Abstract

Introduction: Medical education aims to produce healthcare professionals who are not only competent, but also able to perform effectively in clinical practice settings. Assessment systems are critical to achieving this by guiding learning, ensuring competence, and certifying readiness for independent practice. This article proposes a staged assessment approach that integrates both competence and performance to ensure safe and empathetic healthcare practice.

Methods: First, we analysed the strengths and limitations of the existing assessment methods and their roles in medical education. Then, we explored strategies to integrate diverse assessment tools into a cohesive assessment system capable of effectively and reliably evaluating the competencies required for developing holistic practitioners.

Results: Competence is assessed via structured assessment tools such as written assessments. Clinical performance in real-world settings relies on Supervised in-practice assessments (SuPs), including tools like Direct Observation of Procedural Skills (DOPS) and Mini-Clinical Evaluation Exercises (mini-CEXs). Assessment tools used to evaluate performance rely on expert judgement, which, although subjective, is essential for evaluating non-cognitive skills such as empathy and professionalism.

Conclusion: This article outlines the design of a progressive assessment system, transitioning from objective assessment methods such as Multiple-Choice Questions (MCQs) to performance-focused methods, anchored by Entrustable Professional Activities (EPAs), using Workplace-Based Assessment tools and portfolios. The progression from early objective assessment tools to those which leverage expert judgement and situational specificity are highlighted as essential for preparing safe, effective, and empathetic healthcare practitioners.

Abstract

Introduction: Effective and actionable instructional design features improve return on investment in Technology enhanced simulation (TES). Previous reviews on instructional design features for TES that improve clinical outcomes covered studies up to 2011, but updated, consolidated guidance has been lacking since then. This review aims to provide such updated guidance to inform educators and researchers.

Methods: A narrative review was conducted on instructional design features in TES in medical education. Original research articles published between 2011 to 2022 that examined outcomes at Kirkpatrick level three and above were included.

Results: A total of 30,491 citations were identified. After screening, 31 articles were included in this review. Most instructional design features had a limited evidence base with only one to four studies each, except 11 studies for simulator modality. Improved outcomes were observed with error management training, distributed practice, dyad training, and in situ training. Mixed results were seen with different simulation modalities, isolated components of mastery learning, just-in-time training, and part versus whole task practice.

Conclusion: There is limited evidence for instructional design features in TES that improve clinical outcomes. Within these limits, error management training, distributed practice, dyad training, and in situ training appear beneficial.  Further research is needed to assess the effectiveness and generalisability of these features.

Keywords:         Simulation, Instructional Design, Clinical Outcomes, Review

Abstract

Introduction: Conventionally, face-to-face education has been prevalent in medical education because it can help medical students learn interpersonal skills, including medical interviews and physical examination. However, because of the coronavirus disease 2019 pandemic, face-to-face education was suspended to prevent the spread of the infection. As face-to-face classes in Japan were discontinued when the pandemic began in the spring of 2020, we developed an online education program to develop medical interview skills. We were interested in determining the educational outcomes between face-to-face and online medical interview classes. Therefore, we compared them before and after the pandemic.

Methods: Fourth-year students of the University of Tokyo Medical School took medical interview classes. Under consent, the score of the medical interview area of the preclinical clerkship, Objective Structured Clinical Examination (OSCE), as a high-stakes examination, which falls at the top level of the Kirkpatrick’s model, was compared by year or before and after the pandemic.

Results: The online group showed higher item-wise scores of the medical interview of the preclinical clerkship OSCE than the face-to-face group. In terms of the global score, no significant difference was observed. In the computer-based test (CBT), the online group had higher scores compared with the face-to-face group.

Conclusion: The educational outcomes of online medical interview classes were not inferior to those of conventional face-to-face classes, as revealed by high-stakes examination preclinical clerkship OSCE. Similar to face-to-face education, online education is a viable option for developing interpersonal skills.

Keywords:          COVID-19 Pandemic, Medical Interview, OSCE, Educational Outcome, Online Education, Interpersonal Skills, Communication Skills

Abstract

Introduction: Self-care agency, a core concept that helps alleviate the stressors of medical training, is postulated to be practiced by medical students who exhibit a growth mindset. Hence, this pilot study was designed to measure, compare, and correlate the self-care agency and mindsets of undergraduate medical students to assess the potential for scaling to a national survey.

Methods: This cross-sectional study was conducted at one public and one private medical university using a revised version of the Appraisal of Self-Care Agency Scale to measure self-care agency and the Implicit Theories of Intelligence Scale to measure participants’ mindset. Data was analysed using IBM SPSS.

