 3 years of experience) allocated potential outcomes to Core, Extended, or Advanced tiers based on EMS scope of practice. A 75% consensus threshold was applied. Eleven experts completed both rounds (21% attrition). Most were ALS providers (43%), largely employed in the public sector (71%). The final curriculum consists of three sequential courses (Core, Extended, Advanced) which scaffolds learning. The Core course consists of five modules, with each curriculum item achieving > 90% agreement on foundational skills including basic assessment, recognition of critical instability, and escalation pathways. This open-access online course is tailored to resource-limited settings. CONCLUSION: A consensus-driven neonatal interfacility transfer curriculum for South Africa was successfully developed, providing a tiered, evidence-based approach to reinforce provider knowledge and confidence. By leveraging expanding internet accessibility, the Bespoke Online NeoNatal Education for Transfers (BONNETs) framework mitigates geographic disparities while integrating best practices for safe neonatal transfer. However, rigorous validation across diverse contexts and attention to broader systemic challenges, is essential to achieving sustained improvements. Future research should assess the curriculum's performance in improving knowledge and confidence, as well as long-term clinical impact on neonatal outcomes.
How crucial is research philosophy in designing an AI study in medical education?
Azer SA, Song J, Guerrero AP
BMC Med Educ · 2026 Jun · PMID 42288885 · Full text
Research papers are often rejected due to methodological problems, inappropriate tools, and poor alignment between aims, methods, and conclusions. This editorial argues that these problems often stem from neglecting rese...
Research papers are often rejected due to methodological problems, inappropriate tools, and poor alignment between aims, methods, and conclusions. This editorial argues that these problems often stem from neglecting research philosophy when pursuing an idea. Based on the literature and our peer-reviewed experience in medical education and biochemical sciences, we emphasize that clarifying ontological, epistemological, methodological, and axiological assumptions helps select the appropriate paradigm-positivism, post-positivism, interpretivism, critical theory, or pragmatism. To avoid such methodological problems, researchers should clarify their philosophical assumptions, explicitly state the selected paradigm, and ensure that this process is outlined in the methods section or the appendix. This approach increases the rationality, transparency, reproducibility, and defensibility of research, especially in fields like artificial intelligence in healthcare education.
Application and exploration of digital pathology technology in standardized residency training.
Liu W, Gan Y, Gu Q … +3 more , Qiao D, Jiang Z, Shi W
BMC Med Educ · 2026 Jun · PMID 42288879 · Full text
OBJECTIVE: To evaluate the effectiveness of digital pathology technology in the standardized residency training (SRT) in clinical pathology, compare the performance differences between digital slide-based and traditional...
OBJECTIVE: To evaluate the effectiveness of digital pathology technology in the standardized residency training (SRT) in clinical pathology, compare the performance differences between digital slide-based and traditional microscope-based assessments, examine the association between assessment modality and residents' slide-reading scores, explore residents' perceptions and acceptance of digital pathology, and explore the potential presence of the "novice tool dependence" effect among junior residents. METHODS: A retrospective analysis was performed on assessment data from 64 resident physicians at the clinical pathology training base of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between 2021 and 2024. Assessment scores from traditional glass slides (2021-2022) were compared with those from digital slides (2023-2024). Additionally, a questionnaire survey was conducted among 59 resident physicians from six SRT bases in Zhejiang Province to evaluate their usage, functional experience, and acceptance of digital slides. Open-ended responses were independently reviewed by two investigators. Similar responses were categorized into descriptive themes, and the frequency of each theme was documented. Since the open-ended responses were used to supplement and support the quantitative findings, no formal qualitative approach was applied. RESULTS: No significant difference was observed in assessment scores between the digital slide group (n = 33, 73.80 ± 11.34) and the traditional glass slide group (n = 31, 74.65 ± 13.45). Hierarchical multiple linear regression showed no statistically significant independent association between assessment