Medical Teacher最新文献

Background: Current research on generative AI in medical education focuses on AI's performance or risks, such as unreliability. We argue these issues are not isolated flaws but are symptoms of systemic contradictions that emerge when a technology is introduced into a learning environment. To move beyond descriptive reports, a theoretical framework is necessary to analyze the systemic tensions that arise during generative AI integration.

Methods: A total of 141 first-year clerkship medical students used ChatGPT and provided qualitative data, including conversations with ChatGPT, evaluations of the generative AI's responses, and free-text feedback after watching concept videos of 'Acute Liver Failure'. We employed inductive thematic analysis to identify initial patterns, followed by a deductive analysis using Cultural-Historical Activity Theory to identify and interpret systemic contradictions.

Results: The analysis revealed four contradictions within the activity system: 1) a conflict between the Tool's (ChatGPT's) unreliability and the Object of achieving accurate knowledge; 2) a skills gap between the Subject's (students') initial questioning abilities and the Tool's operational demand; 3) an unstable Division of Labor (student-AI) that conflicted with professional Rules, creating a demand for the need for expert validation; and 4) ambiguous Rules that created confusion and conflicted with professional norms.

Conclusions: Challenges like AI unreliability and skill gaps are contradictions that function as catalysts for expansive learning. Resolving these tensions requires systemic transformation, including formalizing prompt engineering training and redefining the educator's role from an information provider to an essential expert validator within a new collaborative practice.

Purpose: This study aims to compare several free large language models (LLMs), identify which provides the most effective feedback, and investigate whether LLM-generated feedback can improve the accuracy and standardization of imaging reports produced by students.

Methods: A randomly selected class (test group, N= 30) was asked to write an imaging report based on each typical teaching case before and after receiving feedback generated by LLM. Another randomly selected class (control group, N= 30) was asked to write an imaging report of the same case without receiving the LLM-generated feedback. The quality of the feedback generated by the 4 main free LLMs was evaluated. The residency training examination marking scale was used to evaluate the quality of the reports. A questionnaire was used to investigate whether the students were satisfied with the feedback given by LLM.

Results: The feedback generated by ChatGPT 3.5, ERNIE Bot v3.5, and Tongyi v2.5 all demonstrated better structure and logic than that of Claude 3 OPUS (Mann-Whitney U Test, p < 0.05), but all exhibited some degree of hallucination. The scores of the reports in the test group were increased after receiving the feedback, and were higher than the control group (t-test, p < 0.05).

Conclusion: The feedback given by LLMs can help the students critically evaluate their reports and improve their reporting skills, but should be supervised by teachers.

Introduction: Increasing the diversity of medical students is a challenge and priority in many countries. In France, systems-level changes have been introduced to attract candidates from diverse backgrounds, specifically the traditional pathway to medical studies, the PASS (Parcours Accès Spécifique Santé/Specific Access to Health Training, biomedical sciences-focused) has been supplemented with a second pathway, the LAS (Licence Accès Santé/Bachelor's Degree with Access to Health Studies) combining a broader major with a health-access module. This study is the first to assess the effectiveness of the LAS in increasing the social, geographic, and sex diversity of candidates admitted to Medical or Dental Schools in France.

Methods: This prospective cohort included candidates to health studies. Socioeconomic origin was determined according to parents' profession. Primary outcome was admission to Medical or Dental School. Mediation analysis assessed the role of prior academic performance (assessed by the French Baccalaureate grade) between socioeconomic origin and admission.

Results: Among 2,059 candidates (women: 70%), 230/1,534 PASS (15% of admission, women: 55%, upper socioeconomic origin: 68%) and 43/525 LAS (8% of admission, women: 74%, upper socioeconomic origin: 49%) were admitted to Medical or Dental School. In multivariable logistic regression, sex (OR = 0.37 for women, 95%CI [0.26-0.53], p<.001), upper socioeconomic origin (OR = 1.78, 95%CI [1.20-2.64], p<.01), and prior academic performance predicted admission in PASS (OR = 5.57, 95%CI [2.90-10.7], p<.001). In LAS, only prior academic performance was independently associated with admission (OR = 8.93, 95%CI [3.99-20.0], p<.001). Prior academic performance partially mediated the effect of socioeconomic origin on admission in PASS, and fully mediated the effect in LAS.

Discussion: Introducing the LAS pathway measurably improved diversity among admitted students and reduced socioeconomic and sex-related disparities. In contrast, the historical PASS system continues to reinforce these inequities. By widening the academic lens used for selection, LAS shows that reforms can meaningfully counteract social reproduction while maintaining academic rigor.