Results: In total, 329 complete responses were obtained. Among the self-care domains, a higher capacity for self-care and a developing capacity for self-care, with a lower ability to indulge in self-care, were reported. Self-care agency showed a significant difference between pre-clinical and clinical students (p = .027; Cohen’s d = .2). Mindset measurements revealed a higher growth than a fixed mindset. The Pearson correlation coefficient showed a weak positive correlation, (r = 0.19) between the means of self-care agency and a growth mindset. Clinical students showed a higher tendency toward self-care than their pre-clinical counterparts in an independent-samples t-test, with no differences between genders and universities.

Conclusion: This pilot study found a positive correlation between self-care agency and growth mindset among undergraduate medical students. Although limited by two prototype universities and response bias, this study provides a solid foundation for future nationwide or cross-country studies.

Keywords:            Self-care Agency, Growth Mindset, Fixed Mindset, Medical Education, Undergraduate Medical Students, Pilot Study

Abstract

Introduction: Tele-clinical training is an effective approach, increasingly adopted post-pandemic and in resource-limited settings. However, it requires systematic development. This study details the first-time implementation of a tele-clinical training in an undergraduate Speech and Hearing Sciences programme, exploring student experiences and validating a novel evaluation tool, specifically designed for tele-clinical training programmes.

Methods: The study used a mixed-method approach. Quantitative data were gathered from 128 students using the developed 23-item Kelaniya Tele-Clinical Evaluation Tool (KeTCET), which covers three broad areas: Learning Environment, Supervisory Attributes, and Telehealth Teaching Practices. Qualitative insights from 13 participants were thematically analysed. The tool was validated for reliability and psychometric robustness using expert feedback and statistical evidence.

Results: Quantitative analysis showed high domain scores: Learning Environment 80.64%, Supervisory Attributes 81.67%, and Telehealth Teaching Practices 80.31%. Strong positive correlations between domains (r > 0.86, p < 0.001) indicated interconnectedness. The 23-item evaluation tool demonstrated high internal consistency (Cronbach Alpha = 0.98) and a single-factor structure (Eigenvalue = 17.12, 74.44% variance explained). Qualitative data highlighted strengths in supervisor interaction and resource availability, also noting challenges such as issues in connectivity and limited peer learning. Students appreciated structured feedback and supervisor presence during tele-clinical sessions.

Conclusions: The successful development of a tele-clinical programme requires consideration of multiple elements broadly categorised as pedagogical environment, supervisory characteristics, and virtual teaching practices. Well-structured programmes can effectively meet training needs in resource-limited settings, although strengths and challenges may vary across learning environments. The validated 23-item KeTCET offers a reliable framework for evaluating and improving tele-clinical programmes.

Keywords:           Tele-clinical Programmes, Tele-clinical Supervision, Speech and Language Therapy, Audiology, Tele-clinical Evaluation, Tool Development, Undergraduate Clinical Training, KeTCET

Abstract

Introduction: Music preferences have been linked to personality traits, which in turn may influence career choices. This study explores the potential relationship between music genre preferences and medical specialty selections among residents at Padjadjaran University, Indonesia.

Methods: A cross-sectional survey was conducted among all residents trained in urology, ophthalmology, and anatomic pathology. Data collected included demographic characteristics, music genre preferences, and work habits related to music. Independent t-tests are used when data are normally distributed, whereas Kruskal-Wallis tests are used when data are not normally distributed.

Results: The study included 125 residents (19 pathology anatomy, 33 urology, 73 ophthalmology). Pop was the most preferred music genre across all specialties (48% in urology, 61% in ophthalmology, 52% in pathology anatomy). However, secondary preferences varied: rock (21%) was the second most popular among urology residents, jazz (10.9%) and indie (10.9%) among ophthalmology residents, and classical music (26%) among pathology anatomy residents. Demographic differences were noted, with pathology anatomy residents being older and urology residents having a higher proportion of males. Ethnic distribution was relatively consistent across specialties, primarily mixed ethnicity, Sundanese, and Javanese.

Conclusion: While pop music was the predominant preference across all specialties, secondary music preferences varied, potentially reflecting different personality traits associated with each specialty. The study’s findings are limited by its single-institution sample and cross-sectional design, necessitating further research with larger, more diverse populations to explore the underlying mechanisms linking music preferences to medical specialisation choices.

