Medical Teacher最新文献

As medical education continues to be influenced by complexity, unpredictability, and change, traditional models of thinking often don't help educators and learners in confronting the real issues and challenges. Quantum thinking can serve as a meaningful way to respond to the ever-changing demands of medical education. Quantum thinking does not work on a theoretical model rather as a disposition of thinking and action, which is supported through curiosity, flexibility, and reflective practice. Quantum thinking provides ways to cope with uncertainty without causing inaction, to rethink assumptions prevailing for a long time, and act intentionally in a system that is all too often in routine. In doing so, quantum thinking supports a more responsive, humane, and dynamic vision of medical education.

Introduction: Professional identity shapes the effectiveness, motivation, and well-being of allied health clinical educators (CEs). Burnout, characterised by emotional exhaustion, depersonalisation, and reduced personal accomplishment, can undermine these outcomes, diminishing both teaching quality and educator retention. While burnout in healthcare professionals is well documented, limited research has explored its relationship with educator identity among allied health professionals (AHPs), particularly in Asian contexts. This study examines the interrelationship between burnout, job satisfaction, and educator identity among AHP CEs, and identifies contextual factors that influence these experiences.

Methods: An exploratory qualitative study was conducted across multiple healthcare institutions in Singapore using a constructivist paradigm. Sixteen AHP CEs representing diverse disciplines participated in semi structured focus group discussions guided by Maslach and Jackson's burnout framework. Data were analysed thematically through iterative coding and team based discussion to identify recurrent patterns and relational dynamics between burnout and educator identity.

Results: Participants described burnout as a multifaceted experience influenced by workload pressures, limited institutional recognition, and insufficient protected time for educational work. Contributing factors included inadequate career pathways and constrained access to faculty development. A strong sense of educator identity and job satisfaction emerged as protective buffers, whereas weak identification with the educator role appeared to heighten burnout risk. Supportive communities of practice and organisational cultures that value teaching were key in sustaining motivation and professional fulfilment.

Discussion: These findings underscore the need for systemic and institutional strategies to strengthen the educator identity of AHP CEs. Enhancing professional recognition, fostering collegial support, and promoting meaningful engagement in education may mitigate burnout and sustain a resilient allied health education workforce.

Purpose: Psychological safety (PS) is necessary for effective simulation-based education (SBE) and students' learning. However, few research examines how undergraduate students conceptualize and actively shape it. This study explored student and teacher perspectives on PS using a co-creation approach designed to minimize hierarchy and enable equitable dialogue.

Methods: Guided by critical realism, this qualitative study employed a four-phase co-creation process: preparation, sensitization using autonomous reflection, structured workshop pairing students and teachers with no prior academic ties, and content analysis with collaborative synthesis. Six guiding questions on PS structured the inquiry. Participants were.

Results: Analysis of 308 meaning units, that reflect input from six participants (three faculty, three students), yielded five interrelated categories influencing PS in undergraduate SBE: (1) Student Capacities (e.g. emotional regulation, self-confidence, adaptability); (2) Teacher Influence (e.g. credibility, communication tone, feedback style); (3) Peer and Social Dynamics (e.g. trust, respectful collaboration); (4) Structural and Physical Environment (e.g. pre-briefing, scenario clarity); and (5) Institutional and Cultural Framework (e.g. confidentiality, safety norms). A timeline-based model illustrated distinct contributions of students and teachers to PS before, during, and after simulation.

Conclusion: Co-creation revealed that PS is not only a facilitator-driven condition but a shared, culturally situated process shaped by students, teachers, and institutional rituals. Engaging students as co-creators offers practical, context-sensitive strategies to strengthen inclusion, relational trust, and resilience in SBE.

What was the educational challenge?: Interdisciplinary medical teams often collaborate for the first time at mass-gathering events. Simulation helps participants navigate interpersonal dynamics. A gamified simulation could offer an engaging, low-stakes method to introduce emotionally charged topics like team conflict.

What was the solution?: Hidden Identity Simulation (HID SIM) is a gamified simulation where participants with randomly assigned secret character roles (e.g. 'The Know-It-All') navigate diverse personalities while managing a case. A debrief highlights team dynamic management strategies.

How was the solution implemented?: A serotonin toxicity case was piloted using HID SIM in a simulation theatre. Twenty-nine participants randomly selected character cards that outline personality descriptions and conditions that modify character intensity.

What lessons were learned that are relevant to a wider global audience?: Participants responded positively, rating HID SIM 4.75/5 overall and 4.43/5 for engagement (n = 28). 'Less stressful than anticipated' scored 3.54/5 (n = 28), and 'less stressful than other simulations' was rated 3.68/5 (n = 19). Participants rated their pre-/post-simulation self-efficacy in several teamwork and medical competencies. All competencies showed statistically significant increases (p < 0.001) post-simulation.

What are the next steps?: Future steps include writing new character cards, expanding HID SIM to other clinical settings, and designing customized decks targeting specific team dynamics.

