Perspectives on Medical Education最新文献

Introduction: Generative AI is a powerful resource for health professions education (HPE) researchers publishing their work. However, questions remain about its use and guidance about disclosure is inconsistent. This study explores journal editors' experiences and expectations of AI-use disclosure, to assist journals to clarify expectations and authors to satisfy them.

Methods: In this descriptive qualitative study, editors were interviewed between January 6, 2025, and May 7, 2025 using Zoom. Eligible participants were identified through journal webpages and snowball sampling. A purposive sampling strategy prioritized HPE journals and included a limited sample of general medical journals to explore transferability. Data collection and thematic analysis proceeded iteratively.

Results: Eighteen participants, including 9 chief editors and 9 associate/deputy editors were interviewed. Fourteen worked in HPE journals, four in general medical journals. The analysis revealed 4 themes: 1) the basics of disclosure, made up of content expectations and process knowledge; 2) the necessity threshold, regarding which circumstances require disclosure; 3) the sufficiency threshold, regarding how much detail to include; and 4) the factors blurring these thresholds, which included the speed of change, the co-construction of standards, and the uneasy fit of some scientific principles with the AI-use context.

Conclusions: While editors shared basic disclosure expectations, these were complicated by blurred thresholds of sufficiency and necessity that may exacerbate uncertainty in the scholarly community. By attending to these thresholds and the factors blurring them, and by working to articulate shared disclosure standards, HPE journals can help authors safely navigate the shifting norms of AI-use disclosure.

Introduction: Ethnic minority medical students often receive lower grades than their majority counterparts, especially in workplace-based assessments. To unravel this phenomenon of "differential attainment", we explore assessor bias focusing on how first impressions of students from ethnic minority groups may be adjusted differently compared to majority students when their performance changes.

Methods: In an online experiment with an incomplete block design we created near-identical videos showcasing varying performances of medical students during history-taking. Eighty-one physicians were randomly assigned to watch four different videos each, two with ascending performances (poor start, good ending) and two with descending performances (good start, poor ending), featuring one ethnic minority actress (Turkish or Moroccan origin) and one ethnic majority actress (Dutch origin) as students. We evaluated ethnicity-related differences in first impression ratings (after 60 seconds), final ratings (after 5 minutes), and rating changes.

Results: No significant differences in first impression ratings were found between ethnic groups. Ethnic minority students received higher final ratings than ethnic majority students for ascending performances, but only when rated by residents and not specialists. Finally, rating changes between first impressions and final ratings were larger for ethnic minority than ethnic majority students, for both ascending and descending performances.

Discussion: Our results do not show evidence of assessor bias in first impressions being an explanation for ethnicity-related differential attainment. However, our finding that rating changes were larger for minority than majority students could indicate that they are generally more scrutinized by assessors, which may affect them positively, but also negatively.

Background: Healthcare professionals must continuously update their competencies to keep pace with evolving clinical practices; however, traditional continuing professional development (CPD) methods often have limited impact on competency and performance. Micro-credentials have emerged as a flexible and personalized alternative to traditional CPD, yet little is known about how they are designed, implemented, and evaluated in health professions education. As educational systems invest heavily in micro-credentials, a clearer understanding of their educational value is essential.

Methods: Using a scoping review guided by Arksey and O'Malley's six-stage framework and PRISMA-ScR guidelines, we systematically searched seven databases (inception-December 2024) and conducted a structured grey literature review. We examined the instructional design features, pedagogical underpinnings, assessment strategies, and reported impacts of micro-credentials.

Results: We included 19 peer-reviewed papers and 35 websites describing health-related micro-credentials. Most studies were published in 2024 (42.1%), originated from the United States (42.1%), and nearly half (47.4%) provided only descriptive accounts. A wide range of instructional design features were identified, though pedagogical theories were rarely stated. Assessment strategies predominantly emphasized summative approaches (e.g., multiple-choice knowledge checks), with limited focus on higher-level competency assessment. Reported outcomes were primarily improvements in knowledge, confidence, or engagement, with no clear evidence of the distinct value of micro-credentials as a teaching modality.

Discussion: Current literature offers limited evaluation of micro-credentials and often lacks theory-informed design. We infer a pedagogical foundation aligned with constructivist, context-sensitive, and stage-based principles, which may inform the development of future micro-credential programs.

Purpose: Renewal of surgical curricula is critical in maintaining relevance to contemporary healthcare needs. A curriculum document usually describes its purpose, intended outcomes, content, methods, and assessment and evaluation processes. The document may also consider cultural, professional, political, and social contexts. While there are published curriculum development approaches, guidance on renewal processes is limited. This scoping review aims to synthesise literature on surgical curriculum renewal, to understand the key elements of this process, and identify areas for improvement.

