Journal of Medical Education and Curricular Development最新文献

Background: Cutaneous Lyme disease presents differently in light versus dark skin, and delayed diagnosis can increase outcome severity. Insufficient exposure to manifestations of Lyme disease in dark skin during medical training may contribute to health inequities due to late or missed diagnoses. It remains unclear how Lyme disease, specifically, is represented in commonly used medical training materials. To inform curricula updates, we identified primary educational resources used for teaching dermatology at top-tier U.S. medical schools and assessed the representation of erythema migrans on light and dark skin in these materials.

Methods: In this cross-sectional content analysis, commonly used training resources for 50 top U.S. medical schools were identified by reviewing websites and syllabi and contacting schools when information was unavailable. Resource images were categorized as "light-skinned" or "dark-skinned" using the Fitzpatrick scale (I-III vs IV-VI). Proportions and counts of light-skinned and dark-skinned images were compared to U.S. demographics, resource format (print-/web-based), and age of publication (pre-/post-2020).

Results: Sixteen resources, containing 47 erythema migrans images, were identified. Two of 16 (12.5%) resources included dark-skinned images; both were web-based resources. None of the print resources or those published before 2020 included dark-skinned images. The proportions of light-skinned (n = 44, 93.6%) and dark-skinned (n = 3, 6.4%) images were significantly different from U.S. demographics (p = .03).

Conclusions: Among commonly used medical student resources, few contain images of erythema migrans on dark skin; these were only found in web-based resources published since 2020. This differential representation has the potential to contribute to inequitable diagnosis and treatment across racial groups.

Objective: It can be difficult to translate learned compassionate communication skills in a patient encounter while also managing a high acuity patient. We created a novel curriculum that assesses compassionate communication during challenging high acuity medical simulations for medical students.

Methods: This study was conducted in March 2025 at a large academic medical center during the 4-week Residency Transition Course for all 4th-year medical students (n = 120). Participants completed the Sinclair Compassion Questionnaire-Healthcare Professional Ability Self-Assessment (SCQ-HCPASA) prior to simulation and the Sinclair Compassion Questionnaire-Trainee Self-Assessment (SCQ-TSA) immediately after participation. Each student engaged in 5 high-fidelity simulations combining acute medical management with communication challenges involving standardized patients and family members. Data was analyzed descriptively to compare pre- and post-simulation self-perceptions of compassionate communication.

Results: Across all 15 SCQ domains, post-simulation self-assessments demonstrated a mean 18.5-percentage-point decrease in students rating themselves as "often" or "always" able to demonstrate compassionate communication. During debriefs, students shared that their prior education in compassionate communication was limited and primarily classroom-based. They felt confident in their abilities when surveyed initially, however when required to use these skills in real-time while also managing critically ill patients, they found the experience challenging. Students expressed a strong desire for more opportunities to practice compassionate communication in a high-pressure environment, as they found it significantly more challenging than anticipated.

Conclusion: Embedding compassion training within high-acuity simulation identified unrecognized gaps in students' self-perceived communication abilities. Findings support integrating longitudinal, high-fidelity compassionate communication training earlier in the medical curriculum to better prepare learners for emotionally and cognitively demanding clinical encounters.

Background: In the United States, poisonings account for the highest number of preventable injury deaths and children disproportionately account for the largest number of poisoning exposures. There is limited exposure to toxicology education. We developed and evaluated an asynchronous case-based, interactive, online pediatric toxicology curriculum to augment foundational knowledge and enable pattern recognition in the diagnosis and management of pediatric toxic exposures.

Methods: We developed 12 cases based on cholinergic, anticholinergic, sympathomimetic, sedative-hypnotic, opioid, and serotonergic toxidromes using Rise 360 e-learning application. Participants were recruited from Accreditation Council for Graduate Medical Education-accredited pediatrics, internal medicine-pediatrics, and emergency medicine residencies and pediatric critical care and emergency medicine fellowship programs across the United States. They completed a precurriculum survey including baseline information on their training and prior educational exposure to toxicology as well as a pre- and post-curriculum self-assessment of their comfort level in the recognition, work-up, differential diagnosis, differentiation, and management of a toxic exposure. Participants also completed a 10-question pre- and posttest and provided qualitative feedback on the curriculum.

Results: Of the 238 participants who initially signed up for the course, 152 (64%) completed the pre-curriculum survey and test, and 52 (22%) completed the curriculum, which was available for 6 months. Across all participants, patient encounters were the most common exposure (197, 83%) and an online or web-based curriculum was the least common (11, 5%). Although participants did not have a significant difference in subgroup analysis and test results after completion of the study, collectively study participants demonstrated a significant improvement in comfort across all 5 domains which were assessed.