modality and assessment scores after adjustment for residency year and educational background (β=-0.015, P = 0.878). In contrast, residency year (β = 0.607, P < 0.001) and educational background (β = 0.218, P = 0.030) were independently associated with assessment scores. Questionnaire responses indicated that the overall use rate of digital slides among resident physicians was 66.10%, with teaching and assessment as the most common applications (86.44%). Exploratory factor analysis showed that junior resident physicians scored significantly higher in the "diagnostic operation efficiency" dimension of digital slides (F = 4.614, P = 0.014). We tentatively describe this pattern as "novice tool dependence". The Kruskal-Wallis H test showed relatively lower acceptance of digital slides for routine reading among senior residents compared to juniors (H = 6.636, P = 0.036). Open-ended responses suggested that residents generally perceived benefits of digital pathology in overcoming time and space limitations, enhancing learning motivation, and standardizing teaching resources across multiple hospital campuses. Nonetheless, participants reported concerns regarding system stability, image resolution, and network dependence. CONCLUSION: Based on this single-center before-and-after comparison, digital slide-based assessment was not associated with a statistically significant difference in archived overall slide-reading scores. These findings provide preliminary support for the feasibility of digital slide-based assessment in SRT, but should be interpreted cautiously because of temporal confounding, limited sample size, and regional restrictions. The observed "novice tool dependence" among junior residents could serve as a preliminary reference for designing targeted SRT training curricula. Within the scope of the present sample, digital slides may serve as an auxiliary educational option for residency teaching and assessment; given limitations, including a limited sample size and regional restrictions, multi-center, cross-regional research is still needed to verify their applicability for wide-scale promotion.
Knowledge of diabetic retinopathy among fifth- and sixth-year medical students at the Faculty of Medicine, University of Khartoum, Sudan: a cross-sectional study 2022.
Izeldin S, Sami L, Ismail T … +5 more , Omar H, S Ibrahim N, Mubarak S, Bargo A, Ali EM
BMC Med Educ · 2026 Jun · PMID 42288849 · Full text
BACKGROUND: Diabetic retinopathy (DR) is a leading cause of preventable blindness worldwide. As future frontline healthcare providers, medical students must be equipped with the knowledge necessary for early detection an...
BACKGROUND: Diabetic retinopathy (DR) is a leading cause of preventable blindness worldwide. As future frontline healthcare providers, medical students must be equipped with the knowledge necessary for early detection and timely referral. This study aimed to assess the level of knowledge regarding the symptoms, risk factors, and management of DR among final- and semifinal-year medical students at the University of Khartoum, Sudan. METHODS: A descriptive cross-sectional study was conducted between February and March 2022 among 166 fifth- and sixth-year medical students. Participants were recruited via systematic random sampling. Data were collected via an adapted questionnaire, which was reviewed for face and content validity and subsequently pilot-tested. Total knowledge scores were categorized as poor (1-9), moderate (10-19), or good (20-27). The data were analyzed using SPSS version 23. Independent-samples t-tests and multivariable linear regression were performed to identify predictors of knowledge levels. RESULTS: The mean knowledge score was 18.11 ± 3.65, indicating a moderate level of overall knowledge. While the majority (79.5%) identified the duration of diabetes as a primary risk factor and emphasized glycemic control (94.6%), significant gaps remained. Only 63.3% recognized DR as a vascular disease, and only 37.3% correctly identified the recommended timing for initial comprehensive ophthalmic examinations. Furthermore, 56% were aware of laser photocoagulation as a treatment modality. Multivariable analysis revealed that reliance on medical college education (p = 0.015) and having a first-degree relative with diabetes (p = 0.031) were significant independent predictors of higher knowledge scores. CONCLUSION: Medical students demonstrated moderate knowledge of diabetic retinopathy with notable gaps in screening and treatment. Medical college education was associated with higher knowledge scores; however, causal relationships cannot be inferred. Strengthening undergraduate medical curricula may enhance their readiness to manage diabetic eye complications. Further multicenter studies are recommended to explore these knowledge gaps across Sudan.
