Submitted: 17 December 2025
Accepted: 6 April 2026
Published online: 7 July, TAPS 2026, 11(3), 1-7
https://doi.org/10.29060/TAPS.2026-11-3/GP3968

Mohamad Hamim Mohamad Hanifah¹ & Jubaida Paraja²

¹Department of Emergency Medicine and ²Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

Abstract

Introduction: Medical education increasingly values experiential learning, yet the profound pedagogical potential of humanitarian deployments remains underexplored. This narrative review, based on a clinician-educator’s first-hand field experiences, argues that humanitarian fieldwork in conflict and resource-limited settings serves as a powerful catalyst for innovation in medical education, offering unique lessons that can transform teaching and learning.

Methods: Drawing on the author’s humanitarian missions in Bangladesh, Myanmar, Afghanistan, and Lebanon, this paper employs a reflective, practice-based analysis from a clinician-educator’s perspective. Key experiences are examined and systematically aligned with established educational theories, including transformative and experiential learning, to extract transferable educational principles and pedagogical strategies.

Results: The analysis identifies four critical themes from humanitarian fieldwork: ethics-in-action, cultural humility, resilience, and clinical improvisation. These themes were translated into concrete educational strategies–low-resource simulation, narrative medicine, case-based ethics, and train-the-trainer models–when integrated into formal curricula, significantly enrich student learning. They foster not only clinical competence but also empathy, ethical reasoning, and a sense of global citizenship.

Conclusion: Humanitarian medicine represents a powerful form of transformative professional development, where discomfort becomes a catalyst for growth. Integrating these field-derived lessons enhances teaching effectiveness, deepens reflective practice, and strengthens institutional capacity for global health education. These insights highlight the educational value of humanitarian experiences in cultivating resilient, ethical, and compassionate educators–qualities essential for preparing future-ready healthcare professionals.

Practice Highlights

• Humanitarian fieldwork generates critical educational themes.
• Low-resource simulation is a powerful, transferable pedagogical tool.
• Integrating authentic field narratives and ethical dilemmas into curricula.
• The “Train-the-Trainer” model empowers learners and build sustainable capacity.
• Humanitarian deployments should be recognised as valuable faculty development.

I. INTRODUCTION

Modern medical education prioritises experiential learning to shape competent and compassionate healthcare professionals (Taylor & Hamdy, 2013). Among the most potent yet underutilised sources of this learning are humanitarian deployments. These missions place clinicians in conflict zones, disaster areas, and resource-limited settings, demanding not only clinical skill but also ethical sensitivity, cultural awareness, and logistical adaptability. For educators, they offer a transformative lens through which to re-examine teaching and curriculum design.

This narrative review is grounded in my first-hand experiences with humanitarian organisations in Bangladesh, Myanmar, Afghanistan, and Lebanon. Each mission, set against a backdrop of crisis, provided unique insights into healthcare delivery under extreme duress. More importantly, they revealed the essential competencies for humane and effective practice–skills increasingly vital in today’s unpredictable global health landscape.

I argue that humanitarian fieldwork, when critically reflected upon, is a powerful engine for educational innovation. By aligning field-based lessons with established educational frameworks, I demonstrate how these experiences can enrich mainstream medical education. My aim is to advocate their structured integration to foster a new standard of clinical excellence, empathy, resilience, and global citizenship. 

II. FIELD-BASED LEARNING: THE WORLD AS A CLASSROOM

Humanitarian deployments are immersive, high stakes learning environments where conventional medical training is both tested and transcended. Far from the structured confines of academia, these missions unfold in unpredictable and resource-constrained contexts. They demand real-time clinical decision-making, deep cultural sensitivity, and the ability to improvise–skills often peripheral in standard curricula. My experiences across four distinct settings illustrate how such environments become unparalleled classrooms.

A. Bangladesh-Myanmar Food Flotilla (2017): Learning through Adaptability

During a maritime aid mission, bureaucratic delays in port clearance were inevitable. Instead of idling, we transformed this time into a training opportunity. Onboard the vessel, we conducted capacity-building sessions for volunteers, using realistic simulation drills for man-overboard and mass casualty scenarios. This was not abstract theory; it was essential preparation for potential emergencies at sea. The core educational insight was clear: when original plans fail, meaningful learning can still thrive if we reimagine our objectives with flexibility and purpose.

B. Afghanistan (2024): Education Amidst Extreme Scarcity

A mission to a high-volume maternity hospital in Kabul presented a starkly different challenge: profound resource scarcity. With only two CTG monitors for hundreds of high-risk patients, the constraint was omnipresent. Yet, the commitment of local staff was extraordinary.

Despite exhausting clinical shifts, they engaged deeply in hands-on workshops on basic life support (BLS), advanced life support (ALS), neonatal resuscitation, obstetric emergencies, and point-of-care ultrasound (POCUS). Navigating Dari and Pashto language barriers through interpreters and translated materials embedded inclusivity into our teaching. The most powerful validation came hours into the training, when a resident successfully revived a newborn using the techniques just practiced–a direct testament to the life-saving impact of contextually relevant education.

C. Lebanon (2025): Building Community Capacity

In Beirut’s Shatila refugee camp, the focus shifted to sustainable, community-based learning. Within the camp’s dense and fragile infrastructure, we delivered interactive simulation workshops on BLS, ALS, trauma care, and pain management to Palestinian healthcare providers. Physical space was limited, necessitating creative scheduling and use of communal areas. A pivotal moment occurred when a volunteer physiotherapist excelled in an ALS simulation. Recognising her potential, we empowered her to become a trainer herself. This outcome embodies a core educational principle: sustainable capacity is built by identifying and empowering talent within the community.

Collectively, these missions reveal field-based learning as a multidimensional crucible. It forges not only clinical competence but also emotional intelligence, cultural humility, and emergent leadership. This process aligns perfectly with Kolb’s (1984) experiential learning cycle, where concrete experience sparks reflection, conceptualisation, and active experimentation. In each setting, the field itself–with all its challenges–became the most authentic and relevant curriculum. A summary of these missions, their challenges, and derived educational themes is provided in Table 1.

Mission Location	Context	Key Challenges	Educational Themes	Pedagogical Translation
Bangladesh (2017)	Maritime humanitarian aid	Restricted clinical access	Flexibility, resilience	Emergency drills, BLS training
Afghanistan (2024)	Maternity hospital	Resource scarcity, language barriers	Ethics-in-action, cultural humility	Low-resource simulation, translated materials
Lebanon (2025)	Refugee camp	Infrastructure limitations	Empowerment, improvisation	Train-the-Trainer model, peer teaching

Table 1. Summary of Humanitarian Missions and Educational Insights

III. CORE EDUCATIONAL THEMES FROM THE FIELD

Beyond technical skills, humanitarian deployments expose broader, transformative themes that are difficult to replicate in a traditional classroom. From my missions, four essential themes emerge as critical for holistic physician development.

A. Ethics in Action

Medical ethics are often taught as abstract principles. In Kabul’s maternity hospital, they became urgent, daily dilemmas. With only two CTG monitors, deciding which high-risk patient received monitoring was a matter of distributive justice in real time. Allocating the last ICU bed or final dose of a critical drug required instant ethical reasoning rooted in clinical urgency and compassion. These experiences underscore that ethics must be taught as a dynamic, context-sensitive process, not a detached philosophical debate.

B. Cultural Humility and Linguistic Sensitivity

Effective cross-cultural practice requires cultural humility–an ongoing openness to self-reflection and acknowledgment of one’s limitations. In Kabul, this meant adapting all materials and using interpreters for Dari and Pashto speakers. In Shatila, it involved localising content into Arabic and framing it within the Palestinian refugee experience. These efforts shift the paradigm from one-way knowledge transfer to building collaborative learning partnerships that respect and integrate linguistic and cultural realities.

C. Resilience and Emotional Intelligence

The emotional weight of humanitarian work is profound. In Bangladesh, our team faced moral distress when logistical barriers prevented direct clinical care. Pivoting our role from healers to educators required significant emotional resilience and a reframing of purpose. Witnessing local providers in Lebanon continue to offer dignified care amidst overwhelming adversity highlighted the indispensable role of emotional intelligence–self-awareness, empathy, and peer support–as a core clinical competency.

D. Improvisation and Clinical Agility

Each mission demanded creative problem-solving. On a ship’s rolling deck in Myanmar, we adapted emergency drills to the moving environment. In Afghanistan, we taught ALS using minimal equipment, relying on inventive substitutions. In Lebanon’s cramped spaces, we redesigned schedules and used community resources innovatively. These experiences cement the value of “thinking on one’s feet”–maintaining safety and efficacy despite severe constraints, a skill of increasing relevance in all healthcare settings.

IV. PEDAGOGICAL TRANSLATION: FROM FIELD TO CURRICULUM

Transforming the raw lessons of humanitarian fieldwork into structured medical education requires more than storytelling–it demands intentional pedagogical design (Milota et al., 2019). My experiences have been translated into educational strategies, simulations, and reflective exercises that enrich clinical teaching and professional identity formation. These core strategies, their origins, and their educational benefits are outlined in Table 2.

Table 2. Pedagogical Strategies Derived from Humanitarian Deployments

A. Simulation-Based Learning in Low-Resource Contexts

Simulation was a cornerstone of all field missions, proving that high-fidelity learning doesn’t require advanced technology. Inspired by maritime drills in Myanmar and low-equipment ALS simulations in Afghanistan, I developed low-resource simulation modules for students. These exercises challenge learners to manage emergencies with limited personnel and tools, emphasising adaptability, teamwork, and clinical reasoning over technical dependence.

B. Ethics and Cultural Humility through Case-Based Discussion

The ethical dilemmas of Kabul and the cultural adaptations of Shatila have been transformed into compelling case studies. Students now grapple with scenarios like triaging the last ICU bed, sparking deep discussions on justice in resource-poor settings. Cases involving language barriers prompt reflection on informed consent and cross-cultural trust-building, grounding abstract ethical principles in tangible complexity.

C. Narrative Medicine and Reflective Writing

Authentic field stories are powerful catalysts for discussion. The journey of the Shatila physiotherapist who became a trainer sparks conversations about identity, potential, and medicine’s social mission. Reflections on the pivot from clinical care to training in Bangladesh form the basis of writing assignments that help students process concepts of frustration, failure, and purpose, humanising their own educational journey.

D. Train-the-Trainer and Peer Teaching Models

The success of empowering local providers in Lebanon inspired the adoption of peer-teaching models in my home institution. Senior medical students now co-facilitate BLS and trauma sessions for their juniors. This reinforces their knowledge while developing essential skills in leadership, communication, and mentorship, creating a self-sustaining educational culture.

These translations are rooted in Mezirow’s (1991) transformative learning theory. The “disorienting dilemmas” faced in the field–ethical, cultural, logistical–act as powerful triggers for critical reflection. When imported into the classroom via simulation and narrative, they disrupt students’ assumptions about healthcare and their role within it, fostering the perspective shift essential for transformative growth. The complete model for translating humanitarian fieldwork into curricular innovation is illustrated in Figure 1.

 

Figure 1: From Humanitarian Fieldwork to Curricular Innovation: A Model for Transformative Integration in Medical Education

(Note: This diagram illustrates the authors’ original conceptual framework and was visually rendered using OpenAI’s DALL-E 3 image generation tool on 17 December 2025.)

V. DISCUSSION: THEORETICAL ALIGNMENT AND INSTITUTIONAL IMPLICATIONS

The case for integrating humanitarian field experiences into medical education is strengthened by its firm grounding in foundational learning theories. This alignment provides a robust rationale for formal inclusion in faculty development and curriculum design.

A. Transformative Learning in Practice

Mezirow’s (1991) theory finds vivid expression in these missions. The discomfort and dissonance encountered are not impediments but the essential catalysts for deep learning. When educators model the vulnerability of grappling with ethical ambiguity or logistical failure, they give students permission to engage in the critical self-reflection necessary for their own transformative professional development.

B. Enacting the Experiential Cycle

These deployments perfectly illustrate Kolb’s (1984) experiential learning cycle. The concrete experience of teaching neonatal resuscitation in Kabul leads to reflective observation (debriefing), then to abstract conceptualisation (understanding the power of low-resource simulation), and finally to active experimentation (designing and implementing a new curriculum module). This cycle ensures field learning is an active, iterative process of knowledge creation, not a passive event.

C. Building Communities of Practice

The Train-the-Trainer model’s success in Lebanon is a direct embodiment of Lave and Wenger’s (1991) situated learning theory. By progressing from peripheral participant to central trainer, local volunteers fully entered their community of practice. Similarly, when students engage with these global health narratives, they begin to envision themselves as part of an international community of healthcare providers, fostering a sense of shared responsibility and belonging.

To harness this potential, institutions must act. Humanitarian work should be formally recognised as valuable Continuing Professional Development (CPD) for educators. Faculty development programs should incorporate modules on “contextual pedagogy,” teaching in low-resource settings, and using narrative and simulation drawn from global health. Creating structured platforms–such as dedicated grand rounds or digital story repositories–for faculty to share field-based insights can enrich an institution’s entire educational ecosystem.

Ultimately, humanitarian medicine teaches us to reframe discomfort. The field’s unpredictability, emotional intensity, and ethical complexity create a fertile ground for the deepest form of learning. By embracing these experiences as central to our educational mission, we can prepare a generation of physicians who are not only clinically expert but also emotionally intelligent, culturally humble, and equipped to lead in an uncertain future.

VI. CONCLUSION

Humanitarian medicine is more than service; it is a transformative educational journey. Stepping beyond institutional comfort zones fosters profound growth. These missions demanded a synthesis of clinical expertise, emotional resilience, cultural humility, and ethical clarity–the very qualities that define a compassionate, globally minded physician.

Challenges like language barriers, scarcity, and human suffering were not obstacles but essential catalysts for learning. These “disorienting dilemmas” prompted deep reflection, reshaped my professional identity, and inspired innovative approaches to teaching.

By integrating humanitarian narratives, low-resource simulations, and real-world ethical dilemmas into curricula, we bridge the gap between theoretical knowledge and practical wisdom. We invite learners to explore not just how to treat disease, but what it means to serve, lead, and care in adversity. These lessons cultivate empathy, global citizenship, and a service-oriented mindset–qualities indispensable in our interconnected world.

For educators, humanitarian deployments are unparalleled faculty development. They refine pedagogy, deepen reflective practice, and foster knowledge co-creation with diverse communities. Academic institutions must recognise and support these experiences not as extracurricular, but as essential to health professions education.

The most powerful education occurs in the messiness of real life–in refugee camps, on ships, in under-equipped hospitals, in moments of shared humanity. Here, textbook knowledge meets compassion, theory is tested by reality, and both learners and educators grow. Humanitarian medicine must be embraced not only as service but as a transformative force that teaches with both knowledge and heart.

Notes on Contributors

Mohamad Hamim Mohamad Hanifah conceived the work based on firsthand field experiences; acquired and interpreted the narrative data and drafted the initial manuscript and its critical intellectual content.

Jubaida Paraja contributed to the conceptual design of the pedagogical translation framework and critically revised the manuscript for important intellectual content.

All Authors provided final approval of the version to be published and agree to be accountable for all aspects of the work.

Acknowledgement

We are deeply grateful to the humanitarian partners and the dedicated local health teams in each field location for their partnership, resilience, and shared commitment to care under extreme conditions. Their work is the foundation of this reflection. We also thank our peers for their insightful comments during the development of this article.

Funding

No specific grant was received from any funding agency for the writing of this manuscript. The humanitarian deployments described were conducted in a voluntary capacity with various non-governmental organisations.

Declaration of Interest

The authors declare no conflicts of interest related to the research, authorship, or publication of this article.

Declaration of AI and AI-assisted Technologies in the Writing Process

All structural mapping, pedagogical pathways, and textual content were defined solely by the authors; the AI tool DALL-E 3 was used exclusively for graphic synthesis and formatting.

References

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice-Hall.

Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press. https://doi.org/10.1017/CBO9780511815355

Mezirow, J. (1991). Transformative dimensions of adult learning. Jossey-Bass.