What is the educational challenge?: Healthcare emergencies are common and heterogenous, but conceptually poorly defined in health professions education. This gap was highlighted while developing educational materials for medical students and newly qualified doctors learning to manage healthcare emergencies. We found no existing comprehensive framework to describe the nature of emergencies for educational and other purposes.

What are the proposed solutions?: We propose the Predictability-Urgency-Scale-Harm (PUSH) model, a multidimensional taxonomy that characterises healthcare emergencies by predictability (fully to unpredictable), urgency (pressing to immediate), scale (individual to population) and harm (none to severe). This adapts the WHO definition of emergencies to clinical practice and goes beyond existing one-dimensional acuity or triage scales.

What are the potential benefits to a wider global audience?: The PUSH model can be used by educators and clinicians to design and debrief simulation scenarios, map learners' real-life emergency exposure, and support shared mental models of emergencies in healthcare teams. It can enhance research design and comparability of studies. Other benefits include being low-cost, requiring no technology and applicability in both high- and low-resource settings.

What are the next steps?: Future work will refine the PUSH model through expert consensus and evaluate reliability, usability and educational impact when applied to clinical incidents and simulation-based education.

Introduction: Medical schools are often characterized by rigid hierarchical structures that may suppress student voices. Student governments provide an avenue for students to represent their peers, influence institutional policies, and foster personal and professional development. This study aims to reveal how participation in self-governance shapes students' attitudes, skills, and orientations toward change within their educational environments.

Methods: This qualitative study recruited current executive members and recent graduates who had served in the Japan Association for Medical Student Societies (Igakuren), the only nationally elected medical student body in Japan. Participants were identified through email invitations, personal networks, and official meetings. The first author conducted in-depth online interviews, which were audio-recorded, transcribed verbatim, and analyzed via a thematic analysis using a framework approach.

Results: A total of 21 medical students and doctors participated in the study. A thematic analysis identified four main themes: learning through everyday negotiations; advocacy and empowerment; cooperation and interaction; and contribution to professional development.

Discussion: Student self-governance cultivates medical students' self-efficacy, leadership, and professional development. Participants acquired key competencies by recognizing systemic issues, collaborating with diverse stakeholders, and leading initiatives for change-demonstrating the principles of Freire's problem-posing education. For health professions education to be genuinely student-centered, faculty and institutional leaders must support and engage in equitable, respectful dialogue with students.

Background: Following the COVID-19 pandemic, there has been renewed global attention on One Health (OH) as a framework to address the numerous global health challenges. Despite its growing recognition, the integration of OH into medical education has been limited. Many institutions are still unclear on the best approach to introduce and deliver OH within their academic programs.

Aim: To map the pedagogical strategies, implementation experiences, and challenges in integrating OH into medical curricula.

Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed and Scopus databases were searched for peer-reviewed studies published between January 2015 and December 2024. Data were charted using a standardized extraction form and synthesized descriptively through thematic content analysis.

Results: A total of 14 articles were found from institutions across North America, Africa, and Europe, representing initiatives ranging from integrated modules and stand-alone courses to extracurricular activities. Many utilized interactive, interdisciplinary pedagogies such as problem-based learning, simulations, capstone projects, and community outreach programs. The expected competencies ranged from interdisciplinary collaboration to recognizing human-animal-environment interconnectedness to applying OH principles in identifying and managing health conditions. Content areas extended beyond zoonotic diseases and environmental health to include broader aspects of health systems and health policy development. All the initiatives emphasized on fostering collaborative competencies and broadening students' perspectives on health. However, implementation was challenged by institutional constraints such as curriculum overload, limited faculty expertise, and logistical barriers to interdisciplinary teaching. Many institutions encountered epistemological resistance and reluctance to move beyond reductionist, human-centric paradigms, which was a likely factor in students finding it difficult to relate OH concepts to their medical practice.

Conclusion: The review highlights the importance of faculty capacity building, early introduction of systems thinking, and alignment of clinical training with OH principles to ensure a more sustainable integration of OH in medical education.

Purpose: The quality of online medical videos is often unknown despite their common use in health professional education. A number of studies have shown that online videos, especially on YouTube, are of variable quality. The aim of this mixed methods study is to describe the conceptual design, item development and content validity of a rubric constructed to assess the quality of online procedural videos.