Perceptions of students regarding influential factors in delivering didactic dental lectures.
Siluvai S, Kshetrimayum N, Bennadi D … +3 more , Av S, Nayak PP, Lazar VR
BMC Med Educ · 2026 Jun · PMID 42288783 · Full text
INTRODUCTION: A challenge faced by numerous educators, particularly those who are young and less experienced, is ensuring effective student learning during didactic dental lectures. The lecture stands as a defining featu...
INTRODUCTION: A challenge faced by numerous educators, particularly those who are young and less experienced, is ensuring effective student learning during didactic dental lectures. The lecture stands as a defining feature of university education, while also being one of its most commonly scrutinized aspects. This study aimed to investigate dental students' attitudes concerning factors that may influence the effectiveness of didactic dental lectures. MATERIALS AND METHODS: This cross-sectional study was carried out involving 280 dental students at a Dental College in Tamil Nadu. The study was carried out over 3 months. The study was conducted using a pretested questionnaire-based assessment. The students participated in the process voluntarily, and the questionnaire was designed to be anonymous, not requiring any names. The initial section gathered the participant's personal details and educational history. The second part consisted of 45 multiple-choice questions focused on the effective factors influencing the teaching of didactic dental courses in classroom settings. Each question has been calculated with three choice scales: (1) Agree, (2) Neutral (3) Disagree. RESULTS: The response rate was 100%. 83.2% (n = 233) of respondents were females and 16.7% (n = 47) were males. Table 1 gives the overall attitude of the students towards didactic lectures. The majority of the students (61.4%) had an average attitude towards effective lecturing in didactic dental lectures. There was no significant difference in attitude among the different years. CONCLUSION: In conclusion, the overall attitude of dental students towards the teaching faculty delivering didactic lectures was positive; however, it is essential to implement continuous monitoring of both faculty and student performance through regular assessments. Lecture-based learning, while inherently passive, can be enhanced through the implementation of interactive teaching modalities.
Process assessment of the attitude, ethics, and communication (AETCOM) sessions: student engagement and satisfaction among medical students in central India.
Dhaneria M, Shrivastava S, Shaiva R … +2 more , Golecha A, Pathak A
BMC Med Educ · 2026 Jun · PMID 42286671 · Full text
BACKGROUND: The Attitude, Ethics, and Communication (AETCOM) module-integral to India's competency-based medical curriculum-has been designed to foster professionalism, empathy, and ethical decision-making among students...
BACKGROUND: The Attitude, Ethics, and Communication (AETCOM) module-integral to India's competency-based medical curriculum-has been designed to foster professionalism, empathy, and ethical decision-making among students graduating from medical colleges in India. However, the process of delivering AETCOM sessions remains insufficiently assessed. Focusing on Phase-III, Part-II MBBS students at R.D. Gardi Medical College, Ujjain, the present study examines how process assessment, based on student feedback and structured observer-based assessment, can provide insights into AETCOM session delivery and student engagement. METHODS: This observational study was conducted on 126 Phase-III, Part-II MBBS students (Batch 2021) over 3.5 months. Four AETCOM competencies-patient autonomy, medical error disclosure, confidentiality, and fiduciary duty-were taught in small groups by using interactive methods, such as role-play and discussions. Data were collected using the modified System for Evaluation of Teaching Qualities (SETQ) survey and an observer-based engagement checklist. The SETQ score ranges from 19 to 95. The actual scores were converted to percentages. Statistical analysis included Cronbach's alpha for reliability, one-way analysis of variance (ANOVA) for session comparison, and Pearson's correlation to link the learning environment with student engagement. RESULTS: The participants' attendance rate ranged from 92.0% to 99.2%. The modified SETQ demonstrated excellent internal consistency (α = 0.92). Satisfaction scores across the four sessions ranged between 87.97% and 89.86%, categorized as "very good." A one-way ANOVA revealed significant differences between sessions (p = 0.038), with the confidentiality module rated significantly higher than the patient autonomy module. Engagement metrics showed high levels of eye contact (91%-96%) and on-task behavior (84%-94.4%). Pearson correlation showed a strong positive relationship between the facilitator's professional attitude and student engagement (r = 0.70, p < 0.01). Note-taking was notably lower (30%-54%), which may reflect greater emphasis on active participation than traditional note-taking. CONCLUSION: Process assessment using validated tools like the SETQ provides useful insights into AETCOM session delivery. The findings suggest that interactive methods and positive facilitator-student rapport are associated with higher student engagement. These observations suggest that AETCOM sessions may support student engagement and reflective discussion in ethics-related learning.