Milota, M. M., van Thiel, G. J. M. W., & van Delden, J. J. M. (2019). Narrative medicine as a medical education tool: A systematic review. Medical Teacher, 41(7), 802–810. https://doi.org/10.1080/0142159X.2019.1584274

Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561–e1572. https://doi.org/10.3109/0142159X.2013.828153

*Assoc. Prof. Dr. Jubaida Paraja
Faculty of Medicine and Health Sciences,
Universiti Malaysia Sabah,
88400 Kota Kinabalu,
Sabah, Malaysia
Email: jubaida@ums.edu.my

Submitted: 25 November 2024
Accepted: 18 November 2025
Published online: 7 July, TAPS 2026, 11(3), 8-16
https://doi.org/10.29060/TAPS.2026-11-3/OA3575

Pasin Tangadulrat, Jongdee Bawornpatarananon & Nisalak Upho

Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Thailand

Abstract

Introduction: Game-based learning (GBL) is a well-known method for enhanced learning. However, literature suggests varying engagement and outcomes with various types of GBL. Therefore, we aimed to evaluate the effectiveness of a Japanese-style role-playing game (JRPG) on improving the learning of fifth-year medical students.

Methods: We conducted a mixed method explanatory study using a quasi-experimental study with a historical control as the quantitative component. A JRPG was introduced to fifth-year medical students in 2023 and compared with the 2022 cohort using MCQ and MEQ scores. Student experiences were assessed through a Likert-scale questionnaire and focus group interviews analysed by thematic analysis.

Results: We recruited 57 participants. The demographic data, and overall test scores of the participants did not differ from those of their counterparts in the previous year. The mean score for the paediatric orthopaedics MCQ (five questions) test did not differ between the two groups (3.2 ± 0.9 for the 2023 class vs. 3.5 ± 0.8 for the 2022 class, p = 0.477). The 2023 class had slightly higher mean paediatric orthopaedics MEQ test scores than did the 2022 class (66.8 ± 8.8 vs. 62.8 ± 8.7, p = 0.06), with no statistically significant difference. Most students reported good experiences while playing the game, mainly saying that it was fun and interesting and helped motivate them to study more about the subject.

Conclusion: While JRPG did not significantly affect student performance, it is one of the approach that can provide good engagement, motivation, and learning experiences.

Keywords:       Game-based Learning, Japanese-style Role-playing Game, Medical Education, Paediatric Orthopaedics, Medical Learning, Academic Knowledge

Practice Highlights

• Game-based learning can enhance student engagement and motivation.
• JRPGs provide a novel and interesting teaching method
• Game genres might help simulate students’ engagement
• Students appreciate the teacher’s effort, leading to better engagement
• Further evaluation is needed to assess the impact on academic performance.

Figure 1. Various screenshots from the game, including in-game explanation of game mechanics (upper left), a multiple-choice style question (upper right), a critical learning point explanation (lower left), and part of the game story with humorous and engaging dialogue (lower right).

Table 1. Medical students’ demographic data

Figure 2. Comparison of various test score between the historical control group and GBL group. The paediatric MCQ score was scaled to 100 to better visualise the difference.

Most students strongly agreed or agreed with a positive statement regarding the game (Table 2). The proportion of students who answered “neutral” was higher than 10% for two of the statements: “I feel that the gameplay is easily understood and easy to play” and “The time taken to finish the game was appropriate”.

Table 2. Satisfaction of the students participating in game-based learning

A total of 57 fifth-year medical students participated in the GBL , and all were included in the qualitative analysis through focus group interviews. These interviews were conducted across 7 rotations, with 8-9 students participating in each session. Using thematic analysis, we coded the responses into two themes, along with their supporting subthemes and corresponding responses (Table 3).

Theme	Subtheme	Illustrative Student Quotes
GBL can stimulate students’ learning experience and engagement	Novel and interesting teaching method	– I feel it is like a switch. I know I need to study, but sometimes I feel tired and do not want to open a book. Nevertheless, the game was interesting. Therefore, I decided to play the game. After playing it, it piqued my interest in studying more, and now, I intend to read more about the subject.
	Familiarity with the game style	– It reminded me of a game called Ragnarok, which I used to play a lot when I was in middle school. I did not think that similar educational games could be created.   – The looks of the game were surprising to me, because I used to play a game like this. The in-game system and progression were also interesting to me, because I want to know if the character progression would be similar to what I had experienced in this game genre.
	Teacher’s efforts and student reciprocity	– Actually, I am not that familiar with JRPG. However, I know that making this kind of thing probably requires significant time and effort, so I feel I will give it a try for the teacher’s sake.   – I feel that the knowledge inside the game is probably really important because the teacher spent a lot of time making it. I don’t want to waste the teacher’s effort.
Theme 2: Technology-based GBL models should be optimised for the user experience	Game length and pacing	– I feel that the time it took to finish the game is too long. I was not interested in the story, but the part where I got to treat patients was interesting. It would be good if there were a skip button for the story.
	Technical issues	– I did not finish the game in one go and wanted to pause and save. However, the saved file was gone, and I had to restart from the beginning, which was very frustrating.

Table 3. Thematic analysis results, including their supporting subthemes and responses

IV. DISCUSSION

Our study reported results obtained from using a distinct type of JPRG with a case-based study. We found that most students had positive experiences using the game in addition to the current curriculum. However, this did not lead to significantly better test scores.

GBL is an interesting topic in medical education. Many studies have demonstrated that GBL can improve the engagement and learning experiences of medical students (Al-Mugheed et al., 2022; Boeker et al., 2013; Gorbanev et al., 2018). We found that the participants enjoyed playing the game and felt engaged with the subjects. The reasons for feeling engaged were attributed to many factors. First, the novelty of the game likely stimulated curiosity and intrinsic motivation, which are critical for sustained engagement in learning. This was directly evidenced in the interview results, where students expressed excitement for a new, unconventional learning method. In addition, we incorporated many recommended mechanics known to enhance GBL effectiveness, such as using a familiar game style, feedback, and competition via leaderboard (Pitt et al., 2015).

A particularly interesting finding is that familiarity with the game type may have an effect on participants’ engagement. For many students in Thailand, the JRPG format resonated due to their extensive exposure to video games from a young age (Jirasatmathakul & Poovorawan, 2000). A study of the Canadian student population also reveals that students with an East Asian background have significantly more positive experiences with GBL than other cultural groups, which may be attributed to their greater exposure to and familiarity with gaming (Jossan et al., 2021). Game types might also play a role in stimulating engagement. Role-playing games have been shown to have high engagement in younger players and persist throughout young adulthood (Ream et al., 2013). This highlights how leveraging existing gaming culture and game types could help stimulate interest in academic learning.

Lastly, we found an interesting insight regarding the teacher’s perceived effort and student reciprocity. In Asian cultures, a deep-rooted sense of gratitude towards teachers can influence student behaviour. Some students expressed feeling motivated to engage with the game as a reciprocal gesture, appreciating the significant effort involved in its development, even if the game style wasn’t initially their preference. This suggests that the perceived value and investment from the educator, beyond the game’s mechanics, can profoundly enhance student motivation and participation. However, it is crucial to acknowledge that this cultural concept may not apply in other cultural contexts, limiting the generalisability of this factor.

GBL implementations, especially those utilising new or unique technologies, must be carefully optimised for user experience. As shown in our study, some students encountered technical problems, such as issues saving game progress when playing on an iPad. While these problems were eventually addressed, they undeniably disrupted the learning experience for affected students. These technical aspects, alongside other user experience considerations, are reflected in the higher proportion of “Neutral” answers observed for questions regarding gameplay ease and the appropriateness of game length, with some students expressing that the game felt too long, and others struggling to fully grasp the gameplay mechanics.

To enhance future participant experiences, incorporating features such as a skipping or fast-forward system for narrative sections, and providing more detailed orientation on game progression and mechanics, would be beneficial. Furthermore, as medical education integrates newer technologies like virtual reality and advanced high-tech gear for educational games, it is critical that game developers thoroughly check and rigorously play-test the game prior to student deployment. This approach, coupled with immediate support for technical issues, is crucial to prevent disruptions and ensure an optimal learning environment.

Our study reported positive student experiences with a JRPG-style game, yet this did not translate into statistically significant improvements in examination scores. A slight positive trend was, however, observed in the  paediatric MEQ scores. Several factors likely explain the lack of a statistically significant effect on test scores. First, our quasi-experimental design used a historical control group and assessed knowledge at the end of the curriculum, rather than in a pre- and post-test fashion. This design introduces potential confounding variables, such as individual student study habits and knowledge retention over the rotation, which may obscure the direct impact of the intervention. A potential recall effect from the in-game questions may have influenced performance, but it is difficult to isolate this from routine self-study.

Second,  paediatric orthopaedics questions constituted only about 10% of the total examination content. With such a low weighting, any genuine knowledge gains from the game would be difficult to detect statistically. Third, as the game was an optional, adjunct activity, the “dosage” of the intervention varied significantly among students. This inconsistency in exposure makes it challenging to measure a uniform effect across the cohort. Future implementations could explore mandatory integration to ensure a consistent level of engagement. Our finding that a GBL tool did not produce significantly better test scores aligns with other studies in the field, which have also found that game-based interventions may not outperform traditional teaching methods like didactic lectures (Trevino et al., 2016). Lastly, as our qualitative data revealed, student motivation and familiarity with the JRPG style varied, likely contributing to a wider variance in learning outcomes and diluting the overall mean effect on test scores.

Although overall scores did not significantly improve, the slight increase in MEQ scores suggests a potential alignment between the game’s design and the cognitive skills assessed by that format. The game’s integrated case-based scenarios were designed to promote higher-order cognitive skills such as ‘Application’ and ‘Analysis’ within Bloom’s Taxonomy. These skills are more effectively evaluated by MEQs, which require deeper reasoning and synthesis of information, than by MCQs, which often assess knowledge recall. The trend in MEQ scores may therefore indicate that the GBL was beginning to foster the intended clinical reasoning skills, even if the effect was not powerful enough to be statistically significant.

Our findings also signify that the efficacy of a GBL tool can be deeply influenced by cultural context. The selection of the JRPG genre was a deliberate attempt to leverage its cultural relevance and nostalgic value in Thailand, where the population has a high degree of exposure to this video game genre from a young age (Jirasatmathakul & Poovorawan, 2000). However, this cultural specificity has important implications for generalisability. While familiarity may have boosted engagement for many, it may also have acted as a barrier for those unaccustomed to this game genre.

We observed that some students were motivated by a sense of reciprocity towards the instructor’s effort. In many Asian cultures, deep-seated cultural values of high power distance and collectivism shape a hierarchical teacher-student relationship. This structure, in turn, could frame the teacher’s effort as a form of benevolence that induces a specific form of gratitude, one defined by indebtedness and obligation. This, in turn, motivates a response through the fulfillment of one’s role as a diligent student. Conversely, in Western contexts, where egalitarianism and individualism are more pronounced, this specific motivational response may be less robust (Allen et al., 2024; Chen, 2023; Kee et al., 2008).

A. Limitations

First, the controls were fifth-year medical students in the previous academic year, and their selection might have influenced the test scores. However, it was deemed unethical to include a control group that did not have the chance to experience GBL, which could potentially improve their learning experience. Choosing the historical control group is reasonable because the circumstances regarding the overall curriculum and tests were similar in both academic years. This similarity was evidenced by the absence of significant differences in the overall test scores and demographic data of the students between the two groups. However, we acknowledge that subtle differences in teaching quality or emphasis on specific topics by instructors, and different in student’s motivation between the academic years (2022 and 2023) could not be entirely ruled out as potential confounding variables.

The educational expert’s role as an undergraduate coordinator for the department may influence the responses of participants in the interviews, as students may attempt to provide more positive responses due to the authoritative role of the interviewer. In addition, from the interviews, we noted that some students were more excited or were readily engaged in the game than others, potentially because of their familiarity with this type of game. Therefore, the efficacy of game formats may be culture specific. For example, students who have previously engaged in similar gaming styles, such as those from Southeast Asia, may find the game more appealing. Conversely, students who lack experience with this game type may not demonstrate the same enthusiasm level, therefore, reduce the generalisability of the method beyond Thailand.

Building on these limitations, future research should adopt more rigorous designs. Longitudinal studies would be able to assess long-term knowledge retention and the sustained impact of GBL on clinical reasoning skills. Pre- and post-test designs would also provide a more direct measure of knowledge acquisition attributable to the game, mitigating self-study or recall effects. Comparing the JRPG group with other active intervention group could help isolate its unique benefits.

V. CONCLUSION

In conclusion, JRPG-style gamed-based learning is one approach that can engage and motivate student learning experiences. Game types and styles may help stimulate learners’ engagement due to familiarity and experience. Lastly, the test score did not show significant improvement; therefore, future evaluations should prioritise rigorous longitudinal or pre- and post-test designs to better assess GBL’s impact on academic performance and clinical reasoning.

Ethical Approval

This study was approved by the Ethics Committee, Faculty of Medicine, Prince of Songkla University (REC-4850).

Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to ethical concerns.

Funding

There is no funding for this research.

Declaration of Interest

The authors report there are no competing interests to declare.

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*Nisalak Upho
15 Kanchanavanit Road, Hat Yai,
Songkhla, 90110
Email: nisalak20@gmail.com

Submitted: 1 June 2025
Accepted: 23 March 2026
Published online: 7 July, TAPS 2026, 11(3), 17-26
https://doi.org/10.29060/TAPS.2026-11-3/OA3767

Luu Thi Thuy¹, Tran Thi Hoang Oanh², Nguyen Thi Thu Thao¹, Dang Van Thoi³, Le Thi Anh Tuyet⁵, Nguyen Hoa Van Chi¹, Nguyen Huong Giang¹, Nguyen Thi Ai Ny⁴ & Tran Thi Thu Trang¹

¹Faculty of Nursing, Da Nang University of Medical Technology and Pharmacy, Vietnam; ²Institute of International Education, Hue University of Medicine and Pharmacy, Hue University, Vietnam; ³Faculty of Medicine, Da Nang University of Medical Technology and Pharmacy, Vietnam; ⁴Danang Oncology Hospital, Vietnam, ⁵Da Nang Hospital, Vietnam

Abstract

Introduction: ChatGPT, a large language model, has considerable potential in higher education. However, its academic use and associated factors among Vietnamese postgraduate healthcare students remain underexplored. This study aimed to examine the academic use of ChatGPT and identify factors associated with its use.

Methods: A cross-sectional study was conducted among 301 postgraduate students at a public healthcare university in Central Vietnam between August and December 2024. Data were collected using a self-administered questionnaire assessing demographic characteristics, ChatGPT-related knowledge, attitudes, and academic use. Descriptive statistics and non-parametric analyses, including point-biserial and Spearman’s rank-order correlations, were performed.

Results: The mean academic use score was 4.32 out of 10 (SD = 4.00). More than half of participants reported using ChatGPT to clarify unclear content (57.5%) and to develop writing outlines (53.2%). Academic use was positively correlated with ChatGPT knowledge (r = 0.373, p < 0.001) and with attitudes toward technology and social influence (r = 0.282, p < 0.001), but was not associated with gender, age, or working position.

Conclusion: Vietnamese postgraduate healthcare students demonstrated moderate academic use of ChatGPT. Greater knowledge and more favourable attitudes toward technology and social influence were associated with higher levels of use. Structured training and clear institutional guidance may therefore support more effective and responsible integration of ChatGPT in postgraduate education.

Keywords:           Academic Use, Artificial Intelligence, ChatGPT, Health Education, Postgraduate Students

Practice Highlights

• Postgraduate students most frequently used ChatGPT to clarify unclear contents and develop writing outlines, underscoring its emerging role in academic learning.
• Students’ knowledge of ChatGPT was a significant predictor of academic use, emphasising the importance of awareness and training initiatives.
• Positive attitudes toward technology and social influence were associated with increased use of ChatGPT, suggesting that institutional norms may shape its adoption.
• Structured training and clear institutional guidance may strengthen students’ competence and promote responsible use of ChatGPT.

Scale	CVI	KR-20kr		Cronbach’s alpha coefficient
		Pilot study	Actual study	Pilot study	Actual study
ChatGPT Knowledge Scale	0.93	0.58	0.53	–	–
Attitude Scale	0.95	–	–	0.51	0.79
Perceived risk dimension	1.00	–	–	0.84	0.89
Anxiety dimension	0.93	–	–	0.91	0.93
Attitude to technology/social influence dimension	0.92	–	–	0.94	0.91
ChatGPT Usage Scale	0.94	0.96	0.95	–	–

^krKuder-Richardson’s method

Table 1. Content validity index and reliability of the scales

An email containing a link to a Google Form was distributed to invite potential participants. The email outlined the purpose of the study and informed recipients of their right to withdraw at any time. Anonymity was assured throughout the survey process. Informed consent was obtained electronically, with participants indicating their agreement by clicking “Yes” to access the questionnaire. Completion of the survey typically required approximately 10-15 minutes.