Keywords:           Music Preferences, Medical Specialty Selection, Personality Traits

Abstract

Introduction: Nutrition literacy represents a critical determinant of oral health outcomes. Guided by Social Cognitive Theory and the Nutrition Literacy Skills Framework, this study evaluated the implementation and effectiveness of a nutrition literacy programme for oral health promotion among village health volunteers (VHVs), key implementers in Thailand’s healthcare system, during January to December 2024.

Methods: A convergent parallel mixed-methods design was employed to address existing methodological gaps in nutrition literacy research. The quantitative component comprised a cross-sectional survey (N=60 VHVs trained in January 2024) and clinical outcome monitoring via electronic health records. The qualitative strand involved a multi-case study approach with purposive sampling (n=20) through in-depth interviews. Data collection occurred at 6-month post-implementation (July 2024), with clinical monitoring through December 2024. Analysis integrated descriptive and inferential statistics with thematic analysis.

Results: Post-implementation analysis revealed significantly enhanced nutrition literacy skills (M=4.14, SD=0.414), with notable improvements in communication (M=4.74, SD=0.511) and implementation (M=4.21, SD=0.440). All six nutrition literacy domains showed strong correlations (r=0.712-0.868, p<.01), supporting the framework’s interconnected nature. Clinical outcomes improved significantly: oral health check-up rates increased from 1.41% to 2.61% (p<.05), and functional teeth retention rose from 87.36% to 92.72% (p<.01). Qualitative findings revealed adaptive knowledge transfer methods and context-specific implementation strategies influenced by community readiness.

Conclusion: Through comprehensive mixed-methods evaluation, the 12-month implementation data demonstrated significant improvements in both VHVs’ nutrition literacy skills and clinical oral health outcomes. Success factors included theoretically-grounded implementation strategies and stakeholder engagement in resource-limited settings.

Keywords:         Convergent Parallel, Health Literacy, Mixed Methods, Nutrition, Oral Health, Thailand, Village Health Volunteer

Abstract

Introduction: Healthcare professionals need to advocate for mothers and understand breastfeeding challenges, especially in a community-based culture. We developed a breastfeeding management course for healthcare professionals and students in health-related majors on an online platform at our university. This study aimed to explore what participants learned from an experiential learning assignment to interview mothers regarding their breastfeeding challenges, and write a reflection on it.

Methods: In this qualitative study, we analysed the written reflections of 56 participants after they interviewed mothers regarding their breastfeeding challenges. Thematic analysis and triangulation among the researchers were conducted to obtain themes.

Results: Four themes were identified: (1) differences in knowledge and beliefs about breastfeeding among mothers and their families, (2) breastfeeding challenges that can be a threat to breastfeeding, (3) healthcare professionals’ central role in providing education and advocating for breastfeeding, and (4) involvement of the family and community in breastfeeding education.

Conclusion: This interview and reflective writing assignment strengthened the participants’ awareness of how to advocate for breastfeeding mothers, including considering the influence of the community context.

Keywords:           Breastfeeding, Communal Culture, Experiential Learning, Reflective Writing

Abstract

Introduction: Response rates to surveys of medical students and junior doctors have not previously been explicitly examined. Reasons for the observed response rates have not been scrutinised.  The aims of the present study were to establish an expected response rate to electronic survey among medical students and junior doctors, and to explore reasons behind non-response.

Methods: A follow-up online survey was sent to 93 medical students and junior doctors. The primary method for participants to complete the survey was via the Internet using a well-known and established survey tool. Descriptive and inferential statistics were used to assess response rates and reasons for non-response.

Results: Out of 93 invited medical students and junior doctors, 47 returned the follow-up survey (response rate = 50.5%). The main reasons for non-response were: there were too many surveys (74.4%), lack of time (25.5%), and the original survey being too long (10.6%).

Conclusion: We found a mediocre response rate (50.5%) to electronic surveys by medical students and junior doctors included in this study. Several factors that may impede response to surveys (survey-related, and participant-related) have been identified, and these may be specifically targeted to improve survey response rates.

Keywords:           Medical Student, Survey, Response Rate, Research, Methodology

INTRODUCTION

Lifelong learning is an essential skill for a successful medical practitioner to keep pace with rapidly advancing medical knowledge and technologies. Artificial intelligence(AI) has a potential in developing and promoting the skill of lifelong learning among medical undergraduates. AI can facilitate adaptive learning, collaborative learning, coaching, and incorporating evidence-based learning in undergraduate education as measures promoting lifelong learning. Users should be aware of the capabilities and limitations of the technology to promote effective incorporation in education. Medical undergraduates should receive a basic AI education to harness its’ potential in the best possible ways in lifelong learning.