Conclusion: We developed and evaluated the first pediatric-focused interactive online case-based toxicology curriculum. Self-reported comfort measures on the recognition and management of pediatric toxic exposures improved across various specialties with this curriculum. The curriculum can augment program efforts in improving toxicology education.

Background: High-stakes Objective Structured Clinical Examinations (OSCEs) are resource-intensive and may constrain access and equity, especially for candidates from remote locations. Smartphone-based tele-OSCEs could reduce logistical burdens while maintaining assessment quality.

Objective: To evaluate whether a smartphone tele-OSCE yields assessment outcomes comparable to an in-person OSCE while improving implementation efficiency, costs, and acceptability within an undergraduate medical curriculum.

Methods: We conducted a quasi-experimental historical-control study (2021 tele-OSCE vs 2019 in-person OSCE) in 5th-year medical students at a single university in China. The tele-OSCE comprised 2 stations (history taking, clinical reasoning) aligned with the course blueprint. Primary outcomes included overall scores and pass/fail decisions; secondary outcomes included examiner/standardized patient (SP)/student acceptability, direct per-candidate costs, total examination time, and logistical metrics. Psychometric analyses included interexaminer correlations and descriptive consistency checks.

Results: Of 176 candidates scheduled for the 2021 tele-OSCE, 164 without prior online-OSCE exposure were analyzed; 272 in-person candidates from 2019 served as historical controls. Students in the tele-OSCE cohort obtained lower mean scores than those in the 2019 in-person OSCE cohort (65.6 ± 11.2 vs 72.0 ± 10.6; P < .001; Cohen's d = 0.59), although pass rates remained similarly high in both years. Interexaminer correlations across 4 cases ranged from r = .47 to .93 (all P < .05), indicating moderate-to-high agreement. Direct costs per candidate were modestly higher for tele-OSCE than in-person (USD45.22 vs 40.13; +12.7%). The tele-OSCE eliminated the need for candidates to travel (commuting) and reduced on-site density; most students, SPs, and examiners reported positive acceptability.

Conclusions: A smartphone tele-OSCE can support curriculum-integrated, high-stakes competency decisions with performance outcomes that remain within an acceptable range relative to the conventional format, while improving logistical feasibility. We provide implementation details and practical guidance to facilitate replication in similar curricular settings.

Purpose: We aim to evaluate the performance of 5 large language models (LLMs) and human teachers in answering optometry-related questions raised by medical undergraduate students.

Methods: This prospective and comparative study collected 108 questions from 30 students. The questions were sent to their teachers for responses and were also inputted into 5 LLMs, including 2 local models (Mistral-7B and Llama-2-13B) and 3 online models (Claude-3, Gemini-1.0 pro, and GPT-4.0), to generate corresponding answers. All answers were independently evaluated by 2 optometry experts in a blind manner for accuracy, completeness, comprehensibility, and overall quality, using a 5-point scale. Students were asked to complete a 6-item questionnaire about their satisfaction and perspectives on the integration of LLMs.

Results: LLMs responded more quickly and generated more extensive answers compared to humans (P < .001). In terms of overall performance, human teachers ranked fifth among the 6 participants, with scores significantly lower than GPT-4.0 (P < .001), Claude-3 (P < .001), and Gemini-1.0 pro (P < .001). GPT-4.0 received the highest scores for accuracy (3.87/5) and completeness (4.11/5), while Claude-3 excelled in comprehensibility (3.91/5) and overall quality (3.93/5); however, the differences between them were not statistically significant. Online LLMs outperformed both humans and locally deployed LLMs (P < .001). Students agreed that LLMs provided more comprehensive and detailed information (3.80/5), but found human answers easier to understand (4.17/5). They were less supportive of replacing teachers with LLMs for answering questions (2.93/5).

Conclusion: Our findings demonstrate the potential of LLMs to serve as valuable tools in optometry education, particularly in addressing students' real-world questions.

Objectives: The primary objective of the study was to analyze the extent of ChatGPT usage and students' attitudes about ChatGPT. The secondary objective is to examine the potential underlying structure of students' perceptions about this AI tool in academic settings. Additionally, the focus on students studying in Serbian and English may shed light on the cultural and linguistic influence of technology implementation in educational settings.

Methods: This descriptive study investigated how medical students perceive the application of ChatGPT in educational settings using a 3-part questionnaire: a demographic section collecting participants' overall experience and perceptions of ChatGPT, and a section collecting students' attitudes toward artificial intelligence who did not use ChatGPT.

Results: In the survey, there were 1212 students (1037 students in the Serbian and 175 students in the English language). Almost four-fifths of students have heard of ChatGPT (79.4%), but less than half of students have used ChatGPT (42.2%). Principal component analysis revealed 4 components: Positive Perception and Usefulness, Negative Impacts and Risks, ChatGPT Usability and Improvement, and Interaction and Communication Challenges items.