C. Data Analysis

Data were analysed using SPSS version 26.0 (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics, including frequencies, percentages, means (M), standard deviations (SD), ranges, medians, and interquartile ranges (IQR), were calculated to summarise participants’ demographic characteristics, knowledge, attitudes, and ChatGPT usage.

Prior to conducting correlation analyses, the distribution of ChatGPT usage scores was examined using histogram inspection to assess normality. As the data were not normally distributed, non-parametric tests were applied. Specifically, point-biserial correlation and Spearman’s rank-order correlation were performed to examine associations between the investigated factors and ChatGPT usage. Statistical significance was set at p < 0.05.

D. Ethical Considerations

This study received approval from the Ethics Committee in Biomedical Research, Da Nang University of Medical Technology and Pharmacy on December 16, 2024 (Reference #97/CT-HDDD). Participants were fully informed about the study, confidentiality, and their right to refuse or withdraw. Informed consent was obtained from all participants prior to questionnaire administration.

III. RESULTS

1. Characteristics of Participants

A total of 301 postgraduate students participated in the study. The mean age of participants was 37.98 years (SD = 5.72), and 76.7% were female. More than half (54.8%) held non-managerial positions. The mean duration of work experience was 15.14 years (SD = 5.63). Detailed participant characteristics are presented in Table 2.

Table 2. Characteristics of the participants (N=301)

B. Knowledge and Attitude Regarding ChatGPT Among Participants

Participants had a mean knowledge score of 2.18 (SD = 1.39) out of a possible 6. The mean overall attitude score towards ChatGPT was 2.93 (SD = 0.46) on a 5-point scale, with observed scores ranging from 1.77 to 4.85. This value was close to the neutral midpoint (3.0). Detailed statistics are presented in Table 3.

Variable	Mean (SD)	Possible range	Observed range
Knowledge score	2.18 (1.39)	0 – 6	0 – 6
Attitude score	2.93 (0.46)	1 – 5	1.77 – 4.85
Perceived risk	2.53 (0.72)	1 – 5	1 – 4.6
Anxiety	2.39 (0.91)	1 – 5	1 – 5
Attitude to technology/social influence	3.66 (0.69)	1 – 5	1 – 5

Table 3. Knowledge and attitudes toward ChatGPT among participants (N=301)

C. Academic Use of ChatGPT Among Participants

As shown in Table 4, participants reported using ChatGPT for a range of academic purposes. More than half indicated that they used ChatGPT to clarify unclear contents and to develop outlines for writing projects. The mean score for academic use of ChatGPT was 4.32 (SD = 4.00) out of a possible 10, with a median of 4.00, indicating a moderate level of overall engagement. Floor and ceiling effects were observed in 33.9% and 20.6% of participants, respectively, suggesting notable clustering at both the lowest and highest possible scores.

Activity	“Yes” Answer n (%)	Mean (SD)	Median (IQR)
Using ChatGPT to clarify unclear contents in class.	173 (57.5)	0.57 (0.49)	1 (1.0)
Using ChatGPT to create writing project outlines.	160 (53.2)	0.53 (0.50)	1 (1.0)
Using ChatGPT to get an overview of a new topic.	144 (47.8)	0.48 (0.50)	0 (1.0)
Using ChatGPT to get content ideas for a paper.	139 (46.2)	0.46 (0.49)	0 (1.0)
Using ChatGPT to get feedback on the texts created.	136 (45.2)	0.45 (0.49)	0 (1.0)
Using ChatGPT to have texts summarised.	120 (39.9)	0.40 (0.49)	0 (1.0)
Using ChatGPT to get advice (e.g. on time management).	116 (38.5)	0.39 (0.48)	0 (1.0)
Using ChatGPT to create template-based content blocks (e.g. writing internship reports for various rotations)	115 (38.2)	0.38 (0.48)	0 (1.0)
Using ChatGPT for self-motivation (e.g. talking about stress and anxiety).	111 (36.9)	0.37 (0.48)	0 (1.0)
Using ChatGPT to have pre-written emails.	87 (28.9)	0.29 (0.45)	0 (1.0)
Academic use of ChatGPT		4.32 (4.00)	4.0 (9.0)
Floor percentage (Score = 0): 33.9%                    Ceiling percentage (Score = 10): 20.6%

Table 4. Academic use of ChatGPT among participants (N=301)

D. Factors Associated with the Academic Use of ChatGPT Among Participants

Table 5 presents the associations between demographic characteristics, knowledge, attitudes toward ChatGPT, and its academic use. A statistically significant moderate positive correlation was found between knowledge and ChatGPT usage (r = 0.373, p < 0.001). Although overall attitude was not significantly associated with usage, a weak positive correlation was observed for the dimension of attitudes toward technology and social influence (r = 0.282, p < 0.001). No statistically significant differences in ChatGPT usage were identified across demographic variables.

Variable	Academic use of ChatGPT
	r	95% CI	p-value
Age	-0.069sp	-0.179 – 0.047	0.232
Gender	0.024rb	-0.088 – 0.133	0.677
Work experience	-0.071sp	-0.182 – 0.037	0.217
Working position	-0.059rb	-0.170 – 0.060	0.306
Knowledge	0.373sp	0.270 – 0.469	< 0.001
Attitude	0.090sp	-0.028 – 0.198	0.120
Perceived risk	0.006sp	-0.115 – 0.125	0.924
Anxiety	-0.011sp	-0.132 – 0.099	0.855
Attitude to technology/social influence	0.282sp	0.164 – 0.391	< 0.001

^rbRank-biserial correlation coefficient       ^spSpearman’s Rho correlation coefficient

Table 5. Factors associated with the academic use of ChatGPT among participants

IV. DISCUSSION

A. Academic Use of ChatGPT Among Participants

The academic use of ChatGPT has been widely documented; however, its application among postgraduate healthcare students remains underexplored. In this study, the moderate mean and median usage scores suggest overall modest engagement. At the same time, the marked floor (33.9%) and ceiling (20.6%) effects indicate a polarised distribution, with a considerable proportion of students either not using ChatGPT or using it extensively. Such divergence may reflect differences in confidence, perceived legitimacy, or access to institutional guidance. Clustering at the extremes may also limit the scale’s sensitivity to detect more nuanced variation in usage behaviour.

The moderate level of academic use observed in this cohort may reflect contextual constraints rather than limited interest. Postgraduate healthcare students in Vietnam commonly balance academic study with ongoing professional and clinical responsibilities, which may encourage selective and task-oriented engagement. In this context, ChatGPT use may be shaped by pragmatic considerations, including time pressures, professional accountability, and caution regarding ethical boundaries in academic and clinical settings. Furthermore, where institutional guidance on ChatGPT remains emergent, students may adopt a measured approach rather than pursuing widespread or experimental integration.

Participants most frequently reported using ChatGPT to clarify unclear content, consistent with prior research highlighting its role in concept clarification and complex problem-solving support (Monib et al., 2025). In postgraduate healthcare education, where learners often balance academic, clinical, and professional responsibilities, such task-oriented use may reflect pragmatic rather than exploratory engagement. ChatGPT appears to function primarily as a cognitive scaffold, supporting comprehension and structuring of ideas in self-directed learning contexts.

More than half of participants reported using ChatGPT to generate writing outlines, and many used it to gain overviews of new topics, generate content ideas, summarise academic readings, and obtain feedback on drafts. These patterns align with prior findings that postgraduate students predominantly use ChatGPT for writing, revising, editing, and summarising tasks (Acosta et al., 2024; Belaldavar & Angadi, 2024). Similarly, Chauke et al. (2024) reported its use in refining research focus, rephrasing content, and reducing time spent searching for literature. Collectively, these findings suggest that ChatGPT is integrated into early-stage knowledge exploration and drafting processes, supporting efficiency and academic productivity.

In contrast, more personalised or practical applications were reported less frequently. Although over one-third of participants used ChatGPT for advice related to time management or emotional concerns, entertainment-related use appeared limited. This differs from findings among undergraduates, where entertainment significantly influenced usage (Lee et al., 2025). One possible explanation is that postgraduate students, who often manage study, work, and family responsibilities simultaneously, may prioritise efficiency over recreational experimentation. However, as such contextual factors were not directly measured, these interpretations remain tentative and warrant further investigation.

Fewer than one-third of participants reported using ChatGPT to draft pre-written emails. Although ChatGPT has been recognised as useful for improving academic communication, including writing style and clarity (Liu et al., 2024), its adoption for administrative or professional correspondence appears comparatively cautious in this cohort. This hesitation may stem from uncertainty regarding the appropriateness of AI-assisted communication in academic or clinical settings, particularly in the absence of clear institutional guidance. The relatively modest scores on perceived risk and anxiety dimensions suggest ambivalence rather than overt resistance. Notably, the positive association between ChatGPT use and the technology/social influence dimension indicates that institutional endorsement or peer normalisation may facilitate broader acceptance of AI-supported communication.

Overall, these findings indicate that postgraduate healthcare students primarily use ChatGPT to support learning and writing processes. The comparatively lower engagement in emotional support or administrative communication may reflect professional norms, ethical caution, and evolving institutional policies. These patterns highlight the need for structured AI literacy initiatives and clearer guidance on responsible and context-appropriate use within postgraduate programmes.

B. Factors Associated with the Academic Use of ChatGPT Among Participants

Knowledge of ChatGPT was moderately associated with academic use (r = 0.373, p < 0.001), consistent with prior research identifying awareness as a key predictor of adoption among postgraduate students (Yakubu et al., 2024). However, the relatively low internal consistency of the knowledge scale (KR-20 = 0.58) suggests potential measurement limitations. The instrument primarily assesses factual recognition and may not adequately capture procedural skills, such as prompt design or deeper conceptual understanding of how ChatGPT functions. As ChatGPT-related knowledge is likely multidimensional, this limited scope may have introduced measurement error and attenuated the observed association. Future research should therefore consider multidimensional assessments of ChatGPT literacy to enhance reliability and conceptual precision.

Attitudes toward technology and social influence were positively associated with ChatGPT use (r = 0.282, p < 0.001), consistent with prior research linking perceived ease of use and normative influences to utilisation among postgraduate students (Abdaljaleel et al., 2024; Yakubu et al., 2024). Notably, overall attitude was not significantly associated with usage. This pattern suggests that behavioural engagement may be shaped more strongly by contextual and normative factors than by general affective disposition. In institutional settings where formal guidance on ChatGPT remains emergent, peer endorsement and prevailing academic norms may exert a particularly influential role in shaping adoption. The influence of social norms may be further amplified by cultural and institutional characteristics. In hierarchical academic environments, supervisory attitudes and peer expectations may carry substantial weight in behavioural decision-making. Where formal policy frameworks are still developing, informal signals of approval from lecturers or senior peers may function as indicators of legitimacy, thereby facilitating engagement. This may help explain why the technology and social influence dimension was associated with ChatGPT use, whereas general attitude was not.

In addition, no significant differences in usage were observed across gender, age, work experience, or working position. These findings are consistent with prior research reporting no significant association between gender and ChatGPT usage (Bouzar et al., 2024), and reflect broader patterns in technology adoption where demographic differences are diminishing. Within this postgraduate cohort, engagement appears to be influenced more by knowledge and contextual factors than by personal characteristics.

These findings extend beyond descriptive prevalence by illustrating how ChatGPT engagement among postgraduate healthcare students may be selective, instrumental, and socially mediated. Rather than reflecting universal or novelty-driven adoption, ChatGPT use appears shaped by professional academic demands, institutional norms, and levels of familiarity with the tool. In contrast to undergraduates, postgraduate students typically undertake more autonomous, research-intensive, and writing-focused tasks, which may position ChatGPT not merely as a supplementary resource but as a cognitive scaffold supporting higher-order academic functions such as conceptual clarification and structural organisation of scholarly work. In this sense, ChatGPT use among postgraduate students may reflect developmental academic needs and professional pragmatism rather than simple technological experimentation. The observed polarisation in usage further underscores uneven integration within the cohort, raising the possibility of widening disparities in digital competence and academic strategy. Accordingly, responsible integration of ChatGPT in postgraduate education may require structured and transparent literacy initiatives that enhance practical knowledge, foster critical evaluation skills, and cultivate supportive institutional environments to ensure equitable and reflective adoption across programmes.

C. Limitation of the Study

This study has some limitations that should be considered when interpreting the findings. First, the reliance on self-reported data may have introduced response biases, including social desirability and recall bias, potentially leading to over- or underestimation of actual ChatGPT use. Second, the use of an online Google Form may have resulted in digital literacy bias, as students more comfortable with technology could have been more likely to participate or complete the survey. Third, the use of convenience sampling within a single public healthcare university limits representativeness and restricts the generalisability of the findings to other institutional or academic contexts. Fourth, the predominantly female sample may not reflect gender distributions in postgraduate populations elsewhere, which may further limit external applicability. Finally, although the quantitative design enabled the identification of statistical associations, it did not capture the underlying motivations or contextual influences shaping ChatGPT use. Future research incorporating qualitative approaches may provide deeper insight into students’ experiences and decision-making processes.

V. CONCLUSION

This study highlights that postgraduate healthcare students engage with ChatGPT in diverse academic ways, particularly for clarifying complex contents, supporting academic writing, and enhancing research efficiency. Although personal and administrative uses were less frequent, their presence suggests that ChatGPT may be gradually extending into broader aspects of postgraduate learning. Knowledge and positive attitudes toward technology and social influence were significantly associated with ChatGPT use, whereas demographic characteristics were not. These findings indicate that structured training, such as incorporating prompt-writing modules into research-focused courses, and clear institutional guidance may strengthen both competence and responsible engagement. Faculty development initiatives may further support this process by enabling educators to model appropriate and effective integration of ChatGPT in teaching and supervision. Future research should evaluate the impact of such initiatives on knowledge and usage patterns, providing evidence on whether targeted training and institutional support enhance both adoption and responsible practice in postgraduate education.

Notes on Contributors

Luu Thi Thuy contributed to the conceptualisation, design of the work, and was responsible for reviewing and editing the manuscript.

Tran Thi Hoang Oanh participated in the conceptualisation and design of the work, prepared the original draft, and revised the manuscript.

Nguyen Thi Thu Thao was responsible for data analysis and original draft preparation.

Dang Van Thoi contributed to the interpretation of data and original draft preparation.

Le Thi Anh Tuyet worked on methodology, literature search, data analysis, and original draft preparation.

Nguyen Hoa Van Chi participated in analysis, literature search, interpretation of data, and original draft preparation.

Nguyen Huong Giang contributed to the literature search, data collection, and original draft preparation.

Nguyen Thi Ai Ny was involved in data collection, interpretation of data, and original draft preparation.

Tran Thi Thu Trang contributed to data collection, data analysis, and original draft preparation.

All authors reviewed and approved the final manuscript.

Ethical Approval

Participation in this study was entirely voluntary. All participants were informed about the purpose of the study, the anonymity and confidentiality of their responses, and their right to withdraw at any time without penalty. Written informed consent was obtained from all participants prior to data collection. The study received ethical approval from the Medical Ethics Committee of Da Nang University of Medical Technology and Pharmacy (97/CT-HDDD).

Data Availability

The data that support the findings of this study are openly available in the Figshare respository
http://dx.doi.org/10.6084/m9.figshare.30148834.

Acknowledgement

The authors expressed appreciation to all postgraduate students who contributed to the study.

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Interest

The authors declare that there are no conflicts of interest pertaining to this study.