Methods: A scoping review was conducted by the core author team, with co-creation involving a Knowledge User Group (KUG). Seven databases were searched for sources published since 2003. Sources relating to curriculum renewal were included, and data were extracted via iterative and consultative processes involving both core authors and the KUG. Themes were identified via qualitative content analysis and thematic mapping of reported features.

Results: Eighteen sources were included from an originally identified 2359 articles. Six models of curriculum development were characterised, yet no curriculum renewal model was delineated. Terminology was inconsistent. Primary participants (trainees and trainers) tended to be consulted but not included in curriculum renewal teams. Factors including participant engagement, educational support, and financial resources were identified as enablers in particular environments, and considered as barriers in other contexts. Drivers for renewal included changes in surgical education and training; in surgical practice; and, participant concerns.

Discussion: Addressing identified barriers can transform them into catalysts for change. Greater standardisation of terminology in surgical curriculum renewal is needed. The field would benefit from purpose-built frameworks, educational scholarship, co-design, and the implementation of strategies to ensure barriers to renewal become enablers of the surgical curriculum renewal process.

Background: As team-based learning (TBL) has gained traction in health profession education (HPE), so too has TBL research expanded. However, to date, the literature lacks an overview of TBL research that could inform research and education practice by identifying patterns of scholarship productivity over time. To address this gap, the current study aimed to explore the temporal, geographical and intellectual influences within TBL in HPE research.

Methods: Using a bibliometric approach, we investigated the geographical distribution of TBL research, the main influencers in TBL research over the last two decades, and the characteristics of the most cited and co-cited articles. Rogers' Diffusion of Innovation Theory was employed as a heuristic framework to map and interpret the global trajectory of TBL research.

Results: TBL has been widely adopted in the USA, followed by the Western Pacific and the Eastern Mediterranean. The number of outputs suggests less traction in other global regions. Generally, TBL research is characterised by many one-off publications in lower-impact journals. Only 5% of papers were cited 50 times or more. The scholars who first brought TBL into HPE continue to collaborate and have a significant impact, as evidenced by citations and productivity.

Conclusions: Our findings indicate that TBL in HPE research has been driven by a group of early adopters. However, while TBL seems to be widely adopted, there is a relative lack of cumulative research on this topic. More qualitative work and collaboration sare needed to explicitly examine what drives the adoption and normalisation of TBL and new pedagogies in HPE globally, as well as associated research.

Purpose: Peer mentorship has emerged as an important strategy for supporting medical students, demonstrating multiple benefits for mentees and mentors. However, to our knowledge, no studies have focused on medical students' simultaneous experiences as students (receiving mentorship) and near-peer mentors (providing mentorship). This study explored students' experiences as students and mentors in a longitudinal, group mentorship course.

Method: The authors used interpretive description to explore how senior medical students acting as near-peer mentors understood their dual roles. In-depth semi-structured interviews were conducted between April and October 2023. Additionally, students were asked to record audio diaries. Using an iterative, reflexive approach, the authors conducted a constant comparative data analysis.

Results: 20 students completed 2 interviews and audio diaries. Four themes were identified: Participants understood their dual roles to be complementary, highlighting a continuity between being students and near-peer mentors, which they called "closing the loop." Many participants cited their experiences in the course as the reason they decided to become student mentors, expressing their desire to "pay it forward." Mentorship roles reminded them of their experiences as new medical students, and "gazing backwards" helped boost their confidence and renew their empathy. Several participants drew attention to how their mentorship role helped them "imagine the future," reaffirming their desire to continue mentoring or teaching.

Discussion: Being in two roles was perceived as a positive experience. Dual roles helped boost students' confidence and empathy while fostering meaningful reflection on career trajectories, findings that could help inform or enhance peer mentorship programs.

Purpose: Healthcare is delivered by teams, yet individualism continues to be foregrounded in training and assessments. In contrast to individualism is collectivism, a sociocultural phenomenological lens that considers the degree to which people are integrated into groups. Along with collectivism is interdependence, which characterizes how two or more people or things are interconnected with each other. The purpose of this review was to examine the current body of work on collectivism and interdependence to examine their potential within healthcare and health professions education (HPE).

Method: This narrative review included English-language publications from peer-reviewed journals between 1990 and 2024, and excluded non-English articles, perspective pieces, commentaries, and studies that were unrelated to healthcare or HPE. The initial search in January 2024 included MEDLINE, Embase, PsycINFO and ERIC databases and was updated in November 2024 with forward and backward reference mining.