Introduction: The transition from medical student to doctor is widely recognized as a challenging period, yet most studies capture this transition at single time points and provide limited guidance on how educational environments can better support learners. Longitudinal insights are needed to understand how challenges emerge, how learners adapt, and where educational interventions may be most effective. This study aims to explore how medical students experience and adapt to increasing clinical responsibility across the transition from clerkship to the first postgraduate year (PGY1), interpreted through Gruppen's Learning Environment Framework.

Methods: This longitudinal study was conducted between August 2017 and July 2020 using audio diaries collected from medical students as they progressed from clerkship through their first postgraduate year (PGY1). Participants recorded regular audio diaries reflecting on experiences that made them feel unprepared for clinical practice. Data were analyzed inductively to identify recurring challenges and coping strategies. Gruppen's learning environment framework was subsequently used as an analytic scaffold to organize findings across personal, social, and organizational domains and to inform intervention-oriented interpretation.

Results: During clerkship, learners reported substantial challenges related to applying theoretical knowledge to patient care, limited participation within clinical teams, and uncertainty about professional roles and responsibilities. As learners transitioned into PGY1, they described adaptive processes including proactive engagement in clinical tasks, relationship-building with supervisors and team members, and increased self-reflection. Longitudinal analysis demonstrated both continuity and change across the transition: while some challenges persisted, learners' responses evolved as they assumed greater responsibility and autonomy.

Discussion: This study illustrates how challenges during the transition to practice are shaped by learning environment factors and how learners adapt over time. Using a learning environment framework as an analytic and intervention-guiding tool, the findings offer practical insights for designing educational strategies to better support learners as they move from student to doctor.

Background: Effective communication is essential in clinical training, yet opportunities for realistic and interactionally authentic practice remain limited. Standardized patients (SPs) provide realism but are resource-intensive, whereas virtual patients (VPs) offer scalability but have limited capacity to reproduce responsive, interactionally authentic dialogue. Recent advances in generative artificial intelligence (AI), particularly real-time voice models, have opened new possibilities for natural and synchronous dialogue in virtual simulations.

Aim: To evaluate whether a real-time voice-based virtual patient (RT-VP) can achieve communication performance, perceived realism, and self-efficacy outcomes comparable to SP training, thereby addressing the global challenge of scalable, authentic communication training.

Methods: The RT-VP was developed on the Doubao real-time voice generative AI platform, which supports synchronous, bidirectional spoken interaction. In a randomized controlled study, 134 residents were assigned to RT-VP, standardized-patient (SP), or peer role-play (PR) groups. All groups received identical SPIKES-based instruction and practiced in their assigned simulation modality. Outcomes included communication performance, self-efficacy, and perceived realism.

Results: Post-training SPIKES scores were highest for SP (26.6 ± 3.0), followed by RT-VP (24.9 ± 2.9) and PR (20.4 ± 4.3) (p < .001). Both SP and RT-VP outperformed PR (p < .001), and the difference between SP and RT-VP did not reach statistical significance (p = .06). Perceived realism generally followed an SP > RT-VP > PR pattern, with RT-VP demonstrating comparable linguistic realism to SP, while SP remained superior in contextual, emotional, and engagement realism.

Conclusions: This study represents, to our knowledge, the first controlled comparison of real-time voice generative AI-based VPs and SP encounters in communication training. RT-VP simulation approximated SP-level communication performance and perceived authenticity while offering scalability and consistency. Real-time voice simulation offers a scalable means to expand access to emotionally authentic communication training worldwide.

What is the educational challenge? Efforts to improve skin-of-color (SoC) education in dermatology have increased, yet standardized methods to evaluate how this content is taught in routine didactic and clinical settings remain limited.

What is the proposed solution?We propose the SoC-TEQ Framework (Skin of Color - Teaching Exposure & Quality), a resident-led, low-cost, and reproducible model to support the evaluation and improvement of SoC education in dermatology residency training. The framework draws on the Kirkpatrick model and principles of situated learning. It assesses three domains: Teaching Exposure, which reflects how often SoC content is addressed; the Representational Metric, which captures instructional quality; and Resident Engagement, which reflects learner participation. Individual teaching encounters serve as the unit of analysis, allowing consistent evaluation of SoC incorporation across teaching activities.

What are the potential benefits to a wider global audience?A defining feature of SoC-TEQ is its active feedback loop, in which residents identify educational gaps and participate in peer-led remediation. Designed to be scalable across programs with varying resources, the framework enables longitudinal evaluation of SoC instruction and supports data-informed curricular refinement.

What are the next steps?Initial next steps include single-program pilots, evaluation of inter-rater reliability, and refinement of exposure benchmarks.

Introduction: Simulated patients (SPs) are widely used in Objective Structured Clinical Examinations (OSCEs) and increasingly contribute to summative scoring in high-stakes clinical assessments. While their judgments inform pass-fail decisions, concerns remain about variability and potential bias. There is limited theory-driven evidence explaining how SP involvement contributes to assessment decisions, and under what conditions this supports fair and credible assessment. This study aimed to develop and refine a programme theory explaining how SP involvement contributes to decision-making in high-stakes OSCEs.

