Journal of Medical Education and Curricular Development最新文献

Introduction: Career path decisions among medical students are crucial for strengthening health systems, particularly in Tanzania, where physician shortages persist despite increasing medical graduate numbers. While many studies have focused on specialty preferences, few have examined whether students nearing graduation intend to remain in clinical medicine. In Tanzania, this decision is shaped by intrinsic motivation, poor learning environments, limited job opportunities, and systemic challenges. This study assesses the proportion of students intending to remain in the profession and identifies key influencing factors.

Methods: An analytical cross-sectional study was conducted among 292 medical students from Tanzanian medical universities between September and December 2024. Stratified random sampling was employed. Data were collected through an online structured questionnaire. Variables included demographics, initial motivations, and theory of planned behavior (TPB) constructs. Data analysis involved descriptive statistics, chi-square tests, and binary logistic regression.

Results: Of the participants, most were male (64.0%) and those aged 21-25 years old (77.7%). Precisely, 64.7% intended to remain in the medical profession, while 35.3% considered alternative careers. Intrinsic motivations such as a desire to help others (odds ratio [OR] = 2.90, p < .001) and personal interest (OR = 1.99, p = .016), along with perceived behavioral control (OR = 2.26, p = .005), were significant predictors. No significant associations were observed with demographic variables.

Conclusion: A significant portion of final-year medical students in Tanzania (over one-third) consider leaving the clinical field. This underscores the critical role of intrinsic motivation and perceived behavioral control in shaping career intentions. To enhance the retention of medical professionals, stakeholders should prioritize strategies that strengthen intrinsic drivers, reinforce self-efficacy, and improve supportive training environments.

Background: Social media and serious games are key drivers of engagement in medical education.

Objective: This review explores the current challenges faced when integrating web-based learning into teaching curricula.

Methods: A literature review included studies on social media and web-based games in medical education.

Results: From 219 references, 14 studies highlighted two key challenges medical educators encounter.

Conclusions: Exciting opportunities exist for the adventurous educator to wield new electronic teaching methods.

Background: Climate change is one of the greatest health threats, yet many medical schools fail to adequately teach students about its impact. This article describes the development and implementation of an online elective in planetary health education.

Methods: The online elective was designed for medical students in the clinical study term and delivered in a blended learning format. It features presentations, lectures, and transformative online teaching methods including a flipped classroom with final reflection, peer role-play for simulation of climate-sensitive health counseling, producing infographics, and problem-based activities. A pre-/post-course survey was conducted at the medical faculty of Goethe University Frankfurt for the years 2021 to 2024 and used to assess how effectively the elective contributed to participants' knowledge, beliefs, behaviors, and attitudes about the impact of climate change on health.

Results: Overall, participants rated the elective extremely positively. They were very satisfied with the design and content of the elective. The course effectively enhances self-reported knowledge of climate-related health effects and management while strengthening students' confidence in their role in climate protection. Intentions to apply new knowledge in medical practice and in one's own daily life significantly increased. Participants recommended incorporating the topic into the regular curriculum.

Conclusions: The success of this pilot is evidence in favor of integrating climate change-related health topics into the medical curriculum, while the results provide insights useful to future research and development of online planetary health courses.

Objective: We developed a curriculum map of the neurology residency program's academic half-day (AHD) at our institution from 2018 to 2024 to assess topic coverage and identify gaps relative to board certification content.

Methods: We cataloged 280 unique AHD lectures over 6 years, recording attributes including title, date, duration, speaker, and subspecialty. These were compared against the American Board of Psychiatry and Neurology (ABPN) certification blueprint using chi-square analysis.

Results: The 280 lectures totaled 358.5 h. We found significant differences across multiple subspecialties. Content categorized as "Questions not associated with a specific neurologic disorder" (4.93%) was overrepresented (P < .05), while topics on metabolic disorders (0.26%), psychiatric disorders (0%), and autonomic nervous system disorders (0%) were underrepresented (P < .05).

Conclusions: Curriculum mapping revealed both strengths and gaps in the current didactic content, underscoring the need for more comprehensive and aligned curricular material. This process offers a data-driven framework for iterative curricular improvement and may serve as a replicable model for other neurology residency programs. Future efforts will focus on building a 2-year curriculum that aligns more closely with ABPN content specifications while considering institutional strengths and resources.