INTRODUCTION

Soft skills help a person to boost his or her own performance. They are necessary for professional development. Effective communication and decision making are an integral part of good clinical care. Introduction to soft skills during undergraduate training helps students to appreciate and learn effective interpersonal communication with patients and their families. Soft skills training was not a part of academic curriculum in formal traditional medical training. (Sancho-Cantus et al., 2023). However, since 2019, AETCOM module was added in medical profession in India, in which students need to learn attitude, ethics and communication (Medical Council of India [MCI], 2018). In addition to verbal communication, non-verbal communication including body language, eye contact, facial expression, touch and gestures are equally important in building trust in doctor-patient relationships. In order to inculcate these soft skills in their future profession, students need to practice these skills again and again.

INTRODUCTION

The concept of “gamification” has been introduced to medical education: game elements employed for education enhance learning outcomes by making the educational process more interactive and engaging (Lee et al., 2025). Various games have been introduced—serious games, escape rooms, simulation games, and others. Although the theoretical underpinnings of why “gamification” improves educational outcomes are not yet fully clarified, incorporating game mechanics into medical education appears to enhance learner motivation, engagement, and performance, particularly in teaching clinical reasoning and collaborative decision-making (Lee et al., 2025).

In this manuscript, I wish to introduce the application of “gamification” to medical meetings, especially from the viewpoint of the audience. More accurately, I have been practicing it for 30 years—long before the term “gamification” became widely recognised. Here, “gamification” does not refer to a systematic process involving meeting stakeholders, but rather to the individual audience member’s attitude toward how to attend. I believe that “gamification” activates attendees and benefits them: it helps them remain well informed in the face of ever-expanding knowledge.

INTRODUCTION

This article proposes a Chinese philosophical approach to well-being for medical education by drawing on the thought of Mencius (372-289 B.C.E.). As it is not possible to cover all areas of Mencius’ philosophy within this short essay, our focus is on Mencius’ idea of interpersonal joy, as recorded in the classic Mengzi. This paper shall explain how interpersonal joy, from a Mencian perspective, centres on the shared delight from benefiting others while cultivating personal virtue.

INTRODUCTION

Medical education is a cornerstone of effective healthcare delivery, directly shaping professionals responsible for addressing the complex and evolving needs of patients, families, and communities. Over the last few decades, medical education has undergone significant transformations due to global trends that have influenced curricula structures, learning methodologies, and competency requirements for healthcare professionals. These shifts reflect broader societal, technological, and policy changes, necessitating adaptable and forward-thinking medical education systems.

One key driver of change is globalisation, fostering interconnected healthcare systems and necessitating curricula that emphasise global health perspectives, cultural competence, and cross-disciplinary collaboration.

Additionally, technological advancements, such as simulation-based learning, virtual reality (VR), augmented reality (AR), and telemedicine training, have revolutionised medical education, improving accessibility and enhancing learning experiences.

The increasing importance of accreditation and quality assurance frameworks ensures standardisation in medical education across regions, promoting transparency and continuous improvement (Bedoll et al., 2021). Simultaneously, the shift towards outcome-based education (OBE) prioritise competency-driven frameworks over traditional content-heavy curricula, aligning medical training with healthcare needs. Furthermore, cultural and contextual adaptations are crucial in tailoring curricula to regional healthcare priorities while maintaining global standards.

This paper examines how these international trends, globalisation, technological advancements, accreditation, outcome-based education, and cultural contextualisation, are shaping the future of medical education and influencing curricula to remain responsive to evolving healthcare demands.

We are currently living in a time in which different assessment paradigms co-exist. There are contexts in which assessment is purely seen as a measurement, for instance national licensing. There are contexts in which assessment is predominantly judgement, such as in VIVAs and there are contexts in which these are combined to form an integral programmatic assessment for learning program.

Although a programmatic assessment for learning aims to combine both measurements and judgements, the manner in which all assessment data is synthesised and fed back to the learner is always through judgement and narratives. That is inevitable because numerical outcomes without added narratives are as meaningless as a scientific paper without an introduction, methods and discussion section and only the tables of the results. Numerical outcomes can only drive learning purely by punishment and reward and cannot provide the learner agency or support with meaningful self-regulation of their learning. Modern professionals, however, need capabilities to self-regulate their learning.