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*Tran Thi Hoang Oanh
Institute of International Education,
Hue University of Medicine and Pharmacy,
Hue University, Hue, Vietnam
+84 914660704
Email: tthoanh@huemed-univ.edu.vn;
tthoanh@hueuni.edu.vn

Submitted:5 August 2025
Accepted: 5 February 2026
Published online: 7 July, TAPS 2026, 11(3), 27-36
https://doi.org/10.29060/TAPS.2026-11-3/OA3816

Tinh Thi-Thanh Tran¹ & Hanh Thi-Bich Tran²

¹Department of Anesthesia and Resuscitation, School of Nursing-Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam; ²Department of Rehabilitation, School of Nursing-Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam

Abstract

Introduction: Speech and Language Therapy (SLT) plays a critical role in supporting individuals with communication and swallowing difficulties. While well-established in developed countries, SLT remains a nascent discipline in Vietnam with low student enrolment. While studies in other contexts have explored motivations for pursuing SLT major, little is known about the determinants influencing students’ choice of SLT in Vietnam. This study explored the determinants influencing students’ decision to choose SLT as their undergraduate major in Vietnam.

Methods: A phenomenological approach using Focus group discussions (FGDs) was applied with 39 SLT-major students from year 1 to year 3 at University of Medicine and Pharmacy at Ho Chi Minh City (UMP).  Students were divided into 5 groups. Data was collected from September 2024 to February 2025. Thematic analysis was conducted.

Results: Five thematic domains emerged: Personal – Curriculum fit, Personal – Vocational fit, Personal – Institutional fit, A gateway to new opportunities, Social and familial factors. In the FGDs, students were asked to identify the strongest factor influencing their choice. Of the 39 participants, 26 described factors that aligned with theme “A gateway to new opportunities”. This recurring emphasis supports the interpretation that “A gateway to new opportunities” was the most decisive factor in shaping their decisions.

Conclusion: “A gateway to new opportunities” emerged as the most decisive factor, with Social and familial influences shaping other themes. The findings highlight the need for structured career guidance and national strategies to strengthen recruitment, curriculum development, and workforce planning for a sustainable SLT workforce in Vietnam.

Keywords:           Undergraduate Major Selection, Speech and Language Therapy, Major Decision-Making, Focus Group Discussion, Phenomenology

Practice Highlights

• Identifies five major factors influencing SLT specialisation choice in Vietnam.
• Emphasises alignment between student characteristics and the SLT profession.
• Highlights social and familial influences in major decision-making.
• Shows students’ expectations about job prospects and professional identity.
• Provides insight for recruitment, academic counselling, curriculum development, and workforce development in SLT.

Figure 1. Interrelated themes shaping major choice decisions among SLT students

IV. DISCUSSION

This study aimed to explore the determinants influencing students’ decision to choose SLT as their undergraduate major at the UMP. In addressing this aim, the analysis identified five key themes shaping students’ decision to choose SLT. Personal – Curriculum fit reflects students’ perceptions of their academic strengths and learning preferences. Personal – Vocational fit captures the match between the nature of SLT and students’ preferences for cognitive tasks, helping people with disabilities, and non-shift-based clinical roles. Personal – Institutional fit highlights the importance of the university’s reputation and location in making SLT feel like a realistic and prestigious choice. A gateway to new opportunities show that students viewed SLT as a new but promising field because of employability, good income, and opportunities for further study. Finally, Social and familial influences emphasise that decisions were not made in isolation but were shaped by family traditions, peer influence, and faculty mentorship.

In addition to familial and peer influences, institutional factors also shaped students’ understanding of SLT, particularly because many first encountered the profession only after entering the Rehabilitation Technology programme, through the faculty-led orientation sessions. However, this account indicates that students’ knowledge of SLT was often limited or absent prior to admission. In fact, it was indicated that early curricular exposure significantly shapes major decision-making in emerging health disciplines (Buddeberg-Fischer et al., 2008). For newly established programmes such as SLT at UMP, this highlights the curriculum’s pivotal role as a primary source of information. In other words, strengthening early-course design may support more informed choices and enhance student engagement.

About the central and most decisive factor shaping students’ decisions – A gateway to new opportunities, female students most often expressed expectations related to job stability, social contribution, and work–life balance, whereas male students focused on career advancement, higher income, and recognition. This demonstrates a distinct difference in the nature of theme A gateway to new opportunities between the two groups. Similar differences have been reported in other health professions. In physiotherapy and nursing, women tend to prioritise relational and caring values, while men emphasise technical competence and leadership (Prosen, 2022; Stenberg et al., 2021). In medicine, men are more likely to choose high-status or demanding specialties, whereas women prefer stable and flexible options (Lee, 2013). These consistent findings suggest that the gender differences observed in this study are aligned with patterns widely reported across other health-related fields.

With regards to Social and familial influences, the strong role of family and peers in students’ decisions can be understood within Vietnam’s social and cultural context. In Vietnamese families, parents often act as co-decision makers, giving moral and financial guidance to secure family stability and social mobility (Dormeier Freire & Giang, 2012). Such influence reflects Confucian traditions, where education and career are family responsibilities and ways to bring honour to parents (Truong et al., 2016). At a broader level, Vietnam’s collectivist culture and high respect for authority encourage young people to align their choices with family and community expectations (Hofstede, 2001). Following parental and peer advice is therefore viewed not as a lack of independence but as an expression of filial duty and social harmony deeply rooted in Vietnamese society.

The findings support SCCT theory (Lent et al., 1994). Personal- Curriculum fit reflects students’ self-efficacy, while A gateway to new opportunities highlights perceived career benefits, both key components of SCCT. Personal – Vocational fit demonstrates career goals shaped by personal interests and values. Social and familial influences and Personal – Institutional fit emphasise contextual factors like family, peers, mentors and institution. Together, these themes align well with SCCT in explaining students’ decisions to pursue SLT.

Compared to previous studies in Vietnam, this study identified similar factors influencing the choice of major to others. However, there is no single study covering all factors found here. Besides, unlike previous quantitative studies using linear regression models, this phenomenological study explored students’ voices in depth, identifying five key factors, with social and familial factors embedded in all others. In addition, while other studies in Vietnam emphasised personal competencies, passion, and university reputation (Nguyen & Do, 2023; Nguyen et al., 2023; Tran & Nguyen, 2024), this study found the theme A gateway to new opportunities – such as job prospects, income, and learning opportunities – to be the most decisive factor. This difference reflects the specific decision context, where students chose SLT among three closely related rehabilitation majors, not across all fields. From this study, family influence and exposure to the profession were important to choose SLT. This is similar to Byrne’s studies (Byrne, 2007; Byrne, 2008). However, among the themes, A gateway to new opportunities remained the strongest driver. This finding may relate to the limited development of SLT training in Vietnam (Atherton et al., 2017; Atherton et al., 2020), compared to the long-established and large SLT workforce in other countries (Armstrong et al., 2017; McLeod et al., 2023). Overall, this study adds a distinct perspective by highlighting how factors related to the theme A gateway to new opportunities, shaped by context, influence students’ choice of SLT.

Beyond recruitment and counselling, the findings highlight implications for the long-term development of the SLT workforce in Vietnam. Students voiced ambitions to “be pioneers,” pursue advanced study, and expand SLT services nationwide, showing motivation that extends beyond job attainment. These aspirations point to the need for policies supporting continuous professional development, clear career pathways, and institutional collaboration to strengthen workforce capacity and retention. Such directions reinforce the conclusion that structured career guidance and national planning are essential for building a sustainable SLT workforce in Vietnam.

A. Limitations

This study has several limitations. Firstly, most participants were from the South of Vietnam, and the data were collected from a single institution – UMP. Consequently, the findings may not fully represent the perspectives of students across other regions or universities. Secondly, while focus group discussions encouraged interaction and collective reflection, they may have limited the depth of personal disclosure due to peer influence and social desirability bias (Leung & Savithiri, 2009). Thirdly, the strong gender imbalance among participants could have shaped particular perceptions of SLT. Finally, researcher positionality may have subtly influenced data interpretation, especially since one member of the research team was an SLT lecturer.

Methodological triangulation, such as the combination of focus group discussions and individual interviews, is recommended for future studies to enhance the richness and trustworthiness of the data.

B. Application

The findings of this study have practical implications for both education and policy. At the institutional level, the results can guide the development of targeted recruitment strategies and curriculum development, ensuring that early SLT modules and pedagogical approaches align with students’ motivations and expectations. Because students only learned about SLT after entering the programme, a more effective approach would be to offer the introductory SLT module before students select their major. This may help them understand the profession sooner, make more informed decisions and engage earlier with the SLT track. At the policy level, the study offers evidence to support structured career guidance and national strategies for sustainable SLT workforce development through coordinated recruitment, public awareness, and human resource planning in rehabilitation services. For students, these findings also provide a valuable reference and motivation to pursue and remain committed to this newly emerging profession.

V. CONCLUSION

This study identified five interrelated themes influencing students’ decision to choose SLT as their major: Personal – Curriculum fit, Personal – Vocational fit, Personal – Institutional fit, A gateway to new opportunities, and Social and familial influences. Through iterative thematic analysis, A gateway to new opportunities were recognised as the central driving factor, while Social and familial influences provided the overarching context shaping all other themes. The findings also show that students often gained their first accurate understanding of SLT only after admission, underscoring the important role of early curricular exposure in an emerging profession. Ensuring that introductory SLT modules are offered prior to major selection and designed to provide clear information about the profession, expectations and career pathways may help students make more informed and confident choices. Together, these findings offer an integrated understanding of how personal, institutional, and contextual factors interact in major decision-making within an emerging profession. Building on this, the findings highlight the need for structured career guidance and national strategies to strengthen recruitment, curriculum development, and workforce planning for a sustainable SLT workforce in Vietnam.

Notes on Contributors

Tinh Thi-Thanh Tran, as the principal investigator, was responsible for the conceptualisation, literature review, development of the methodological framework, conducting interviews, transcription, data analysis, drafting the manuscript, and giving final approval. Hanh Thi-Bich Tran contributed to the conceptualisation, literature review, study design, conducting interviews, transcription, data analysis, and writing of the manuscript. All authors have read and approved the final manuscript. 

Ethical Approval

Ethical approval was obtained from the Institutional Review Board of UMP (Ref. No. 3406/HDDD-DHYD). Written informed consent was collected from all participants prior to data collection. 

Data Availability

The data that support the findings of this study are available from the author upon reasonable request. 

Acknowledgement

First of all, this study was made possible through financial support from the University of Medicine and Pharmacy at Ho Chi Minh City. In addition, we are grateful to Yen Thi-Kim Nguyen and Anh Khoa-Dieu Nguyen, students of the School of Nursing-Medical Technology, for their assistance as support staff. Finally, we also extend our thanks to the students of the Department of Rehabilitation, School of Nursing-Medical Technology, whose participation was essential to the completion of this research.

Funding

This research was funded by the University of Medicine and Pharmacy at Ho Chi Minh City under contract number 232/2024/HD-DHYD, dated 10/9/2024.

Declaration of Interest

There is no conflict of interest to declare for the authors.

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*Tinh Thi-Thanh Tran
217 Hong Bang, Cho Lon ward,
Ho Chi Minh City, Vietnam
+84 975 337 558
Email: tranthithanhtinh@ump.edu.vn

Submitted: 15 August 2025
Accepted: 5 February 2026
Published online: 7 July, TAPS 2026, 11(3), 37-47
https://doi.org/10.29060/TAPS.2026-11-3/OA3851

Hidayatul Radziah Ismawi, Azril Shahreez Abdul Ghani, Wan Fatein Nabeila Wan Omar, Wan Muhamad Salahudin WS & Nurulhasanah Mustapar

Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia, Malaysia

Abstract

Introduction: Mentoring plays a crucial role in pre-clinical medical education, providing academic, emotional, personal, and professional support to students during early medical training. Although established in 2015, the impact of the pre-clinical undergraduate mentor-mentee programme at the Kulliyyah of Medicine, International Islamic University Malaysia (KOM, IIUM), has yet to be studied. This study aimed to explore the experiences and perceptions of pre-clinical students participating in the programme to assess its effectiveness and identify areas for improvement.

Methods: A cross-sectional study was conducted using a self-administered online questionnaire distributed to all Year 1 and Year 2 students. The survey included 5-point Likert-scale items measuring satisfaction and perceived helpfulness, alongside open-ended questions for qualitative insights. Quantitative data were analysed using descriptive statistics, while qualitative responses underwent thematic synthesis, involving open, axial, and selective coding.

Results: Results showed high satisfaction (mean score: 4.74 ± 0.74) and perceived helpfulness (mean score: 4.69 ± 0.81), with students praising the programme for fostering academic improvement, mental health support, peer collaboration, and holistic development. Thematic analysis revealed four categories: benefits of sessions, characteristics of effective sessions, challenges, and suggestions for improvement. Key themes included a safe and supportive environment, motivational reassurance, Islamic ethical guidance, and challenges such as infrequent interactions and emotional barriers. Strengthening frequency of interactions, mentor training, and feedback mechanisms was suggested for improvement.

Conclusion: This study highlights the holistic value of the structured mentor-mentee programme at KOM, IIUM in enhancing students’ academic and personal growth, providing valuable feedback for improvement.

Keywords:           Feedback, Medical Student, Mentoring, Qualitative Research

Practice Highlights

• Pre-clinical students were highly satisfied, finding it helpful for academic and personal growth.
• Academic, mental, and peer support with values-based mentorship rooted in Islamic principles.
• Students urged more mentor-mentee interaction, better mentor training, and structured feedback.

I. INTRODUCTION

A. Background

Medical mentoring is crucial in pre-clinical education, as it bridges foundational knowledge and clinical practice, while supporting students both academically and personally. Mentors help students grasp challenging medical concepts, improve performance, and contextualise learning within patient care, which is especially vital during crises like the COVID-19 pandemic (Gaur et al., 2020). Beyond academics, mentoring develops critical thinking, communication, and professionalism essential for healthcare roles (Santiesteban et al., 2022). It also fosters a sense of belonging by connecting students with experienced professionals who offer insights into the culture and ethics of medicine, enhancing motivation, resilience, and mental well-being. Longitudinal mentoring programmes have been shown to improve students’ quality of life and reinforce lifelong learning and service values (Dent et al., 2021).

B. Previous Research on Medical Mentoring

Previous studies have explored mentoring in medical education, emphasising its significance in fostering academic, professional, and personal growth. One study demonstrated how mentorship programmes significantly improved academic performance among first year MBBS students in a medical school in India, alleviating academic pressures during their transition into medical education (Guhan et al., 2020). Similarly, another study highlighted the role of mentoring in enhancing mentees’ confidence, academic skills, and emotional resilience at the Universiti Kebangsaan Malaysia Medical Centre during clinical years (Kamarudin et al., 2021). Both studies underline the importance of a structured mentoring approach with clear communication and alignment of goals.

Mentoring also supports a broader sense of well-being and professional preparation by addressing critical gaps in medical education, such as emotional support and skill-building for clinical practice, which are often underemphasised (Bhatnagar et al., 2020). A longitudinal mentorship programme for Brazilian medical students was found to improve their mental health, quality of life, and motivation, underscoring the importance of sustained mentoring efforts (Secchin et al., 2020). Such programmes go beyond academics to strengthen resilience and promote holistic development.

Moreover, mentoring helps clarify professional roles and fosters lifelong learning. Mentoring is distinct from advising or coaching, focusing on personalised guidance that nurtures professional identity formation, clinical reasoning, and ethical values (Santiesteban et al., 2022). This distinction highlights mentoring’s unique contribution to developing well-rounded medical professionals capable of adapting to the complexities of healthcare delivery. Together, these findings affirm that mentoring, when carefully designed and implemented, serves as a cornerstone of comprehensive medical education.

Mentoring serves as a foundational element in medical education, providing students with support to navigate the complex demands of their training. It aids in bridging the gap between theoretical knowledge and practical application, especially during critical transitions such as moving from pre-clinical to clinical training. Mentoring helps students adapt to clinical environments by fostering professional development, teamwork, and communication skills (Malau-Aduli et al., 2020).  Moreover, mentoring programmes often address stress and mental health challenges faced by medical students. For example, one study highlighted that mentoring interventions could reduce stress levels, improve coping mechanisms, and promote well-being. They also found that pre-clinical mentoring enhances personal development, helping students manage stress, improve time management, and strengthen peer support networks (Dederichs et al., 2020). It also cultivates professional behaviours and provides insights into clinical roles, as seen in mentoring programmes designed to prepare students for placements (Ng et al., 2020). Effective mentorship can bridge the gap between academic knowledge and clinical skills while promoting resilience, empathy, and professionalism (Brown et al., 2021; Corcoran et al., 2020). By providing role models and guidance, mentoring instils essential competencies such as empathy, ethical practice, and lifelong learning.