Exploring Challenges and Enablers of Pediatric Residency Training in a Resource-Limited Teaching Hospital in Northern Ethiopia.
Leake Y, Hagos HH, Kidanu MG … +1 more , Reta BK
BMC Med Educ · 2026 Jun · PMID 42286656 · Full text
BACKGROUND: Pediatric residency training is essential for developing a skilled pediatric workforce, particularly in low- and middle-income countries such as Ethiopia. Newly established programs in resource-limited, post-...
BACKGROUND: Pediatric residency training is essential for developing a skilled pediatric workforce, particularly in low- and middle-income countries such as Ethiopia. Newly established programs in resource-limited, post-conflict settings face multiple challenges that may compromise training quality. Understanding both barriers and facilitators from residents' perspectives is critical to identifying priority areas for program improvement. Despite the rapid expansion of pediatric residency programs in Ethiopia, empirical evidence on implementation challenges remains limited. Therefore, this study aimed to explore the barriers and facilitators affecting pediatric residency training at Aksum University College of Health Sciences and identify actionable priorities for program improvement using the Consolidated Framework for Implementation Research (CFIR). METHODS: A descriptive qualitative study was conducted in May 2025 among all first- and second-year pediatric residents at the Aksum University Comprehensive Specialized Hospital (n = 10). Semi-structured in-depth interviews were conducted, audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) constructs. Barriers and facilitators were mapped to the CFIR constructs, and a prioritization matrix was used to guide actionable recommendations. RESULTS: Participants identified barriers and facilitators across four CFIR domains: Inner Setting, Intervention Characteristics, Characteristics of individuals and teams, and process factors. High-priority barriers included the absence of a Pediatric Intensive Care Unit (PICU) and limited diagnostic services, which constrained clinical exposure and evidence-based decision-making. Moderate barriers included inadequate teaching infrastructure, subspecialty shortages, residents' welfare concerns (housing and workload), and administrative limitations. Facilitators included functional Neonatal Intensive Care unit (NICU) and emergency wards, peer and senior support, structured morning sessions, proactive learning, and the harmonized curriculum, which collectively mitigated some systemic constraints. Participants highlighted the value of collaborative peer learning and senior supervision in sustaining the quality of training. CONCLUSION: Pediatric residency training in this resource-limited, post-conflict setting faces interconnected structural, resource, and administrative challenges. Existing facilitators help offset some constraints, but targeted interventions to strengthen critical care and diagnostic capacity, expand subspecialty training, enhance educational infrastructure, and address residents' welfare could improve training effectiveness. These findings provide actionable, context-specific evidence to guide program improvements in Ethiopia and similar low-resource settings.
Developing quality improvement awareness, skills, and emerging leadership behaviors through clinical audits in postgraduate medical education.
Hut-Mossel L, De Felice E, Welker G … +3 more , Tulleken J, Ahaus K, Gans R
BMC Med Educ · 2026 Jun · PMID 42286609 · Full text
BACKGROUND: Quality improvement (QI) is a crucial competency for medical residents navigating the complexities of modern healthcare systems. This study explores the impact of experiential learning, through clinical audit...