Results: In total, 3,415 articles were identified, of which 63 were included in the review. We used reflexive thematic analysis to consolidate the literature. Our analysis developed four interconnected themes: 1) reshaping the culture of healthcare and the learning climate of HPE, 2) accounting for individual contributions to the team, 3) the many facets of leadership, and 4) belongingness as an essential step towards collective well-being. Together, these themes expose tensions between individualistic educational structures and the team-based realities of clinical work, and highlight pathways toward relational, trust-based learning environments.

Conclusion: Healthcare and HPE can be effectively examined through the paradigms of collectivism and interdependence, which transcend and challenge the current models of individualism and independence. Collectivism and interdependence offer conceptual and practical tools to reorient HPE toward relational accountability, shared leadership, and compassionate belonging. By embracing these guiding principles, healthcare workers and educators can better prepare for the collaborative, team-based nature of healthcare, and create protective and transformative learning environments.

Background: Medical students regularly report poorer mental health outcomes than students from other faculties and in other degree programmes. Gender and year of study have been discussed as factors influencing mental health. However, study results for both factors are inconclusive. Moreover, little is known about the associations between gender and study progression with perceived study demands.

Methods: The purpose of this study was to analyse medical students' self-reported mental health status and perceived study demands with particular focus on gender differences and study progression. We conducted an online survey in two German universities across three data collection waves during the winter terms of the academic years 2021, 2022, and 2023. We included 1,083 medical students (73% women) in our analyses: bivariate t-tests and ANOVAs with gender, study progression, and university as predictors of depression, exhaustion, six dimensions of study demands, and satisfaction with learning and study.

Results: Our results demonstrated gender differences regarding mental health and study demands, favouring men on all outcomes in t-tests and ANOVAs. We did not find differences between beginners and advanced students in mental health, but beginners reported greater difficulty with performance pressure and self-structuring.

Conclusions: Our findings confirm persistent gender differences in mental health and study demands, with women reporting higher distress. We did not find differences in terms of satisfaction with studies or learning. To improve medical students' well-being, we suggest targeted interventions for vulnerable groups using gender-sensitive approaches and designs. Beginners likely benefit from support with self-structuring and managing performance pressure.

Introduction: Formula scoring, widely used in medical progress tests (PT), includes a question mark option to discourage guessing, but this feature may disadvantage risk-averse students and bias results due to test-taking strategies. To enhance reliability and more accurately assess ability, Dutch medical schools recently transitioned to a computer adaptive-PT (CA-PT) based on Item Response Theory, which adjusts question difficulty dynamically, excluding the question mark option. This provided a unique opportunity to evaluate the impact of the question mark option in a large cohort. We specifically explored the relationship between question mark use in conventional PT and performance on CA-PT.

Methods: Retrospective data from medical students across seven faculties who took both PT formats were analyzed. Z-scores for total score and question mark score (number of unanswered questions) in the conventional PT, and theta score for the CA-PT were assessed. A linear model assessed the effect of the question mark score on theta, corrected for the conventional PT-score. Cluster analysis explored student subgroups per year.

Results: Students with similar conventional PT scores who left more questions unanswered on the conventional PT generally performed better on CA-PT. This effect diminished as students advanced through their studies. Cluster analysis revealed a variable effect between different students, most pronounced in year 4, and a reverse effect in year 5.

Discussion: Question mark option use significantly impacted student performance on PT, with a remarkable variability among students. This variability suggests that formula scoring captures more than knowledge alone, highlighting the need to align scoring methods with intended assessment goals.

Introduction: It is estimated that large language models (LLMs), including ChatGPT, are already widely used in academic paper writing. This study examined whether certain words and phrases reported as frequently used by LLMs have increased in medical literature, comparing their trends with common academic expressions.

Methods: A structured literature review identified 135 potentially AI-influenced terms from 15 studies documenting LLM vocabulary patterns. For comparison, 84 common academic phrases in medical research served as controls. PubMed records from 2000 to 2024 were analyzed to track the frequency of these terms. Usage trends were normalized using a modified Z-score transformation.

Results: Of the 135 potentially AI-influenced terms, 103 showed meaningful increases (modified Z-score ≥3.5) in 2024. Terms with the highest increases included "delve," "underscore," "primarily," "meticulous," and "boast." The linear mixed-effects model revealed significantly higher usage of potentially AI-influenced terms compared to controls (β = 0.655, p < 0.001). Notably, these terms began increasing in 2020, preceding ChatGPT's 2022 release, with marked acceleration in 2023-2024.

Discussion: Certain words and phrases have become more common in medical literature since ChatGPT's introduction. However, the use of these terms tended to increase before 2022, indicating the possibility that the emergence of LLMs amplified existing trends rather than creating entirely new patterns. By understanding which terms are overused by AI, medical educators and researchers can promote better editing of AI-assisted drafts and maintain diverse vocabulary across scientific writing.