C. Teacher as Mentor in Medical Education

It is important to distinguish the teacher-as-mentor role from conventional educational supervision or academic advising. Teacher-mentors typically provide longitudinal, holistic support that includes academic coaching, psychosocial reassurance, professional identity formation, and, in our context, ethical and spiritual guidance (Addai et al., 2023). By contrast, academic advisors or educational supervisors more commonly focus on academic progress, curricular navigation, assessment requirements, and administrative or remediation tasks (McKinney et al., 2024; Wenham et al., 2019) Emphasising the lecturer-mentor role targets not only students’ study skills but also their well-being, values formation, and early professional socialisation. These components have been associated with improved resilience and professional development in recent studies. (Brown et al., 2021; Kusner et al., 2022; Santiesteban et al., 2022).

Mentoring in medical education is often framed within two key theoretical perspectives. Mentoring is viewed as a complex adaptive system (CAS) in which students learn through participation in a professional community, gradually gaining confidence and internalising professional norms through interaction with experienced faculty (Teo et al., 2024). Professional Identity Formation (PIF) further emphasises the role of mentoring in shaping students’ values, behaviours and sense of purpose as future doctors (Krishna et al., 2023). These frameworks clarify how lecturer-led mentoring differs from academic advising, which typically focuses on administrative or academic progress.

D. Specific Challenges of Pre-Clinical Mentoring

Pre-clinical mentoring presents unique challenges. One challenge is maintaining consistent engagement and effective communication, where mismatched expectations between mentors and mentees occasionally hinder the programme’s success (Kamarudin et al., 2021). Time constraints and varying mentor availability also pose obstacles to achieving programme objectives (Ng et al., 2020).

Although mentoring in medical education is widely discussed in the literature, the novelty of this study lies in its cultural and institutional context and its emphasis on holistic student development. At the International Islamic University Malaysia (IIUM), mentoring extends beyond academic and emotional support to include ethical and spiritual dimensions in line with the university’s educational philosophy. This aspect has received limited attention in existing studies, which largely focus on Western or secular settings. Within this unique context, the programme facilitates academic, professional, and personal growth through structured interactions between students and lecturers, providing a distinctive opportunity to examine the perceived benefits, challenges, and areas for improvement within a formal mentoring framework that has not previously been explored at this institution. The objective of this study is to explore the experiences and perceptions of pre-clinical students in the International Islamic University Malaysia participating in the mentor-mentee programme.

II. METHODS

A. Research Context

This study investigates the experiences of pre-clinical medical students participating in the mentor-mentee programme at the Kulliyyah of Medicine, International Islamic University Malaysia (KOM, IIUM). The programme comprises 67 groups, each with 4 to 5 students and a pre-clinical lecturer from Department of Basic Medical Sciences and Department of Pathology and Laboratory Medicine as the mentor, mandating one meeting every 10 weeks to discuss academic and non-academic issues such as study progress, difficulties encountered while studying, exam results, family issues, financial constraints, emotional and spiritual well-being, and other issues important to each student. While this meeting is mandatory, mentors and students are welcomed to arrange additional informal meetings for ongoing support. Each mentor is provided with general guidelines by the faculty on how to conduct these sessions, ensuring a structured approach while allowing flexibility to address specific mentee needs.

B. Research Design and Approach

This study employed a cross-sectional design.

C. Study Population

The study included all Year 1 and Year 2 medical students (n = 305) enrolled in the mentor–mentee programme during the 2023/2024 academic session. Given that the programme is organised into 67 small groups comprising 4 to 5 students each, and mentoring activities are primarily delivered at the group level rather than through one-to-one interactions, the sampling strategy required at least one response from every mentor–mentee group. This ensured that feedback was obtained from all groups represented within the programme while minimising non-response and reducing the logistical burden of data collection. This approach enabled broad coverage of the diverse experiences and perceptions across the programme’s group-based structure. Participation was voluntary, and no incentives were offered.

D. Data Collection Methods

Data were collected using a self-administered online questionnaire distributed through the social media WhatsApp Messenger application designed to capture both quantitative and qualitative feedback, with approval from IIUM Research Ethics Committee (IREC) – IREC 2024-336 from October to November 2024. The questionnaire was developed by the authors, based on the Kulliyyah of Medicine in-house student feedback survey, and adapted specifically for the mentor-mentee programme. It included two Likert-scale questions on satisfaction and perceived helpfulness, and five open-ended questions exploring experiences, challenges, and suggestions (see Appendix A). Content validity was ensured through review by a medical educationist and the mentor-mentee coordinator, with minor revisions made for clarity and relevance. Following their feedback, minor revisions were made to enhance clarity and alignment with the study objectives. As this was a novel adaptation rather than a previously validated instrument, formal reliability testing (Cronbach’s alpha) was not conducted; however, pilot feedback confirmed that the questionnaire was clear, appropriate, and capable of capturing the intended information. All students were informed of the study purpose at the start of the questionnaire, and by choosing to complete it, they indicated their understanding and provided implied consent to participate.

To ensure participants’ anonymity, the questionnaire was administered using an online survey platform that did not require users to sign in, thereby preventing the capture of email addresses or other identifiable login credentials. No personal identifiers such as name, student identification number, or contact information were collected however, mentor name was requested to keep track of group submissions. Although the survey link was disseminated through a social media application for convenience and wider reach, all responses were submitted independently and anonymously through the survey platform itself. The research team was therefore unable to trace responses back to individual students or specific devices, maintaining full confidentiality throughout the data collection process.

E. Quantitative Analysis: Data Analysis

Quantitative data from the two 5-point Likert scale questions were analysed using descriptive statistics to summarise participants’ satisfaction with and perceived helpfulness of the mentor-mentee programme. The mean scores, standard deviations, and 95% confidence intervals were calculated for each metric to provide insights into the overall trends and the consistency of responses across participants.

F. Qualitative Analysis: Thematic Synthesis

The qualitative data were analysed using thematic analysis, following the six-phase approach outlined by Braun and Clarke (2006, 2021). This method was selected for its flexibility and suitability in identifying patterns across short, open-ended reflections. The analysis was conducted in three stages: open coding, axial coding, and the development of overarching categories (See Table 1). During the initial stage, responses were examined line by line to identify distinct codes representing specific ideas, perceptions, or experiences. For example, phrases such as “felt supported during challenges” and “gained useful feedback on academics” were coded as emotional support and academic guidance, respectively. Then the open codes were grouped into related categories by exploring connections and relationships among them for axial coding. For instance, codes such as confidence-building, peer collaboration, and stress reduction were clustered under the category personal development, while guidance on ethical practice and improved study techniques were grouped under academic and professional growth. Finally, the axial codes were synthesised into four overarching categories to provide a comprehensive structure for interpretation. The researchers reviewed the codes and themes independently, and discrepancies were resolved through discussion to achieve consensus.

Stage	Process	Examples	Output
Open Coding	Line-by-line coding of responses to identify specific ideas, perceptions, or experiences	– “Felt supported during challenges” → Emotional Support – “Gained useful feedback on academics” → Academic Guidance	Initial Codes
Axial Coding	Grouping related codes by identifying patterns and relationships	– Confidence-building, Peer collaboration, Stress reduction → Personal Development – Ethical guidance, Study techniques → Academic & Professional Growth	Thematic Categories
Overarching Categories	Synthesising themes into broad, interpretable structures	– Personal Development – Academic & Professional Growth	Final Thematic Framework

Table 1. Three-Stage Thematic Synthesis Process for Analysing Open-Ended Responses

III. RESULTS

A total of 83 students responded to the survey out of 305 eligible Year 1 and Year 2 students, yielding a response rate of 27.2%. The responses were received from 65 of the 67 mentor–mentee groups, yielding a group response rate of 97.0%. The quantitative results showed high levels of satisfaction and perceived helpfulness among participants in the mentor-mentee programme. The mean satisfaction score was 4.74 ± 0.74 (95% CI: 4.58 – 4.89), while the mean perceived helpfulness score was 4.69 ± 0.81 (95% CI: 4.51– 4.86) on a 5-point Likert scale.

A. Benefits of Mentor–Mentee Sessions

Students consistently highlighted the positive impacts of the mentor-mentee sessions on their academic, personal, and emotional well-being. Many reported that their mentors provided a safe space where they felt acknowledged and supported.

“I feel safe and acknowledged with my efforts. My mentor would always reassure me and the other mentees even though our results are not exceptional.” – Student 54

“My mentor always reassures me and believes that I can do well in my exams. It gives me a lot of comfort as a person who always felt anxious about exams.” – Student 49

These statements emphasise the role of mentors in offering motivation and reassurance, particularly to students experiencing academic and emotional challenges. Students also appreciated the academic guidance received during these sessions, which contributed to their academic performance improvement. Mentors provided study techniques and advice on how to excel in exams, further enhancing students’ confidence. They also highlight the impact of Islamic-based spiritual guidance during the session.

“My mentor’s spiritual guidance is invaluable. We get reminded to become a good, safe Muslim doctor in each session. Great supporting and inspiring advice, both mentally and spiritually, for both dunia and akhirat.” – Student 3

The peer collaborative environment was another significant benefit, with one student stating,

“Whenever I share something or other people sharing (sic), all of us could learn a lot between each other.” – Student 79

This highlights how sessions facilitated collective learning and mutual support among mentees.

B. Characteristics of Effective Mentor-Mentee Sessions

Thematic analysis revealed key characteristics that defined effective mentoring practices (Figure 1). Students emphasised the importance of mentors who provided consistent academic encouragement, empathetic communication, and a sense of trust. Islamic-based encouragement was particularly valued, as it integrated spiritual guidance with professional and academic development. Effective sessions were described as those that fostered holistic well-being and supported mentees emotionally, psychologically, and academically. Mentors who actively listened, offered personalised feedback, and encouraged open communication were viewed as instrumental in creating a positive mentoring experience.

Figure 1. Key characteristics of effective mentoring practices

C. Challenges and Barriers

Despite these benefits, some students reported several challenges, including emotional and psychological barriers that hindered open communication. A few students also mentioned having a language barrier with some mentors. Some felt hesitant to share personal struggles due to anxiety or a lack of rapport with their mentors. Time constraints and limited opportunities for interaction also posed challenges, highlighting the need for more frequent and structured meetings.

D. Suggested Improvements

Students suggested enhancing support structures and improving interaction and communication within the programme. Recommendations included providing additional mentor training to ensure consistent quality across groups, more group activities, and increasing the frequency of sessions to address the emotional and academic needs of mentees more effectively. Focusing on mental health within the sessions was another key recommendation to further align the programme with the students’ values and holistic development needs (Table 2).

Recommendations	Quote
Providing additional mentor training	“Provide comprehensive training for mentors to enhance their coaching, communication, and interpersonal skills, ensuring they are well-equipped to support their mentees effectively.” – Student 67
Additional group activities	“Maybe we can hold some activities involving our mentor to strengthen the bond like sports or celebrations.” – Student 24   “Bonding activities with mentor and between the mentees.” – Student 35
Increase frequency of sessions	“I think the session should be often.” – Student 15   “Add more session so that we could spend more time together.” – Student 39
Focusing on mental health and emotional well-being	“Ensure that mentors are trained to recognize signs of stress or mental health issues and can guide mentees to appropriate professional support services.” – Student 67   “If mentor can focus on mental health issues especially for the year 1 students, I think it would be very beneficial and helpful.”  – Student 76

Table 2. Recommendations to improve mentor-mentee system

IV. DISCUSSION

The results of this study emphasise the vital role of holistic mentoring programmes in supporting the academic, personal, and emotional growth of pre-clinical medical students. High satisfaction and perceived helpfulness scores underscore the programme’s positive impact, with benefits such as academic encouragement, collaborative peer learning, mental health support, and guidance aligned with Islamic principles. These findings align with broader evidence that mentoring enhances confidence, reduces stress, and improves well-being (Ng et al., 2020; Sonawane et al.2021).

In this study, “holistic mentoring” refers to an approach that supports students’ academic, personal, professional, and ethical development within a single integrated framework. This aligns with the principles of the Humanistic Mentoring Model, which emphasises attending to the whole person, intellectually, emotionally, socially, and morally to foster well-rounded growth (Schirmer & Osterberg, 2022). In the KOM, IIUM context, holistic mentoring additionally incorporates values-based guidance grounded in the institution’s educational philosophy. By nurturing not only academic competence but also character, well-being, and professional identity, the programme reflects a broader conceptualisation of mentoring that other institutions may adapt according to their cultural or pedagogical priorities.

Furthermore, the inclusion of ethical and spiritual dimensions within the IIUM mentoring approach distinguishes it from more conventional models and aligns with recent calls for culturally sensitive mentorship frameworks (Drossard & Härtl, 2024; Whitfield et al., 2024). Studies highlight the importance of tailoring mentorship to students’ values and identities, supporting this programme’s emphasis on integrating character development with academic and professional guidance (Hill et al., 2022; Vieira et al., 2022). Such culturally aligned mentoring offers a foundation for more inclusive and responsive programmes for diverse student populations. Future research should examine how these approaches function across different cultural settings and their long-term effects on students’ academic, psychological, and professional development (Sethia et al., 2020; Whitfield et al., 2024).

Challenges identified include infrequent interactions and emotional barriers that hinder effective communication, a finding consistent with issues reported in other institutions, such as difficulties in rapport-building (Aziz et al., 2020; Sephien et al.,2021; Zainol & Salam, 2021). Enhancing mentor training to improve emotional sensitivity and communication skills, as well as increasing session frequency, could address these challenges and ensure the programme’s consistency and effectiveness (Fulton-Ward et al., 2023; Kusner et al., 2022; Sethia et al., 2020).

Despite occasional less favourable feedback, most students positively perceived the mentoring experience, highlighting its potential to improve academic outcomes and engagement. To maximise impact, the programme could increase session frequency, strengthen support structures for mental health and academic development, and implement robust feedback mechanisms to adapt and refine mentoring practices (Brown et al., 2021; Corcoran et al., 2020; Mohd Shafiaai et al., 2020; Sonawane et al., 2020).

The findings of this study offer several practical insights for institutions seeking to strengthen or redesign their mentoring programmes. Although the KOM, IIUM model incorporates Islamic ethical and spiritual elements, its core features of structured group engagement, attention to holistic well-being, and supportive teacher-as-mentor relationships are broadly adaptable across diverse educational settings. Institutions serving culturally or religiously diverse student populations may tailor the framework by embedding their own value systems, such as professional identity formation, character education, or culturally responsive guidance. Implementing small, stable mentor-mentee groups, equipping mentors with simple communication guidelines, and encouraging regular yet flexible touchpoints can enhance continuity, rapport, and early identification of student needs. Inclusivity can be further strengthened by forming groups with diverse backgrounds, establishing respectful group norms, and providing mentors with training in culturally sensitive communication. Together, these strategies enable other institutions to adopt group mentoring models that are scalable, supportive, and responsive to the needs of diverse learners.

A. Advantages and Limitations

The mixed-methods approach utilised in this study provided a comprehensive understanding of participants’ experiences by combining quantitative and qualitative data, allowing for a nuanced exploration of perspectives. The electronic distribution of the questionnaire enhanced accessibility, enabling participants to respond at their convenience and potentially increasing the response rate. A key strength of this study is its novel contribution to the mentoring literature: it examines a group-based, faculty-led mentoring model situated within a non-Western, Islamic educational context and adopts a holistic framework that integrates academic, emotional, ethical, and spiritual support. This culturally grounded perspective is underrepresented in existing literature, which is largely centred on Western or secular models of mentoring.

However, the study has limitations. Requiring only a minimum response per group, rather than from every individual, may have led to less comprehensive data collection. Additionally, the reliance on self-reported data introduces the possibility of response bias, as participants may have been influenced by social desirability or recall limitations. Furthermore, although content validity was established through review by subject-matter experts, the questionnaire was not formally validated for face and construct validity. Additionally, reliability was not assessed using measures like Cronbach’s alpha, which may affect the robustness of the findings. The study’s focus on a single institution may also limit the generalisability of the findings to other contexts or settings. These factors should be considered when interpreting the results and designing future research.