Objectives: Despite data showing many opportunities for emergency medicine (EM) physicians to practice in rural settings, only 8% of EM graduates are exposed to rural environments during training.⁵ The authors of this study noted a curricular gap in their EM training program and developed a 4-week rural elective for PGY-2 and PGY-3 EM residents. While prior literature has focused on the logistics of a rural rotation and associated procedural experiences, to our knowledge, no previous studies have focused on resident perceptions of the rural experience or preparedness for a future career in rural EM. This qualitative study aimed to gain a rich understanding of the residents' experiences and the impact of those experiences on the 2 study aims.

Methods: Between June 2019 and May 2020, upper-level residents (PGY-2/3) completing a rural EM rotation participated in semistructured interviews exploring their perceptions of a rural EM rotation, and data was analyzed using inductive thematic analysis. Codes were informed by social cognitive theory, and a constant comparative approach was applied, with data collection concluding upon reaching thematic saturation.

Results: Four overarching themes were established. Rural EM electives provide (1) understanding of differing patient presentations in a rural emergency department, (2) exposure to differing approaches to patient care when compared to academic settings, (3) appreciation of the transport logistics associated with transferring patients to higher level care, and (4) understanding of the perceived benefits of the rural experience on EM resident training and preparedness for rural EM practice.

Conclusion: Exposure to a rural EM elective provides residents with unique experiences on rural EM, which enhances a deeper understanding of care provided in a rural environment and leads to a sense of preparedness for practice in rural EM.

Background: Pathophysiology bridges basic and clinical sciences, offering essential insights into disease mechanisms, diagnosis, and treatment. However, lecture-based learning remains predominant in China, often lacking dynamic evaluation systems. In alignment with the "Healthy China 2030" initiative, innovative methods such as problem-based learning (PBL), case-based learning (CBL), team-based learning (TBL), and seminar are increasingly explored to enhance integrated and competency-based medical education.

Methods: Sixty third-year clinical medicine students were randomly assigned to either a traditional instruction group or a Combi-Method group following a standardized preclass exam. The Combi-Method integrated PBL, CBL, TBL, and seminars. Instruction was based on real-world clinical cases. Knowledge acquisition was assessed through a postclass quiz, including multiple-choice, short-answer, and case study questions on renal, pulmonary, and hepatic insufficiency.

Results: The 2 groups exhibited comparable baseline characteristics in age, gender, and preclass scores. The Combi-Method group achieved significantly higher scores in several domains, particularly in renal and pulmonary insufficiency, and demonstrated superior clinical reasoning and knowledge application. Although some areas showed no statistical difference, the overall performance favored the Combi-Method.

Conclusions: The Combi-Method proves to be an effective instructional model for pathophysiology, promoting deeper understanding, enhanced clinical reasoning, and knowledge integration. This approach aligns with the goals of competency-based medical education and supports its broader adoption in undergraduate medical curricula.

Background: Generative Artificial Intelligence (GenAI) has rapidly gained traction in medical education, yet little is known about its use among medical students in Puerto Rico. This study examines GenAI usage patterns among first- and second-year students across all four Liaison Committee on Medical Education-accredited medical schools in Puerto Rico, with comparisons based on user experience.

Methods: A cross-institutional electronic survey was conducted from January to June 2024 among first- and second-year medical students (n = 194) from Ponce Health Sciences University, University of Puerto Rico Medical Sciences Campus, San Juan Bautista School of Medicine, and Universidad Central del Caribe. Students were grouped by program year, and GenAI experience (<1 year vs ≥ 1 year). Chi-square tests were used to evaluate group differences (P < 0.05).

Results: Of the 778 first- and second-year medical students enrolled across all schools, 194 responded. Most (72.7%) reported using GenAI, primarily ChatGPT (89.9%), mainly for academic purposes (75.3%). Students with ≥1 year of GenAI experience were more likely to agree that GenAI helped them understand research papers (89.9%) compared to 51.6% of less-experienced users who disagreed (P < 0.001). From this same cohort, 72.7% also planned to use GenAI for board exam preparation, compared to 63.2% of less-experienced users who did not plan to use it. Although 72.2% believe GenAI will be integrated into Puerto Rico's healthcare system, only 52.1% felt that local medical facilities would be receptive. Challenges such as limited data access (27%) and power outages (34%) were more commonly reported by less-experienced users.

Conclusion: Generative AI adoption among Puerto Rican medical students is expanding, mainly for academic purposes. Greater experience correlates with higher perceived benefit, emphasizing the need for structured, ethical GenAI training, and institutional support within medical education.