BACKGROUND: Quality improvement (QI) is a crucial competency for medical residents navigating the complexities of modern healthcare systems. This study explores the impact of experiential learning, through clinical audits, on residents' QI awareness, QI skills and emerging QI leadership behaviors within their clinical learning environment. METHODS: A retrospective multiple embedded case study was conducted within two departments of a University Medical Centre in the Netherlands. We interviewed residents (n = 11), supervisors (n = 7), training program directors (n = 2), and a quality officer within two years after the clinical audit. Data analysis involved within and cross-department analysis to identify factors influencing the development of QI awareness, QI skills and emerging QI leadership behaviors in residents. RESULTS: Residents develop QI awareness and QI skills through increased experiential knowledge, by presenting audit data and inspiring colleagues to implement change, by being aware of shared QI responsibility, demonstrating emerging QI leadership behaviors legitimized by the clinical audit and its outcome, and by striving to complete the full clinical audit cycle, including implementation and re-evaluation. Challenges for the successful implementation of clinical audits include the following: (1) Recognizing the value of clinical audits by residents and shared responsibility at work for auditing and improving patient care, (2) Department leadership's support in ensuring commitment from all healthcare professionals to clinical audits as a QI Instrument, (3) Faculty role modeling in line with the department leadership's goal that quality improvement is an integral part of daily practice, and (4) Healthcare professionals' commitment to fostering teamwork and collaborative learning. CONCLUSIONS: This study shows that clinical audits can support residents in developing QI awareness and QI skills; however, this effectiveness was variable. Progression beyond data collection and analysis towards implementing improvements and demonstrating emerging QI leadership behaviors was limited and strongly shaped by the clinical learning environment. Effective development of these skills and behaviors therefore depends on a supportive environment in which medical staff values clinical audits, actively participates in the audit process, and embeds audits within departments' clinical governance.
From classroom to clinic: the role of the clinical learning environment in shaping medical students' psychological capital.
You Y, Zhang Z, Zhang R … +6 more , He C, Jia H, Chang W, Jiang S, Ma G, Liu P
BMC Med Educ · 2026 Jun · PMID 42286587 · Full text
BACKGROUND: The transition from classroom to clinical practice poses psychological challenges for medical students. This study examines how the clinical learning environment (CLE) shapes psychological capital (PsyCap) am...
BACKGROUND: The transition from classroom to clinical practice poses psychological challenges for medical students. This study examines how the clinical learning environment (CLE) shapes psychological capital (PsyCap) among Chinese medical interns. METHODS: A total of 2,589 medical students from 18 universities completed the Dundee Ready Education Environment Measure (DREEM) and Psychological Capital Scale (PCS). Confirmatory factor analysis validated both instruments. Structural equation modeling assessed CLE-PsyCap relationships, controlling for gender and university type. RESULTS: Both instruments showed excellent psychometric properties (DREEM: α = 0.91, CFI = 0.92; PCS: α = 0.93, CFI = 0.96). Students' Social Self-Perceptions was the strongest positive predictor of PsyCap (β = 0.33-0.46, all p < 0.0001), whereas Students' Perceptions of Teachers consistently showed negative effects (β = -0.10 to -0.32, all p < 0.001). Students' Academic Self-Perceptions positively predicted resilience (β = 0.19, p = 0.0007) but not hope or optimism. Key university students reported higher CLE and PsyCap scores than provincial peers (both p < 0.0001). Females perceived more favorable CLE than males (p < 0.0001), with no overall PsyCap difference. CONCLUSIONS: The CLE significantly influences medical students' PsyCap. The adverse impact of teacher perceptions may reflect hierarchical training culture in Chinese medical education. Enhancing social support and learning atmosphere, particularly in under-resourced institutions, is critical for fostering psychological well-being and professional readiness.
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