V. CONCLUSION

Pre-clinical students of KOM, IIUM perceive the mentor mentee programme as highly beneficial and reported high satisfaction. The high satisfaction and perceived helpfulness ratings highlight the programme’s success in providing academic guidance, peer collaboration, mental health support, and spiritual and ethical mentoring, which were particularly valued by students. These findings reinforce the importance of a holistic approach to mentoring in medical education. Key aspects of effective mentoring practices included addressing holistic wellbeing, providing targeted academic support, offering personalised feedback, active listening, and fostering open communication between mentors and mentees. Identified areas for improvement include increasing the frequency of meetings, standardising mentor training to enhance empathy and communication skills as well as incorporating spiritual and ethical guidance for the students. To enhance the programme, the Kulliyyah may consider revising existing mentor guidelines to ensure consistency and provide targeted training to address emotional barriers and communication challenges. Structuring meetings more frequently and effectively can facilitate regular feedback and support. Future research should explore the perspectives of mentors, assess long-term impacts through longitudinal studies, and evaluate mentoring in diverse institutional contexts. These efforts will refine the programme and better prepare students for the demands of clinical practice while supporting their holistic development.

Notes on Contributors

Hidayatul Radziah Ismawi was involved in conceptualisation, methodology, investigation, formal analysis, data curation, writing both the original draft and editing, and reviewing the final draft, visualisation of data and project administration.

Wan Fatein Nabeila Wan Omar was involved in conceptualisation, methodology, data curation, editing and reviewing the final draft, and visualisation of data.

Azril Shahreez Abdul Ghani was involved in conceptualisation, methodology, investigation, formal analysis, data curation, editing and reviewing the final draft, and visualisation of data.

Wan Muhamad Salahudin Wan Salleh was involved in conceptualisation, methodology, editing, and reviewing the final draft.

Nurulhasanah Mustapar was involved in conceptualisation, methodology, editing, and reviewing the final draft.

Ethical Approval

Ethical approval from IIUM Research Ethics Committee (IREC) – IREC 2024-336 was obtained for data collection from October to November 2024.

Data Availability

Given the personal nature of the data, all data will only made available upon written request to the corresponding author with the agreement of all authors and IIUM.

Acknowledgement

Part of the results was presented as a poster presentation at the 37^th MSPP Scientific Meeting in conjunction with the 9^th Medical Research Symposium 2024. The abstract was published in Medicine and Health Journal as part of the proceedings. The authors would like to thank the Department of Basic Medical Sciences and Department of Medical Education Quality, Kulliyyah of Medicine, International Islamic University Malaysia.

Funding

The authors did not receive any funding for this study.

Declaration of Interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper; a grammar-checking software was used to ensure the language was accurate.

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*Hidayatul Radziah Ismawi
Department of Basic Medical Sciences,
Kulliyyah of Medicine,
International Islamic University Malaysia,
Jalan Sultan Ahmad Shah, Indera Mahkota,
25200 Kuantan, Pahang, Malaysia
+60 127526064
hidayatulradziah@iium.edu.my

Submitted: 14 August 2025
Accepted: 9 December 2025
Published online: 7 July, TAPS 2026, 11(3), 53-57
https://doi.org/10.29060/TAPS.2026-11-3/SC3850

Hirohisa Fujikawa^1,2,3, Takuya Aoki^4,5 & Masato Eto³

¹Department of General Medicine, Juntendo University Faculty of Medicine, Japan; ²Center for General Medicine Education, School of Medicine, Keio University, Japan; ³Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Japan; ⁴Division of Clinical Epidemiology, The Jikei University School of Medicine, Japan; ⁵Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Japan

Abstract

Introduction: Workplace social capital (WSC), a workplace resource focusing on employees’ perceptions of trust, reciprocity, and network interactions among colleagues and individuals of different hierarchical levels or organisations, has recently gained substantial attention in the field of medical education. The Japanese ikyoku system, a traditional unique postgraduate educational system that governs education, research, and patient care, could plausibly shape these relational climates; however, its association with WSC among medical residents remains unclear. In this study, we focused on the ikyoku system and aimed to elucidate the association between affiliation with ikyoku and WSC among residents of postgraduate year 3–6.

Methods: We conducted this cross-sectional study in December 2024 using an anonymous online self-administered survey in Japan. The survey was distributed to senior residents in 25 hospitals via their training directors. We assessed WSC using the Japanese medical resident version of the WSC Scale (score range: 1–5), which has previously demonstrated good validity and reliability. To investigate the association between affiliation with an ikyoku and WSC, we performed multivariable linear regression analysis, with adjustment for possible confounders.

Results: Sixty-one residents (response rate: 13.0%) were included in the final analysis. The majority were male (41, 67.2%) and in postgraduate years 3–4 (36, 59.0%). The results showed that there was no significant association between affiliation with an ikyoku and WSC score. The low response rate may limit generalisability.

Conclusion: The findings of this study will provide in-depth understanding of WSC. However, further larger-scale studies to confirm these findings are required.

Keywords:           Workplace Social Capital, Ikyoku System, Japan, Medical Education

Participant profile
Characteristics	Total (N = 61)	Not affiliated with an ikyoku (N = 19)	Affiliated with an ikyoku and currently working at a university hospital (N =23)	Affiliated with an ikyoku and currently working at a hospital other than a university hospital (N = 19)
Gender, N (%) Woman Man Non-binary	19 (31.1) 41 (67.2) 1 (1.6)	6 (31.6) 13 (68.4) 0	8 (34.8) 14 (60.9) 1 (4.3)	5 (26.3) 14 (73.7) 0
PGY, N (%) 3–4 5–6	36 (59.0) 25 (41.0)	12 (63.2) 7 (36.8)	14 (60.9) 9 (39.1)	10 (52.6) 9 (47.4)
Clinical department, N (%) Internal medicine Surgical medicine Others	29 (47.5) 26 (42.6) 6 (9.8)	13 (68.4) 3 (15.8) 3 (15.8)	9 (39.1) 12 (52.2) 2 (8.7)	7 (36.8) 11 (57.9) 1 (5.3)
WSCa, mean (SD) Total Horizontal trust Vertical trust	4.20 (0.73) 4.12 (0.75) 4.33 (0.84)	4.37 (0.66) 4.28 (0.72) 4.51 (0.70)	4.16 (0.78) 4.13 (0.76) 4.22 (0.96)	4.09 (0.75) 3.96 (0.77) 4.30 (0.85)
Association between affiliation with an ikyoku and WSC
	Unadjusted mean difference (95% CI)	p-value	Adjustedb mean difference (95% CI)	p-value
WSC totala Not affiliated with an ikyoku	Ref.	Ref.	Ref.	Ref.
Affiliated with an ikyoku and currently working at a university hospital	-0.21 (-0.66 to 0.25)	0.37	-0.23 (-0.74 to 0.28)	0.37
Affiliated with an ikyoku and currently working at a hospital other than a university hospital	-0.28 (-0.76 to 0.20)	0.24	-0.33 (-0.87 to 0.21)	0.22
Horizontal trusta Not affiliated with an ikyoku	Ref.	Ref.	Ref.	Ref.
Affiliated with an ikyoku and currently working at a university hospital	-0.15 (-0.62 to 0.31)	0.51	-0.23 (-0.75 to 0.29)	0.38
Affiliated with an ikyoku and currently working at a hospital other than a university hospital	-0.33 (-0.81 to 0.16)	0.19	-0.43 (-0.97 to 0.12)	0.13
Vertical trusta Not affiliated with an ikyoku	Ref.	Ref.	Ref.	Ref.
Affiliated with an ikyoku and currently working at a university hospital	-0.29 (-0.82 to 0.24)	0.27	-0.23 (-0.81 to 0.35)	0.43
Affiliated with an ikyoku and currently working at a hospital other than a university hospital	-0.21 (-0.76 to 0.34)	0.45	-0.18 (-0.80 to 0.44)	0.56

Abbreviations: CI, confidence interval; PGY, postgraduate year; SD, standard deviation; WSC, workplace social capital
^aRanging from 1 to 5, with higher scores indicating greater WSC
^bAdjusted for gender, postgraduate year, and clinical department

Table 1. Participant profile and association between affiliation with an ikyoku and WSC

IV. DISCUSSION

We found that affiliation with an ikyoku was not significantly associated with WSC. This finding suggests that, in Japan and in other Asia–Pacific training systems with comparable hierarchical, university- or specialty-based networks, formal affiliation alone may not be sufficient to enhance WSC.

This study revealed that there was no significant association between affiliation with an ikyoku and WSC. This finding was unexpected, given a previous study that suggested that WSC is contextually patterned (Kouvonen et al., 2006; Oksanen et al., 2013). The ikyoku system has the potential to exert a dual impact on WSC, exhibiting both favorable and unfavorable outcomes. While the system can function as an organised support structure and likely cultivates interpersonal trust and mutual support, it is also subject to the possibility of being linked to distinctive stressors, such as rigid hierarchies and limited autonomy in career decision-making (Kuwabara et al., 2015). These stressors may inhibit the formation of psychologically safe and supportive workplace environment (Ihara et al., 2020). Taken together, these opposing mechanisms – formal support and continuity of supervision versus hierarchical control and constrained autonomy – may coexist and offset one another, which could help explain the absence of a statistically significant association in this sample. However, the results of our study indicated that the point estimates for affiliation with an ikyoku were all negative. This pattern suggests that, in practice, the restrictive and hierarchical aspects of ikyoku may potentially outweigh its benefits for trust and reciprocity. Consequently, a negative association between affiliation with an ikyoku and WSC may become evident in a larger-scale study.

Finally, we should note the limitations of the study. First, the number of participants and the response rate were relatively low. As described above, it is possible that the relatively small sample size led to inadequate statistical power, and consequently yielded non-significant results. The relatively low response rate (13.0%) might raise concerns for the potential of non-response bias. Busier residents may have been less likely to respond to the questionnaire. Future studies should include more participants and try to maximise the response rate (e.g., direct recruitment, incentives). Second, the participant characteristics showed male dominance (67.2%) and skew toward internal/surgical medicine, limiting generalisability. Third, the survey was distributed via training directors, which may have led some residents to respond in a socially desirable manner, even though the responses were anonymised and not accessible to the directors. Fourth, although covariates were selected based on previous studies, unknown confounding factors might have affected the results. For example, while measuring residents’ cooperativeness and career orientation is indeed challenging, these factors could be unmeasured confounders.

V. CONCLUSION

This preliminary study suggests that relying solely on traditional departmental structures may not be enough to promote WSC. Supervisors may need to intentionally cultivate WSC at the local level. Although the findings provide in-depth insight into WSC, confirmation in further larger-scale studies is warranted.

Notes on Contributors

HF conceptualised the study, developed the methodology, conducted the data analysis, wrote the original draft, and reviewed and edited the manuscript. TA supervised the conceptualisation and methodology of the study, and reviewed and edited the manuscript. ME supervised the conceptualisation and methodology of the study, and reviewed and edited the manuscript. Finally, all authors discussed, proofread, and approved the final version of the manuscript.

Ethical Approval

Prior to participation, all study participants provided informed consent by checking a consent box on the survey. This study was approved by the ethical committee of Keio University School of Medicine (no. 20231224).

Data Availability

The data that support the findings of this study are not publicly available; however, upon reasonable request, the data can be obtained from the corresponding author.

Acknowledgement

The authors would like to thank the study participants. The authors would also like to acknowledge the valuable assistance of ChatGPT-5 from OpenAI in refining the academic writing.

Funding

This work was supported by the Japan Society for the Promotion of Science, Japan (grant no. JP24K20148).

Declaration of Interest

The authors report there are no competing interests to declare.

References

Fujikawa, H., Aoki, T., & Eto, M. (2024). Associations between workplace social capital, well-being, and work engagement in medical residents: A multicenter cross-sectional study. BMC Medical Education, 24, Article 1063. https://doi.org/10.1186/s12909-024-06055-0

Fujikawa, H., Son, D., & Eto, M. (2023). Cultural adaptation and validation of Japanese medical resident version of the workplace social capital scale: A cross-sectional study. BMC Medical Education, 23, Article 487. https://doi.org/10.1186/s12909-023-04469-w

Ihara, Y., Son, D., Nochi, M., & Takizawa, R. (2020). Work-related stressors among hospital physicians: A qualitative interview study in the Tokyo metropolitan area. BMJ Open, 10(9), Article e034848. https://doi.org/10.1136/bmjopen-2019-034848

Kouvonen, A., Kivimaki, M., Vahtera, J., Oksanen, T., Elovainio, M., Cox, T., Virtanen, M., Pentti, J., Cox, S. J., & Wilkinson, R. G. (2006). Psychometric evaluation of a short measure of social capital at work. BMC Public Health, 6, Article 251. https://doi.org/10.1186/1471-2458-6-251

Kuwabara, N., Yamashita, M., Yee, K., & Kurahara, D. (2015). The evolution of the Japanese medical education system: A historical perspective. Hawaii Journal of Medicine & Public Health, 74(3), 96-100. https://www.ncbi.nlm.nih.gov/pubmed/25821652

Nishigori, H. (2024). Medical education in Japan. Medical Teacher, 46(sup1), S4-S10. https://doi.org/10.1080/0142159X.2024.2372108

Oksanen, T., Kawachi, I., Kouvonen, A., Takao, S., Suzuki, E., Virtanen, M., Pentti, J., Kivimaki, M., & Vahtera, J. (2013). Workplace determinants of social capital: Cross-sectional and longitudinal evidence from a Finnish cohort study. PLoS One, 8(6), Article e65846. https://doi.org/10.1371/journal.pone.0065846

Tsounis, A., Xanthopoulou, D., Demerouti, E., Kafetsios, K., & Tsaousis, I. (2023). Workplace social capital: Redefining and measuring the construct. Social Indicators Research, 165, 555-583. https://doi.org/10.1007/s11205-022-03028-y

*Hirohisa Fujikawa
Department of General Medicine,
Juntendo University Faculty of Medicine
2-1-1 Hongo, Bunkyo-ku,
Tokyo 113-8421, Japan
+81-3-3813-3111
Email: hirohisa.fujikawa@gmail.com

Submitted: 22 July 2025
Accepted: 9 March 2026
Published online: 7 July, TAPS 2026, 11(3), 48-52
https://doi.org/10.29060/TAPS.2026-11-3/SC3828

Kaho Hayakawa¹, Osamu Nomura¹, Chihiro Kawakami¹, Kazuhiko Fujisaki¹, Keiko Abe² & Takuya Saiki¹

¹Medical Education Development Centre, Gifu University, Japan; ²Department of Nursing, Kinjo Gakuin University, Japan

Abstract

Introduction: Simulated patients (SPs) are individuals trained to portray patients in medical education. With the adoption of Objective Structured Clinical Examinations (OSCEs) in Japan, high-quality SP training is increasingly important. The Socially Shared Regulation of Learning (SSRL) model is useful to enhance SP collaboration and reflection during OSCE preparation. This study uses the SSRL framework to examine SPs’ learning processes and perceptions of their collaborative roles.

Methods: A qualitative study was conducted with 14 SPs from a Japanese medical university. Semi-structured interviews (approximately 30–60 minutes, in-person or online) explored participants’ experiences and roles. We conducted a thematic analysis for the interview transcripts guided by the SSRL model. Two researchers independently coded the data and resolved discrepancies through discussion. Ethical approval and informed consent were obtained.

Results: Analysis yielded four main themes. 1) Clear goals from educators: SPs valued learning goals and felt anxious when objectives were ambiguous. 2) Educator-facilitated shared regulation: Debriefing and feedback from educators supported SPs’ reflection and collaboration. 3) Support from Senior SPs for Junior SPs: Seniors provided role modelling, emotional support, and motivation for novice SPs. 4) Co-regulation among SPs: SPs respected peers’ roles and learned collaboratively.

Conclusion: SP learning was enhanced through socially shared regulation when supported by clear goals, peer collaboration, and educator guidance. Educators play a key role in setting objectives and facilitating reflection to deepen collaborative learning. Challenges in self- and peer-assessment highlight the need for structured support. These insights can inform the design of SP educator development programs emphasising facilitation of collaborative learning.