Discussion: A positive attitude was prevalent in our population; however, students were also aware of the limitations of ChatGPT, which were recognized as potential academic dishonesty and a risk of job loss. There were significant differences in students' agreement with various statements across 3 components among students studying Serbian and English, implying a possible role of linguistic barriers in AI responses. Therefore, using ChatGPT to promote education and healthcare should be done ethically and responsibly, considering the possible improvements in AI tools and the risks and issues they raise.

[This corrects the article DOI: 10.1177/23821205251398923.].

Background: Point-of-care ultrasound (POCUS) is endorsed by multiple national societies as an important skill in internal medicine (IM). Despite its growing importance, current evaluation methods for POCUS competence focus primarily on image acquisition and interpretation, overlooking clinical decision-making.

Objectives: We developed and evaluated an objective structured clinical examination (OSCE) that assesses IM residents' ability to select appropriate ultrasound examinations, interpret pathological images, and integrate these findings into clinical decision-making.

Methods: Over both the 2022 and 2023 academic years, 110 postgraduate year-2 IM residents participated in a longitudinal POCUS curriculum. Eighty-one of these residents participated in a 40-min OSCE case 9 months later. In the OSCE, residents encountered a clinical case involving a patient with systemic lupus erythematosus and respiratory distress, requiring both lung and cardiac ultrasounds. Residents' performance was evaluated using a 50-question rubric that assessed image quality, interpretation, and clinical reasoning. This is a cross-sectional study.

Results: Most residents successfully identified the appropriate examinations and interpreted pathological images, with 91% performing a lung ultrasound and 96% performing a cardiac ultrasound. However, many residents did not conduct a comprehensive lung exam, and many faced challenges obtaining certain cardiac views. Despite these gaps, most residents articulated appropriate differential diagnoses and management plans.

Conclusions: Our OSCE was able to evaluate the scanning patterns of the residents and test their ability to apply abnormal findings to a case, despite variability in the residents' scanning skills. This OSCE highlights opportunities to improve our POCUS curriculum in emphasizing comprehensive examination techniques and integration of clinical reasoning.

Introduction: Population Health and System Science, a longitudinal course at a new medical school in northeast Texas, incorporates case-based learning and experiential field visits during an 18-month pre-clerkship phase. The course integrates content from public and population health, preventive medicine disciplines, and health administration and leadership.

Materials and methods: A cross-sectional survey assessed student self-reports on achievement of session objectives and introduction to national core curricular, cross-cutting, and systems thinking domains.

Results: Of 36 students, 33 responded. Most rated objectives favorably. Open-ended responses highlighted relevance to future practice and requested more content on biostatistics, epidemiology, health equity, and healthcare economics, financing, and policy.

Discussion: Findings suggest the course effectively introduces key concepts, with opportunities to enhance foundational content in measurement, policy, and financial aspects of healthcare. Future studies should investigate application during required clinical rotations.

Objective: Although video feedback is incorporated into medical education research, its broad implementation in the practical teaching of procedural skills remains challenging. Thus, we aimed to investigate the practical effects of the mobile video feedback teaching method in clinical skills training for abscess incision and drainage.

Methods: A total of 72 second-year medical students majoring in a 5-year clinical medicine program were randomly allocated (1:1) to either the traditional teaching (TT) group or the mobile video feedback teaching (MVFT) group. All students received the same foundational theoretical knowledge, followed by distinct practical training sessions corresponding to their group allocation. The final procedural assessment on a simulation manikin was conducted by 2 examiners simultaneously, and each student's final score was calculated as the average of both examiners' scores. Effects were further assessed using the Mini-Clinical Evaluation Exercise (Mini-CEX), in addition to evaluations of teaching performance and self-perception.

Results: Students in the MVFT group achieved a significantly higher average final score than those in the TT group (78.67 ± 6.72 vs 75.00 ± 7.95, P = .038). Additionally, 4 initially lower-performing students in the MVFT group scored significantly higher than 4 comparable students in the TT group (67.50 ± 1.29 vs 63.00 ± 3.16, P = .039). The MVFT group achieved significantly higher scores in clinical judgment, physical examination, organizational skills, and overall performance (P = .000, P = .000, P = .037, P = .040, respectively). Furthermore, students in the MVFT group reported significantly greater satisfaction across several domains, including their perception of the teaching methodology, comprehension of learning materials, and ability to perform self-directed learning with tools (P = .042, P = .032, P = .041, respectively).

Conclusion: This study demonstrates that the mobile video feedback method enhances comprehension and procedural proficiency in clinical skills, particularly for initially lower-performing students, supporting its integration into the curriculum to improve educational outcomes. The method's accessibility and low cost further facilitate its adoption as a scalable tool for self-directed learning and targeted remediation.