Method: We used a multi-stage mixed methods design with a pragmatist and inductive approach over the years 2023-2024. The study had three phases: 1) rubric development phase, 2) content validity of items and scale assessment, and 3) rubric revision. Health professional educators (academic staff) and learners (postgraduate students) were recruited, and the rubric items were developed using a modified Delphi process in two rounds: an anonymized survey and two facilitated online focus groups. In the second phase, some of the focus group participants rated rubric items for clarity and content. Content validity indices (CVI) were calculated. Finally, rubric items with I-CVI (item-level CVI) <0.78 were modified based on feedback.

Results: The responses from 32 participants (17 educators, 15 learners) were analyzed, and nine questions met consensus in the rubric item development stage. Through the Delphi process, a preliminary 18-item rubric was created. 94% of items had an I-CVI of ≥ 0.78 for clarity. One item received an I-CVI of 0.75. The S-CVI/average of the questionnaire achieved an acceptable level of 0.93 for content clarity. 100% of items had an I-CVI of ≥ 0.78. The S-CVI/questionnaire average (scale-level CVI/average) was an acceptable level of 0.91 for relevance.

Conclusions: We have developed a rubric to assess the quality of online videos used to teach procedural skills. It has good content validity. Further analysis is needed to determine its psychometric properties, feasibility, and user experience.

What was the educational challenge?: Public and professional understanding of female genital anatomy is limited, affecting informed consent, clinical communication, and medico-legal interpretation in cases of sexual violence and female genital mutilation (FGM). Two-dimensional diagrams fail to convey the three-dimensional structure of the vulva, making explanations difficult for patients, students, and legal professionals.

What was the solution?: We developed modular, dismantlable 3D-printed vulva and hymen models in prepubertal and adult versions. They feature detachable anatomical components, hymenal variants, and FGM configurations, using bright, non-anatomical colors to ensure clarity and inclusivity.

How was the solution implemented?: The models were used in clinical consultations to support informed consent and explain medico-legal findings; in medical and legal education to illustrate anatomical variability and debunk myths; and in courtrooms to help judges and juries understand forensic evidence.

What lessons were learned that are relevant for a wider global audience?: Anatomical literacy is crucial for patient autonomy and justice. 3D models enable clear, inclusive, and interactive education, countering persistent misconceptions about female anatomy.

What are the next steps?: Formal evaluation is planned to assess knowledge impact. Wider dissemination across clinical, legal, and public health contexts is underway.

What was the educational challenge?: Planetary Health addresses the interconnections between environmental changes, social systems and human health. Despite its growing recognition, integration into medical education remains limited due to overloaded curricula and educators' unfamiliarity with the subject.

What was the solution?: The ePlanet project developed modular, open-access educational tools, incorporating serious gaming and challenge-based learning (CBL). Teaching guides support educators in implementing the materials.

How was the solution implemented?: The ePlanet online serious game - freely available in English and Spanish at https://eplanet.care/game/ engages students in real-life scenarios on sustainable healthcare, nutrition, air pollution and heat, and infectious diseases. Complementary CBL modules develop competencies in systems thinking, advocacy, sustainability, and health equity.

What lessons were learned that are relevant to a wider global audience?: The ePlanet materials provide a lightweight approach for integrating Planetary Health into medical education without curricular restructuring. The game's availability in multiple languages and its open access format make it globally accessible. Pilot testing showed that serious gaming can effectively introduce Planetary Health in medical contexts.

What are the next steps?: Future steps include presenting ePlanet at international conferences, integrating the materials into digital learning environments, and using them for faculty development.

What was the educational challenge?: Electronic dance music festivals rely on ad hoc, interdisciplinary medical teams to manage emergencies. Since members often meet onsite for the first time, quickly building rapport and practicing teamwork/communication skills before the event is essential.

What was the solution?: TEAMergizers-energizers to build group rapport and practice teamwork/communication skills-were introduced. TEAMergizers include debriefs to reflect on collaborative competencies.

How was the solution implemented?: Twenty-one TEAMergizers were piloted with event medical teams. Participants rated games on engagement and teamwork/communication skill elicitation. Results informed a TEAMergizer Manual with instructions, ratings, debrief guides, and mapping to teamwork/communication domains.

What lessons were learned that are relevant to a wider global audience?: All TEAMergizers were highly rated (n = 314): overall average 8.15/10, average ability to elicit teamwork/communication skills 7.27/10. Games with movement, large groups, a competitive win condition, higher noise levels, and less idea generation scored best. Games with a collaborative win condition, team-versus-team competition, and autonomy of participation extent were perceived best for eliciting teamwork/communication skills.

What are the next steps?: Next steps include sharing the TEAMergizer Manual with educators. Insights on game features that boost satisfaction and skill elicitation will help educators design teamwork-focused games.