Keywords:         Simulated Patient, Communication, Socially Shared Regulation of Learning, Medical Education, Educator Role

I. INTRODUCTION

A simulated patient (SP) is an individual trained to realistically portray patients with specific symptoms and backgrounds. As patient-centred care gains importance, healthcare professionals are increasingly expected to collaborate with patients while respecting diverse values. Therefore, SPs have become essential educational resources in medical education (Lewis et al., 2017). Furthermore, in Japan, the introduction of the Objective Structured Clinical Examination into the national licensing system has emphasised the need for high-quality SPs in clinical communication assessments. Consequently, SPs must develop greater professionalism and competencies. This has led to the creation of SP certification systems in Japan based on international training guidelines (Lewis et al., 2017). SP groups in Japan are operated by universities and nonprofit organisations, with universities often serving as the main managing bodies. However, many institutions lack faculties dedicated to specialised SP training. Moreover, many SPs work on a volunteer basis, and improvements in acting and feedback techniques are largely left to self-directed or peer learning. Under such conditions, opportunities for collaborative learning among SPs are essential, along with timely and supportive interventions.

The Socially Shared Regulation of Learning (SSRL) model offers a useful framework for theoretically understanding this type of learning (Järvelä et al., 2013). SSRL describes a collaborative process in which learners engage in four phases:

• sharing a common understanding of the significance of the task (task perceptions),
• setting goals and planning the direction of learning (goal setting and planning),
• selecting concrete strategies to achieve objectives (strategy use), and
• adjusting learning content based on reflections (adaptation) (Panadero, 2017).

Unlike Self-Regulated Learning, which focuses on individuals’ internal cognitive processes, SSRL involves multiple learners co-constructing their learning through dialogue and interaction and bridges individual and group regulation processes, aligning with SP team training (Panadero, 2017). However, little is known about how SPs collaboratively regulate learning and how educators facilitate this process within training environments. This study aimed to explore how SPs perceive their learning processes and relationships with peers and educators through the SSRL model lens.

II. METHODS

This study employed a qualitative research design, and thematic analysis was used to interpret the data. All members of the SP group affiliated with the study site university in Japan were invited. The final sample consisted of 14 female SPs aged in their 50s to 70s. Their experience as SPs varied: seven had less than five years, three had five to ten years, and four had more than ten years of experience. Data was collected through semi-structured interviews exploring participants’ reflections on their involvement and roles as SPs. Each interview lasted approximately 30 to 60 minutes and was conducted either in person or online. All interviews were audio-recorded and transcribed verbatim. Data analysis followed the six-phase approach to thematic analysis proposed by Braun and Clarke (2006): 1) familiarisation with the data, 2) generation of initial codes, 3) searching for themes, 4) reviewing themes, 5) defining and naming themes, and 6) producing the report.

A. Context, Reflexivity, and Trustworthiness

Educators coordinated the SP program, delivering training before monthly SP activities and facilitating debriefs afterward. Outside scheduled activities, SPs practiced independently. The first and second authors collaboratively analysed interview transcripts using a theory‑informing inductive approach (Varpio et al., 2020). To enhance reflexivity and reduce bias, the team reviewed systematically and cross‑checked codes and themes through researcher triangulation. Written informed consent was obtained from the participants prior to the interviews. This study was approved by the Ethics Committee of the Faculty of Medicine at Gifu University (Approval No: 28-407).

III. RESULTS

Thematic analysis identified four key themes around SPs’ perceptions of their learning processes and relationships with peers and educators. Examples of interview quotes supporting each theme are presented in Table 1.

A. Theme 1: Clear Goals from Educators

Although SPs understood that each practicum had different objectives, they worried whether their performance matched educators’ expectations. This uncertainty was particularly pronounced during early training, when they strongly wished for educators to clearly explain these goals and roles. Many stated that “not knowing what to do or how to act is the most troubling part”, and educators’ clear articulation of these goals was essential.

B. Theme 2: Educator-facilitated Shared Regulation

Peer-to-peer feedback among SPs was not always straightforward. Participants reported difficulty identifying areas for improvement in themselves and others. Within this context, the involvement of SP educators in debriefing and reflection was seen as pivotal. SP educators’ facilitation helped promote dialogue and deepened group learning. Specifically, educators’ concrete feedback supported SPs in articulating their reflections effectively, enhancing collaborative regulation of learning.

C. Theme 3: Support from Senior SPs for Junior SPs

Senior SPs were sometimes reluctant to offer direct feedback, especially when concerned about preserving harmony within the group. Some voiced hesitancy to criticize junior members for fear of straining relationships. Nevertheless, when senior SPs shared their experiences, demonstrated specific performance techniques, or expressed empathy, novice SPs found this emotionally supportive and motivating. The role of expert SPs extended beyond skill transmission to include crucial emotional support, reducing anxiety and encouraging engagement among SPs.

D. Theme 4: Co-regulation Among SPs

SPs demonstrated a strong peer‑learning orientation marked by mutual respect and active engagement. However, several participants reported diminished motivation when peers displayed self-centred behaviours that conflicted with the shared goal of supporting student learning. Some felt discouraged when peers prioritised personal convenience or criticized others in ways misaligned with educational goals, undermining the collaborative atmosphere.

Theme	Interview Quotes	Summary of Theme
1. Clear goals from educators	We SPs should still understand that universities have individual educational goals, and it would be very good to hear about this from the educators when you are new. I’m worried about what to do if I’m not in line with what the teachers are aiming for. I think it’s effective for the educator to say what the target is. This exercise shows what SPs are expected to do and how to do it…Not understanding is what bothers me the most.	Clarity of objectives and criteria stabilises task perceptions, reducing anxiety and aligning performance early in training. Educator actions–briefings, explicit goals, and rubrics–anchor subsequent planning.
2. Educator-facilitated　shared regulation	I think it would be better if the educator told us more about how it should be done. If they don’t tell us, we are not sure. SPs don’t always know what they can do to improve each other’s performance, so if educators point out things that make them realise, like “Oh yeah, that’s right”. If the educator guides the reflection well, it’s easier for me to say things like, “I think this way”, or “Maybe it would be better to say it like this”.	Facilitation turns diffuse reflection into actionable plans, strengthening group coordination across strategy use and adaptation. Structured debriefs, feedback norms, and metacognitive prompts are key educator competencies.
3. Support from Senior SPs for Junior SPs	We don’t want to criticize even if that means risking our relationships, but educators should… They don’t mind being told by their educators, but perhaps their fellow SPs. When I faced difficulties, my senior SP told me, “Everyone goes through this, and if you overcome it, things will get brighter”. It felt like a small hole opened up, letting in a bit of light, and I felt much more at ease. A senior SP told me how she plays her roles and helped me practice, so I was able to improve.	Near‑peer role modelling enhances skills and psychological safety, but reluctance to critique limits effectiveness. Formal mentoring and training in how to give respectful, evidence‑based feedback leverages senior expertise without eroding harmony.
4. Co-regulation among SPs	Everyone is very virtuous, or rather, they are trying to gain knowledge. They are the volunteers who I will try to practice with and learn as much as possible from, if I have a chance. We are here for the students, not for ourselves. Do we need to be here for the SPs and think from the SP side?	Peer climate is pivotal: shared purpose sustains engagement, while self‑focused behaviours disrupt task perceptions and motivation. Clear collaborative norms and educator oversight help preserve effective co‑regulation.

Table 1. Qualitative interview data for each theme

IV. DISCUSSION

The findings of this study indicate that learning among SPs is facilitated through collaborative regulation toward shared goals, as conceptualised in the SSRL framework (Järvelä et al., 2013). Our analysis revealed that each phase of this collaborative process plays an important role in SP learning. Many SPs reported anxiety when the purpose and significance of their tasks–understanding what they were doing and why–were unclear, particularly during initial training. This corresponds to the task perceptions and goal setting and planning phases of the SSRL framework (Panadero, 2017). Although SPs recognised that each practicum or examination has its own objectives and that expected roles may differ, many struggled to translate these differences into their performance and feedback. SPs should not be left to gain an understanding of objectives and roles on their own; rather, these should be explicitly presented as a foundation by educators. Clear communication from educators regarding learning objectives and specific roles was shown to be essential for building shared understanding and enabling SPs to engage with greater confidence and security.  Additionally, several SPs were often reluctant to offer direct peer critique for fear of straining relationships. This tendency likely reflects local professional and cultural norms valuing harmony and hierarchical respect, which constrain open criticism–especially toward peers or seniors. These dynamics shape how shared regulation unfolds in SP groups, favouring indirect feedback (e.g., educator‑facilitated debriefing) and consensus‑building over explicit peer challenge. Furthermore, in the strategy use phase of SSRL, learning among SPs was strongly promoted through sharing specific methods and experiences. When senior SPs shared their experiences and practical tips, it not only facilitated technical skill development but also provided significant emotional support. Such mutual support fostered smoother collaboration and enhanced SPs’ sense of self-efficacy.

Additionally, in the adaptation phase, it is critical for SPs to consider how experiences and feedback gained through practice can be applied to future activities. However, this study found that many SPs experienced challenges with self-assessment and peer evaluation. In such situations, educator support–scaffolding, feedback facilitation, and goal alignment–is vital to learning (Lewis et al., 2017). Scaffolding clarifies task perceptions and criteria; feedback facilitation establishes norms for evidence‑based judgment; goal alignment links individual and group’s aim to student learning. Concrete guidance helps SPs organise thinking, calibrate judgments, and coordinate next steps, strengthening shared regulation across goal‑setting, strategy use, and adaptation. Overall, SP learning rests on collaboration plus educator competencies in scaffolding, feedback facilitation, goal alignment, and psychological safety, with just‑in‑time interventions to guide adaptation.

From an integrative perspective, the four themes map onto SSRL phases: “Clear goals from educators”  corresponds to task perceptions and goal setting; “Educator-facilitated shared regulation”  aligns with strategy use; “Support from senior SPs for junior SPs” reflects additional strategy use that co‑constructs learning; and  “Co-regulation among SPs” relates to adaptation via motivational and collaborative adjustments. This alignment shows how SP learning unfolds across SSRL in practice. Future research should develop SSRL‑based educator training modules that provide practical strategies for scaffolding SP learning, facilitating structured reflective dialogue, and fostering shared regulation within SP groups.

A. Limitations

This study was conducted with a single SP group, limiting the transferability of findings. SPs’ experiences and perceptions may be influenced by institutional cultural contexts. Different settings may present unique trends and challenges. Future research should conduct comparative studies across diverse SP groups and incorporate quantitative methods for broader understanding.

V. CONCLUSION

This study highlights that SPs enhance their learning through socially shared regulation, guided by clear goals and mutual collaboration. These insights can inform the design of SP educator development programs emphasising facilitation of collaborative learning.

Notes on Contributors

Kaho Hayakawa, who served as one of the SP educators in the study site program, conducted all interviews and acted as the lead researcher, overseeing the thematic analysis, contributed to the conception and design of the study, data collection, analysis, and drafting of the manuscript. Osamu Nomura, who is a medical education research specialist with a master’s degree in medical education and substantial experience in thematic analysis, participated in the interpretation of results and critical revision of the manuscript for important intellectual content. Chihiro Kawakami, Kazuhiko Fujisaki, Keiko Abe, and Takuya Saiki critically reviewed the manuscript. All authors approved the final manuscript.

Ethical Approval

Participants were recruited through convenience sampling, and those who provided informed consent participated in this study. This study was approved by the Ethics Committee of the Faculty of Medicine at Gifu University (Approval No: 28-407). Written informed consent was obtained from all participants.

Data Availability

Owing to restrictions imposed by the Institutional Review Board (IRB) at the time of ethical approval, public sharing of the research data via a repository is not permitted. However, the data supporting the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgement

We would like to thank all the simulated patients who participated in this study and Ms. Shino Kurimoto for her support in editing the manuscript. We also thank Ms. Kyoko Kubota and Ms. Rieko Fujii for supporting SP training in our university. We thank Mr. Oliver Stanyon for editing the manuscript.

Funding

This work was not supported by any funding agency.

Declaration of Interest

No conflicts of interest to disclose.

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Järvelä, S., Järvenoja, H., Malmberg, J., & Hadwin, A. F. (2013). Exploring socially shared regulation in the context of collaboration. Journal of Cognitive Education and Psychology, 12(3), 267–286. https://doi.org/10.1891/1945-8959.12.3.267

Lewis, K. L., Bohnert, C. A., Gammon, W. L., Hölzer, H., Lyman, L., Smith, C., Thompson, T. M., Wallace, A., & Gliva-McConvey, G. (2017). The association of standardized patient educators (ASPE) standards of best practice (SOBP). Advances in Simulation, 2, 1–8. https://doi.org/10.1186/s41077-017-0043-4

Panadero, E. (2017). A review of self-regulated learning: Six models and four directions for research. Frontiers in Psychology, 8, 422. https://doi.org/10.3389/fpsyg.2017.00422

Varpio, L., Paradis, E., Uijtdehaage, S., & Young, M. (2020). The distinctions between theory, theoretical framework, and conceptual framework. Academic Medicine, 95(7), 989–994. https://doi.org/10.1097/ACM.0000000000003075

*Kaho Hayakawa
1-1 Yanagido, Gifu, Japan
Email: hayakawa.kaho.w2@f.gifu-u.ac.jp

Submitted: 7 January 2026
Accepted: 16 February 2026
Published online: 7 July, TAPS 2026, 11(3), 58-59
https://doi.org/10.29060/TAPS.2026-11-3/LE3985

Sulthan Al Rashid & Anbarasu Kanchana Mala

Department of Pharmacology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, India

Dear Editor,

Concept mapping is a recognised active learning strategy that promotes meaningful learning by enabling students to organise and integrate complex information (Al Rashid & Rahman, 2023; Al Rashid et al., 2024). With the increasing integration of digital technologies into medical education, concept maps are created in both handwritten and digital formats. However, comparative evidence regarding students’ perceptions of these modalities remains limited. We report findings from a preliminary cross-sectional study comparing undergraduate medical students’ perceptions of handwritten versus digital concept maps.

The study was conducted among second-year MBBS students at Saveetha Medical College and Hospital, India, during routine teaching sessions in Pharmacology, Pathology, and Microbiology. Of 250 eligible students, 213 participated (response rate: 85.2%). Students were exposed to both handwritten and digital concept mapping. Perceptions were assessed using a structured questionnaire comprising seven Likert-scale items for each modality, assessing ease of use, conceptual understanding, recall, organisation of information, overall learning experience, time efficiency, and ease of modification, along with one item assessing overall preference. Responses were recorded on a 5-point Likert scale (0–4). As paired scores were non-normally distributed, comparisons were analysed using the Wilcoxon signed-rank test.

Across all domains, handwritten concept maps received higher perception scores than digital concept maps. The overall mean perception score was significantly higher for handwritten maps (2.73 ± 1.16) than for digital maps (2.15 ± 1.20; p < 0.001). Overall, 44.1% of students preferred handwritten concept maps, 23.5% preferred digital maps, 28.2% perceived both modalities as equally effective, and 4.2% preferred neither.

The preference for handwritten concept maps may reflect enhanced generative processing, deeper conceptual integration, and reduced extraneous cognitive load. Although digital concept maps offer advantages such as ease of storage and modification, limited familiarity with digital tools and interface complexity may reduce perceived effectiveness. The proportion of students who rated both modalities as equally effective highlights individual variation in learning preferences.

This study is limited by its single-institution, cross-sectional, perception-based design. Important covariates such as prior digital exposure, baseline digital literacy, and learning preferences were not measured, introducing potential confounding. Blinding was not feasible, as participants were aware of the modality used, and response bias cannot be excluded.

In conclusion, handwritten concept maps were perceived as more effective than digital concept maps. Structured training in digital concept-mapping tools may enhance their educational value and support a blended instructional approach.

Notes on Contributors

Sulthan Al Rashid contributed to the conceptualisation of the study, manuscript drafting, critical revision, and final proofreading.

Anbarasu Kanchana Mala assisted with data collection and contributed to manuscript writing.

Acknowledgement

ChatGPT was used to improve the English language and stylistic clarity of the manuscript.

Funding

No funding was received for this study.

Declaration of Interest

The authors declare no conflicts of interest. 