Background: Effective communication is essential for patient care and physician development. Connect, Listen, Empathize, Align, Respect (C.L.E.A.R.) Conversations, developed at Henry Ford Health in 2012, is an evidence-based program using experiential learning methods-role play, feedback, and reflection-to build communication skills. During the COVID-19 pandemic, the program transitioned from in-person to virtual delivery. Few U.S. studies have explored challenges and opportunities from the perspectives of facilitators, graduate medical education (GME) partners, and administrators.

Objective: This exploratory qualitative study aimed to understand the experiences and perspectives of facilitators and administrators during the transition of C.L.E.A.R. Conversations to a virtual format. The purpose was to identify key opportunities, challenges, and strategies that supported this transition rather than to evaluate the benefits or compare virtual and in-person modalities, The study also sought to determine whether the adaptation process could inform a practical and scalable framework for other institutions, serving as both internal reflection and a foundation for hypothesis generation and future research in medical education.

Methods: Structured interviews with facilitators, GME partners, and administrators were conducted from April to June 2024 and analyzed through inductive content analysis by two independent coders.

Results: Eleven participants described the adaptation process, yielding five main themes: Modifying Content and Delivery, Adapting to Virtual Format, Challenges and Mitigations, Benefits and Surprises, and Recommendations and Insights.

Conclusion: Findings highlight how facilitator and administrator perspectives can inform the thoughtful adaptation of experiential learning programs to virtual environments, offering a replicable framework for scalable, learner-centered communication training in GME.

Background: Residency programs have the advantage of comparing applicants through a single platform that combines factors that program directors value. Conversely, applicants have innumerable resources with fragmented information, and there are limited data on what they value when considering residency programs. This study sought to identify what students value from existing resources, how resources could be improved, and if a centralized resource would help meet the needs of residency applicants.

Methods: An online survey was sent to medical students at a single academic institution during the 2022 to 2023 residency application cycle. Students were asked to rank resources, identify their favorite and least favorite resources, and rate the utility of specific features and of a centralized platform. Statistical analysis was performed using an ordinal regression model. Statistical significance was defined by P < .05.

Results: Sixty-four out of 188 fourth-year medical students completed the survey. Students ranked program websites and FREIDA (Fellowship & Residency Electronic Interactive Database Access) the highest (P < .01). Program websites were the most favored for reliability, followed by FREIDA for its comparison tools. Student Doctor Network and Reddit were the least favored due to limited reliability, but felt helpful for candid reviews. Respondents indicated that fellowship placement ratings would be most helpful, while unvetted anonymous commentary on resident wellness would also be helpful. Surgical specialty applicants preferred resources like Google Sheets that offered detailed fellowship information, while nonsurgical applicants did not prioritize this. Ninety-one percent of respondents said a centralized platform integrating standardized information would be helpful.

Conclusions: Medical students desire a unified resource that combines reliable information with candid perspectives. A centralized platform with standardized data across programs, tailored to the differing needs of surgical and nonsurgical applicants, could fulfill this need and improve the residency application process.

Introduction: The impact of sex and gender on health is increasingly recognized and incorporated into medical curricula. However, while there is general consensus about the content to be taught, limited attention has been paid to teaching formats. Hence, in the present study we used an action-based research approach to investigate students' preferences in learning about sex- and gender-sensitive medicine (SGSM).

Methods: We applied a qualitative multimethod action-based approach to identify a suitable teaching format for SGSM based on students' preferences. Our study consisted of 3 phases. In the first phase we asked (bio)medical students about their methodological preferences regarding SGSM education. In the second phase, we interviewed teaching experts to identify teaching formats matching the students' preferences. In the third phase, we designed and executed a 1.5 h SGSM seminar based on the students' preferences and the experts' input and evaluated its reception with a focus group and written feedback.

Results: Although students expressed learning preferences in line with state-of-the-art teaching standards, the topic of SGSM added a layer of complexity to their execution. Students expressed distinct learning preferences for the topics of sex and gender. Especially in learning about gender, they requested immersive learning experiences, structural safety in the learning space and a balance between self-directed learning and structural input. The experts suggested experience-based or transformative learning formats. The teaching experiment based on these suggestions resulted in an ambivalent experience for (bio)medical students. It proved to be engaging and instructive, but self-direction challenged the students' expectations about the learning process, which felt uncomfortable to some participants.

Conclusion: Our experiment demonstrated that topics touching upon the personal and professional identity of students, such as SGSM, place learners in a potential position of vulnerability. Medical students reported a preference for experiential learning formats yet lack the familiarity with them. For curriculum design, this implies that SGSM should be taught through a combination of experiential methods and structured input, embedded within a safe learning environment that supports both self-reflection and the acquisition of factual knowledge.