Medical Teacher最新文献

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.

Introduction: The first medical students in the UK sat the General Medical Council's National Licensing Examination, known as the Applied Knowledge Test (AKT) in 2024. Some medical schools introduced Progress Tests (PTs) to prepare students for the AKT. This study aims to understand the expectations and experiences of the first medical students to take the AKT, prepared using PTs.

Methods: The setting was a predefined UK medical school who first administered the AKT in 2024. Using Psychological Contract as a conceptual framework, we interviewed eight Final Year students after completing their AKT. Transcribed data was coded into the analytical framework and agreed by the research team.

Results: The expectations (promises) set by the medical school on PTs as preparation for the AKT did not initially align with the experience of students who used agency to self-teach content attempting to improve performance. However, on successfully passing their AKT, students reached a reciprocity point of agreement with the medical school's prior set expectations.

Conclusion: Whilst happy to pass the AKT, students described unresolved breaches that their learning for AKTs may not prepare them for their upcoming work as doctors. Early undertaking of the AKT allowed more time to prepare for clinical practice.

Purpose: Psychological safety is a cornerstone of effective clinical learning. While extensively studied in Western contexts, little is known about its barriers and facilitators, as well as its relationship to feedback-seeking and competence development in high power-distance, non-Western residency programs. This study explored barriers and facilitators of psychological safety and examined its associations with residents' feedback-seeking behaviors and self-perceived clinical competence.

Materials and methods: We conducted a cross-sectional study in a large Lebanese academic medical center. An online survey assessed psychological safety, feedback-seeking behaviors, and self-perceived clinical competence. Open-ended questions explored barriers and facilitators in the clinical environment. Descriptive statistics, correlation, and mediation analyses were performed, along with inductive qualitative 'conventional content analysis' of narrative responses.

Results: Of 340 residents, 235 (69.1%) consented to participate, 204 (86.8%) completed the survey, and 160 (68.1%) provided narrative responses. Psychological safety was positively associated with direct feedback-seeking (rho = 0.194, p=.005) and perceived competence (rho = 0.184, p=.008). Adjusted mediation analysis suggested that direct inquiry may partially account for the association between psychological safety and competence (b = 0.2886, BootSE = 0.1479, 95% CI [0.0478, 0.6188]), whereas reflective appraisal and indirect inquiry were not significant mediators. Five themes shaped residents' sense of psychological safety [1]: hierarchy and psychological distance [2], social belonging and interpersonal safety [3], workload, burnout, and learning identity [4], leadership responsiveness and institutional climate, and [5] feedback and day-to-day communication.

Discussion: Residents' experiences of psychological safety were linked to more proactive feedback-seeking, which was in turn associated with higher self-perceived competence. However, more passive feedback strategies appeared less sensitive to psychological safety, likely reflecting cultural norms and hierarchical barriers. These safety perceptions were shaped by interpersonal relationships, leadership accessibility, workload pressures, and broader institutional culture, with hierarchy emerging as a dominant concern. Multi-level interventions, including leadership training, faculty development, and structural reforms, are needed to foster psychologically safe learning environments that promote resident growth, team functioning, and patient safety.

Context: Increasing numbers of healthcare students are trained within interprofessional hospital placements, where they learn to be part of the landscape of healthcare practice. Explicitly facilitating (inter)professional identity development has been recommended as a goal of these placements. We aimed to explore students' experiences during their placement, and its relation to their learning and identity development.

Methods: In this multicenter qualitative study, nine medical students, six midwifery students, and six nursing students drew rich pictures of one satisfying and one challenging experience during their interprofessional placement, capturing complex, nonverbal elements of these experiences. We used semi-structured interviews to deepen understanding of students' experiences and their developing identities, adopting an inductive constructivist thematic analysis.

Results: During their interprofessional encounters, a range of emotions supported or challenged students' learning and identity development. These emotions played a pivotal role throughout the three themes we identified: (1) Understanding and appreciating differences; (2) Navigating identity tensions; and (3) Gaining confidence in patient-centered learning and collaboration.

Conclusions: During interprofessional placements, most students engage in learning about each other's responsibilities and values, enhancing knowledgeability. Tutors should be aware of students' emotions during interprofessional encounters, and stimulate reflection on them, as emotions can foster or hamper students' knowledgeability and identity development.

Background: Even though a lot has been written on 'failure to fail' behaviors of educators in developed and resource-rich countries, there have been no studies from developing and resource-constrained countries, which are among the major contributors of international medical graduates to the healthcare systems worldwide. Understanding such behaviors of examiners has significant implications for professionalism, patient safety, and healthcare worldwide. Using game theory, the current study explores the determinants of 'failure to fail' underperforming medical students from examiners of six medical schools in Pakistan.

Methods: A qualitative multi-institutional case study was carried out in Pakistan. Using a purposive maximum variation sampling technique, 15 examiners of basic and clinical sciences from six medical schools providing undergraduate medical education were selected and interviewed. The data were transcribed verbatim and analyzed using a Framework analysis approach.

Results: The examiners were against passing any student who did not deserve to pass, but they reported failure to do so. Using Game Theory, we identified four key elements that may influence examiners' decision-making in assessment: players and their strategies, perceived personal payoffs, perceived social payoffs, and game rules (policies, norms, and practices). The examiners comply under pressure from various players, including the students, friends, family, higher administration, and political figures. Their behaviors were also influenced by rules set by examiners, the assessment system, the competitive market, and socio-culture environment.

Conclusions: The personal, social, and systemic constraints and consequences lead to poor assessment of medical students' knowledge and competence, which has significant implications for patient safety and healthcare worldwide. Some of these constraints may be unique to the developing countries' context; however, many others are prevalent even in the developed countries. Whether through examiner peer mentorship, restructured institutional incentives, or clear assessment policies, breaking the equilibrium of 'failure to fail' lies in a society of integrity and accountability.