References

Al Rashid, S., & Rahman, S. Z. (2023). Pharmacology teaching by concept map method. Bangladesh Journal of Medical Science, 22(4), 942–944. https://doi.org/10.3329/bjms.v22i4.67119

Al Rashid, S., Rahman, S. Z., Patil, S. R., & Karobari, M. I. (2024). Enhancing concept map teaching technology with students’ handwritten concept map notes. The Asia Pacific Scholar, 9(4), 71–75. https://doi.org/10.29060/TAPS.2024-9-4/CS3161

*Sulthan Al Rashid
Department of Pharmacology,
Saveetha Medical College and Hospital,
Saveetha Institute of Medical & Technical Sciences (SIMATS),
Chennai, Tamil Nadu, India
+919629696523
Email: sulthanalrashid@gmail.com

Submitted: 28 January 2026
Accepted: 3 February 2026
Published online: 7 July, TAPS 2026, 11(3), 60-61
https://doi.org/10.29060/TAPS.2026-11-3/LE4010

Galvin Sim Siang Lin

Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Malaysia

Dear Editor,

As an early-career dental educator navigating the formative years of an academic journey, I write to share reflections on what it means to grow within health professions education today. Across Asia and beyond, rapid shifts in healthcare delivery, digital innovation, and interprofessional practice are reshaping educational expectations. Amidst these changes, the sustainability of our educational systems depends significantly on how we support and empower educators at the beginning of their academic journeys. The transition from clinician to academician is challenging. Many early-career educators enter academia with strong clinical expertise, only to realise that effective teaching, curriculum design, assessment, research, and leadership demand additional competencies. Clinical excellence does not automatically translate into educational effectiveness, and thus, structured faculty development becomes a strategic investment in educational excellence and institutional sustainability.

For dental educators, this moment presents a call to action. Dentistry should not remain insular within the broader health professions education discourse. Engagement in interprofessional scholarship, collaborative curriculum initiatives, and shared development platforms enables dental academicians to both contribute to and benefit from collective advancement. Conferences such as the Asia Pacific Medical Education Conference (APMEC) exemplify the power of the academic community. Beyond research presentations (Centre for Medical Education, 2026), they provide opportunities for networking, mentorship, visibility, and create spaces to initiate collaborations that transcend institutional and national boundaries. Yet external opportunities alone are insufficient. Early-career academicians must pursue intentional growth through continuous professional development in education, whether via attending conferences, workshops, certifications, or postgraduate study. Journals such as The Asia Pacific Scholar (TAPS) play an important role in legitimising and disseminating educational scholarship within the region. Faculty development must also address the human dimension of academic life (Sabedra et al., 2025). Burnout, imposter syndrome, and competing responsibilities frequently affect early-career faculty, making mentorship, peer support, and institutional recognition essential.

Reflecting on my journey, I have come to appreciate that academic growth is not solitary. It is sustained through collaboration, humility, and shared purpose. Supporting early-career educators is not simply an act of mentorship; it is an investment in the future of health professions education. I encourage fellow early-career academicians across all health professions to step forward with confidence; share your ideas, engage actively in dialogue, seek collaborations beyond your discipline, and invest intentionally in your development as both educator and researcher. In doing so, we not only shape our own trajectories but collectively strengthen the communities we serve.

Notes on Contributors

Galvin Sim Siang Lin contributed to the concept, scientific content, and manuscript preparation.

Acknowledgement

The author would like to express sincere appreciation to the Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, and the Faculty of Medicine and Pharmaceutical Sciences, Zhejiang University, China, for organising the Asia Pacific Medical Education Conference (APMEC) 2026 and for providing a valuable platform for health professions educators to learn, connect, and grow together.

Funding

No funding is provided.

Declaration of Interest

The author claims to have no conflicts of interest.

References

Centre for Medical Education. (2026). Abstracts of the Asia Pacific Medical Education Conference (APMEC) 2026. The Asia Pacific Scholar, 11(Suppl.1). https://doi.org/10.29060/TAPS.2026-11-Suppl.1

Sabedra, A., Freiermuth, C., Santen, S., & Leenellett, E. (2025). Faculty development committee: Evolution through engagement and empowerment. AEM Education and Training, 9(S1), S66-S72. https://doi.org/10.1002/aet2.70017

*Galvin Sim Siang Lin
Department of Restorative Dentistry,
Kulliyyah of Dentistry,
International Islamic University Malaysia,
Kuantan Campus, 25200, Pahang, Malaysia
Email: galvin@iium.edu.my

Submitted: 17 June 2025
Accepted: 20 November 2025
Published online: 7 July, TAPS 2026, 11(3), 62-65
https://doi.org/10.29060/TAPS.2026-11-3/II3790

Mohamad Hamim Mohamad Hanifah¹, Jubaida Paraja², Zhen Zhen Lo¹ & Fairrul Kadir¹

¹Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia; ²Department of Pathology and Microbiology, Universiti Malaysia Sabah, Malaysia

I. INTRODUCTION

Wilderness and remote medicine have evolved into a recognised subspecialty addressing healthcare in resource-limited, austere, and geographically isolated settings. Globally, its relevance is growing due to environmental emergencies, adventure travel incidents, and humanitarian missions (Wilderness Medical Society, 2024). Training in this field cultivates competencies beyond conventional hospital-based education – such as trauma care in low-resource environments, environmental physiology, medical improvisation, and decision-making under delayed access to definitive care.

In Malaysia, the need is acute. The country’s diverse geography – from Mount Kinabalu’s high-altitude terrain to Sarawak’s remote riverine communities and Peninsular Malaysia’s marine zones – poses unique challenges (Wilderness and Austere Medicine Society Malaysia, 2024). Clinicians often face floods, forest injuries, marine envenomation, and logistical barriers in rural healthcare.

Despite this, undergraduate medical education remains urban-centric and hospital-focused, leaving future doctors underprepared for remote and disaster-prone environments (Malaysian Qualifications Agency, 2024). Addressing this gap through a structured wilderness and remote medicine curriculum is essential to develop a resilient, adaptable, and globally relevant healthcare workforce capable of serving all Malaysians.

II. RATIONALE FOR INTEGRATION

Malaysia’s healthcare system spans advanced urban centres to remote rainforests and coastal communities. Delivering care in rural clinics, flood zones, and mountainous terrain demands specific competencies often absent from hospital-centric undergraduate curricula. This gap leaves future doctors underprepared for real-world challenges in low-resource and disaster-prone settings.

Integrating wilderness and remote medicine directly addresses this gap. It aligns with national priorities in the Malaysian Education Blueprint and disaster risk reduction strategies, emphasising community-based care, emergency responsiveness, and public health preparedness (Malaysian Qualifications Agency, 2024). It also supports Malaysia’s commitment to global and planetary health frameworks by equipping students with skills in tropical medicine, improvisational care, and disaster response.

Beyond clinical skills, the module fosters resilience, adaptability, cultural humility, and leadership – attributes essential for modern medical practice. It also opens pathways to international recognition through certifications like Fellowship in the Academy of Wilderness Medicine (FAWM) and the National Outdoor Leadership School (NOLS) (National Outdoor Leadership School, 2024).

Importantly, wilderness medicine is inherently interprofessional. Effective care in remote settings requires collaboration among physicians, nurses, paramedics, public health officials, and rescue personnel. Early exposure to this teamwork culture prepares students for integrated healthcare systems, especially in outreach and disaster scenarios where coordination is critical.

III. GLOBAL AND REGIONAL PRECEDENTS

Wilderness medicine has matured into an established academic discipline globally, with robust training frameworks informing this proposal. The FAWM by the Wilderness Medical Society offers a modular, competency-based pathway covering essential topics including altitude illness, environmental exposure, and expedition medicine. Similarly, the United Kingdom’s Royal College of Surgeons of Edinburgh has integrated these competencies through its Faculty of Remote, Rural and Humanitarian Healthcare (FRRHH), while organisations like World Extreme Medicine (WEM) (2024) and the NOLS provide additional field-based training standards recognised worldwide.

Regionally, Malaysia demonstrates growing leadership through the Wilderness and Austere Medicine Society Malaysia (WAMS Malaysia), which has successfully developed workshops and certifications tailored to local environmental challenges. This established local expertise, combined with adaptable global frameworks, provides a solid foundation for curriculum integration. The proposed model specifically emphasises interdisciplinary collaboration, engaging emergency medicine, public health, family medicine, and allied health professionals from its inception. This ensures graduates are prepared for the team-based care essential in remote settings, while the framework’s modular design allows for future adaptation across Southeast Asia, where neighbouring nations face comparable geographical and healthcare challenges.

IV. CURRICULUM FRAMEWORK OVERVIEW

The proposed Wilderness and Remote Medicine module follows a three-phase structure integrated across five years of undergraduate training. It combines classroom instruction, simulation-based learning, certified practical skills, rural postings, and immersive field experiences – anchored in global standards and Malaysian realities.

A. Phase 1: Foundational Knowledge (Years 1–2)

Students are introduced to environmental physiology, jungle medicine, marine envenomation, diving emergencies, and tropical diseases. Ethics, risk management, and medicolegal aspects of remote care are taught via lectures, e-learning, and tutorials.

The assessment methods are:

• MCQs and short-answer questions embedded in pre-clinical subjects
• Group presentations and case-based discussions
• Online quizzes and reflective writing assignments

B. Phase 2: Applied Skills and Certification (Years 3–4)

Students acquire certifications in Wilderness Basic Life Support (WBLS) and Wilderness First Aid (WFA). They learn improvisational trauma care, survival skills, and point-of-care ultrasound (POCUS) applications. Training is delivered through hybrid workshops and supervised field exercises.

The assessment methods are:

• Skills checklists during workshops
• Simulation-based OSCEs (e.g., trauma improvisation, POCUS scenarios)
• Peer and instructor evaluations during team-based exercises
• Certification exams (WBLS, WFA)

C. Phase 3: Immersive Application (Year 5)

This capstone phase transitions students into real-world practice. They undertake rural health postings, humanitarian field attachments (e.g., MERCY Malaysia, WAMS Malaysia), and participate in complex field simulations.

Phase	Year	Key Components
Phase 1: Foundational Knowledge	Years 1–2	Environmental physiology, jungle medicine, marine envenomation, diving-related emergencies, tropical medicine topics, ethics and medicolegal considerations.
Phase 2: Applied Skills and Certification	Years 3–4	Certifications (WBLS, WFA), POCUS applications, survival and rescue skills, syndromic management of tropical diseases.
Phase 3: Immersive Application	Year 5	Rural health postings, humanitarian field attachments (e.g., MERCY Malaysia, WAMS Malaysia), capstone field simulations and team-based learning.

Table 1. Three-Phase Framework for Wilderness and Remote Medicine Integration

The capstone Phase 3 is designed to transition students from simulated environments to real-world application. This phase would be conducted through structured partnerships with existing rural health clinics (e.g., Klinik Kesihatan in rural Sabah and Sarawak), humanitarian organisations (MERCY Malaysia, WAMS Malaysia), and national agencies (e.g., the Fire and Rescue Department of Malaysia (BOMBA) and the Department of Orang Asli Development (JAKOA)).

Vital resources for Phase 3 include:

• Partnership Agreements: Formal MoUs with rural clinics and NGOs to define supervision and roles.
• Trained Field Preceptors: Oriented via a dedicated ‘train-the-trainer’ program.
• Reflective Learning Framework: Guided debriefings and structured logbooks to foster resilience.
• Safety Infrastructure: SOPs, risk assessments, satellite communication tools, and insurance coverage.

The assessment methods are:

• Remote-context OSCEs (e.g., managing envenomation, altitude illness)
• Structured logbooks reviewed by field preceptors
• Reflective portfolios on ethical dilemmas and team dynamics
• Capstone simulation evaluations (disaster response, rescue missions)
• Preceptor feedback and peer review using standardised rubrics

V. ANTICIPATED CHALLENGES AND SOLUTIONS

Integrating wilderness and remote medicine into Malaysia’s undergraduate curriculum presents several challenges: curriculum overload, limited faculty expertise, logistical complexities of field components, and the need for valid assessment tools.

To mitigate curriculum overload, a modular and elective-based approach can be adopted initially. Phase 1 topics may be embedded into existing pre-clinical subjects, while Phases 2 and 3 can begin as selective postings or Special Study Modules (SSMs), allowing gradual scaling.

A robust Faculty Development (FD) programmed is essential to build teaching capacity:

• Train-the-Trainer Certification: Conducted with WMS, NOLS, and WAMS Malaysia to certify instructors in wilderness-specific pedagogy, simulation facilitation, and field safety.
• Interprofessional Engagement: Involving educators from emergency medicine, family medicine, public health, surgery, and allied health to reflect the collaborative nature of wilderness medicine.
• Curriculum Co-Creation: FD workshops serve as platforms to adapt global content to Malaysian contexts, ensuring cultural and environmental relevance.
• Simulation and Field Instruction Training: Faculty are trained in designing high-fidelity simulations and supervising immersive field activities.
• Continuous Professional Development (CPD): Supported through annual retreats, online modules, and inter-institutional teaching exchanges.

Nationwide implementation may be phased. Initial pilots can be launched in institutions with strong emergency or rural health programs, community partnerships, or proximity to relevant environments (e.g., East Malaysia). A national consortium of medical schools can facilitate resource sharing, simulation scenarios, and faculty expertise, ensuring standardisation and reducing institutional burden.

Strategic engagement with stakeholders – Ministry of Higher Education (MOHE), MQA, and medical school deans – is essential to formally recognise wilderness medicine as a core competency. This structured rollout ensures feasibility, sustainability, and alignment with national health and education goals.

VI. CONCLUSION

Integrating wilderness and remote medicine into Malaysia’s undergraduate curriculum is timely and aligned with national health priorities, educational reforms, and global best practices. As Malaysia faces increasing public health challenges in remote and disaster-prone areas, equipping future doctors with relevant competencies is essential for national health resilience.

The proposed three-phase framework responds to Malaysia’s unique healthcare needs while aligning with international standards from FAWM, WEM, and NOLS. It also leverages local expertise through WAMS Malaysia, ensuring contextual relevance.

Importantly, the framework promotes interdisciplinary collaboration – engaging emergency medicine, family medicine, public health, and allied health professionals. This prepares students for integrated, team-based care essential in remote and austere environments.

While Malaysia is the primary focus, the framework is scalable to other Southeast Asian nations with similar geographic and healthcare challenges, such as Indonesia, the Philippines, and Thailand. Its modular design and emphasis on local adaptation make it a viable blueprint for regional implementation.

Long-term sustainability is achievable through embedding foundational knowledge into core curricula and leveraging partnerships with national agencies and humanitarian organisations. By pioneering this integration, Malaysia is poised not only to enhance its own healthcare resilience but also to emerge as a definitive regional leader in wilderness and austere medicine education.

Notes on Contributors

Mohamad Hamim Mohamad Hanifah conceptualised the curriculum framework, integrated global and local elements, and drafted the manuscript. He ensured alignment with national and international standards in wilderness medicine education.

Jubaida Paraja critically reviewed the manuscript and provided expertise on tropical medicine.

Zhen Zhen Lo critically reviewed the manuscript, contributed to refining the final structure, and provided expertise on POCUS module.

Fairrul Kadir critically reviewed the manuscript, contributed to refining the final structure, and provided expertise on field-based applications relevant to Malaysian contexts.

Ethical Approval

This article does not involve human subjects or identifiable data requiring ethical approval.

Acknowledgement

The authors would like to thank colleagues and mentors who have provided valuable feedback and support in refining this manuscript.

Funding

No external funding was received for the preparation of this manuscript.

Declaration of Interest

The authors declare no conflicts of interest related to this work.

References

Malaysian Qualifications Agency. (2024). Programme standards: Medical and health sciences. Malaysian Qualifications Agency. https://www.mqa.gov.my

National Outdoor Leadership School. (2024). Wilderness medicine courses. NOLS. https://www.nols.edu/en/courses/wilderness-medicine

Wilderness and Austere Medicine Society Malaysia. (2024). Wilderness medicine programs in Malaysia. WAMS Malaysia. https://www.wamsmalaysia.com/

Wilderness Medical Society. (2024). Fellowship in the Academy of Wilderness Medicine (FAWM). Wilderness Medical Society. https://wms.org/fawm

World Extreme Medicine. (2024). Extreme medicine conferences and training. World Extreme Medicine. https://worldextrememedicine.com

*Assoc. Prof. Dr. Mohamad Hamim Mohamad Hanifah
Faculty of Medicine and Health Sciences,
Universiti Malaysia Sabah,
88400 Kota Kinabalu, Sabah, Malaysia
+60128951525
Email: hamim@ums.edu.my