Methods: We conducted a realist evaluation informed by an initial programme theory developed through a rapid realist review. Semi-structured interviews were undertaken with 19 SPs in a sequential OSCE at a UK medical school. Interviews explored how SPs approached scoring decisions and how features of the assessment environment shaped their judgments. Data were analysed iteratively using abductive and retroductive reasoning to identify context-mechanism-outcome configurations (CMOCs) and refine the programme theory.

Results: Eighteen interrelated CMOCs were constructed across nine domains describing how SP judgments were shaped through interactions between assessment-related factors (including assessment tools, assessment focus, logistical environment, and the sequential format) and SP-related factors (including background and experience, training and benchmarking, role positioning, fatigue, and interaction with examiner). When SPs felt prepared, role clarity was established, and assessment tools and conditions were supportive, they reported making judgments experienced as fair and authentic. In contrast, high cognitive load, role ambiguity, fatigue and insufficient preparation activated mechanisms that increased perceived variability and potential for bias.

Discussion: SP judgments in high-stakes OSCEs are complex and context-dependent. This programme theory provides an explanatory account of how SP judgments are produced and identifies conditions that support or undermine assessment. The findings offer practical implications for assessment design, SP training and faculty-SP collaboration to strengthen the use of SPs as assessors in high-stakes clinical examinations.

Introduction: Diagnostic errors remain a critical patient safety concern, yet teaching diagnostic reasoning is challenging due to its complex, context-specific nature. Traditional teaching methods emphasize analytical reasoning but often neglect non-analytical, pattern recognition processes that are grounded in script theory. Script theory highlights illness scripts-structured mental representations of diseases-as foundational to diagnostic expertise. Advances in artificial intelligence (AI) offer opportunities to support illness script formulation through personalized, scalable feedback. This study evaluated whether chatbot-enabled instruction and feedback improve medical students' illness script quality compared with conventional instruction techniques.

Methods: We conducted a parallel-group randomized controlled trial with 83 medical students at Prince of Songkla University, Hat Yai, Thailand. Participants were randomized to conventional instruction or chatbot-enabled instruction using Microsoft Copilot. Both groups received didactic instruction, followed by illness script formulation tasks at three timepoints: pre-test (T1), immediate post-test (T2), and post-intervention with new cases (T3). Illness scripts were assessed using the validated Illness Script Assessment Tool (ISAT), which evaluates structure, content, richness, and maturity. Data was analyzed using cumulative link mixed-effects models.

Results: Baseline illness script quality was comparable between groups. Chatbot-enabled instruction produced significantly greater improvements in script structure (OR 3.7), content (OR 3.3), and maturity (OR 2.9) at immediate post, with gains sustained at transfer testing for structure. Richness scores showed delayed improvement (OR 2.9). Composite ISAT scores confirmed durable improvements (OR 3.2 at T2; OR 2.7 at T3).

Discussion: Chatbot-enabled instruction accelerated and enhanced illness script development compared with conventional methods, operationalizing deliberate practice principles and making non-analytical reasoning teachable. By integrating structured pedagogy with scalable AI feedback, this approach reduces educator burden while fostering diagnostic expertise. Future multi-site studies should examine long-term retention, clinical transfer, and AI feedback fidelity to ensure reliability and equity.

Introduction: Self-assessment (SA), a crucial psychological process in education, involves learners judging whether they meet their own identified standards. SA is a multi-dimensional construct shaped by various factors, including individual, contextual, and cultural influences. This cross-sectional study aims to explore how medical students develop and enact SA across training stages within an East Asian educational context, with particular attention to multilevel influences.

Methods: Conducted at a Hong Kong medical school, this study involved one-on-one semi-structured interviews with medical students at different stages of training. Interview focused on students' SA practices and the factors influencing their development across different stages of training. Data were analyzed using thematic analysis, informed by the social ecological model, through iterative coding and interpretation.

Results: Interviews with 26 medical students across preclinical and clinical training stages revealed four interrelated levels influencing SA practices: individual level-perceived value, emotional, motivational factors, professional identity, and subconscious reflection; interpersonal level-teacher feedback, peer interaction, and patient feedback; institutional level-curriculum structure, frequency and format of assessments, a supportive environment, and alignment of teaching and learning objectives; and societal level-collectivist cultural norms, humility, and local academic expectations. Additionally, students recognized SA as both a cognitive and emotional regulatory process, shaped by culturally mediated norms around self-evaluation, feedback interpretation, and performance comparison.

Discussion: This study demonstrates that medical students' SA practices are shaped by interacting influences across individual, interpersonal, institutional, and societal levels, with cultural norms playing a structuring role rather than a peripheral one. By highlighting how commonly described SA processes operate differently in an East Asian context, these findings extend existing SA and SRL literature and underscore the importance of culturally responsive educational and assessment practices to support students' development of SA and lifelong learning.